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Xu H, Bayless TM, Østbye T, Dupre ME. Care sequences leading to the diagnosis of Alzheimer's disease and related dementias: An analysis of electronic health records. Alzheimers Dement 2024; 20:2155-2164. [PMID: 38270269 PMCID: PMC10984433 DOI: 10.1002/alz.13669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 10/24/2023] [Accepted: 12/03/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND We examined the sequences of clinical care leading to diagnoses of Alzheimer's disease and related dementias (ADRD) using electronic health records from a large academic medical center. METHODS We included patients aged 65+ with their first ADRD diagnoses from January 1, 2014 to December 31, 2019. Using state sequence analysis, care sequences were defined by the ordering of healthcare utilizations occurred in the 2 years before ADRD diagnosis. RESULTS Of 3621 patients (median age 80), nearly half followed a care sequence of having one primary care visit close to their ADRD diagnosis. Additional care sequences included periodic (n = 322, 8.9%) and multiple (n = 416, 11.5%) outpatient visits to primary care and having one (n = 395, 10.9%), multiple (n = 469, 13.0%), or highly frequent (n = 357, 10.7%) outpatient visits to other specialties. Patients' sociodemographic traits contributed to the variability in care sequences. CONCLUSIONS Several distinct patterns of care leading to ADRD diagnoses were identified. Integrated care models are needed to promote early identification of ADRD. HIGHLIGHTS Dementia patients followed distinct care pathways prior to their dementia diagnoses. Key sociodemographic traits contributed to the variation in the sequences of care. Racial differences in the sequencing of care were also found, but only in women.
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Affiliation(s)
- Hanzhang Xu
- Department of Family Medicine and Community HealthDuke UniversityDurhamNorth CarolinaUSA
- Duke University School of NursingDuke UniversityDurhamNorth CarolinaUSA
- Center for the Study of Aging and Human DevelopmentDuke UniversityDurhamNorth CarolinaUSA
| | - Teah M. Bayless
- Department of Family Medicine and Community HealthDuke UniversityDurhamNorth CarolinaUSA
| | - Truls Østbye
- Department of Family Medicine and Community HealthDuke UniversityDurhamNorth CarolinaUSA
- Duke University School of NursingDuke UniversityDurhamNorth CarolinaUSA
- Center for the Study of Aging and Human DevelopmentDuke UniversityDurhamNorth CarolinaUSA
| | - Matthew E. Dupre
- Center for the Study of Aging and Human DevelopmentDuke UniversityDurhamNorth CarolinaUSA
- Department of Population Health SciencesDuke UniversityDurhamNorth CarolinaUSA
- Duke Clinical Research InstituteDuke UniversityDurhamNorth CarolinaUSA
- Department of SociologyDuke UniversityDurhamNorth CarolinaUSA
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Wang N, Xu H, West JS, Østbye T, Wu B, Xian Y, Dupre ME. Association between perceived risk of Alzheimer's disease and related dementias and cognitive function among U.S. older adults. Arch Gerontol Geriatr 2023; 115:105126. [PMID: 37494832 PMCID: PMC10615679 DOI: 10.1016/j.archger.2023.105126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 07/02/2023] [Accepted: 07/11/2023] [Indexed: 07/28/2023]
Abstract
INTRODUCTION The aim of the study was to assess factors associated with the perceived risk of developing Alzheimer's disease and related dementias (ADRD) and how the perceived risk of ADRD was related to cognitive function. METHODS We conducted a retrospective cohort study using 5 waves of data from the Health and Retirement Study (2012-2022) that included adults aged 65 years or older with no previous diagnosis of ADRD at baseline. Cognitive function was measured at baseline and over time using a summary score that included immediate/delayed word recall, serial 7's test, objective naming test, backwards counting, recall of the current date, and naming the president/vice-president (range = 0-35). Perceived risk of developing ADRD was categorized at baseline as "definitely not" (0% probability), "unlikely" (1-49%), "uncertain" (50%), and "more than likely" (>50-100%). Additional baseline measures included participants' sociodemographic background, psychosocial resources, health behaviors, physiological status, and healthcare utilization. RESULTS Of 1457 respondents (median age 74 [IQR = 69-80] and 59.8% women), individuals who perceived that they were "more than likely" to develop ADRD had more depressive symptoms and were more likely to be hospitalized in the past two years than individuals who indicated that it was "unlikely" they would develop ADRD. Alternatively, respondnets who perceived that they would "definitely not" develop ADRD were more likely to be non-Hispanic Black, less educated, and have lower income than individuals who indicated it was "unlikely" they would develop ADRD. Respondents who reported their risks of developing ADRD as "more than likely" (β = -2.10, P < 0.001) and "definitely not" (β = -1.50, P < 0.001) had the lowest levels of cognitive function; and the associations were explained in part by their socioeconomic, psychosocial, and health status. CONCLUSIONS Perceived risk of developing ADRD is associated with cognitive function. The (dis)concordance between individuals' perceived risk of ADRD and their cognitive function has important implications for increasing public awareness and developing interventions to prevent ADRD.
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Affiliation(s)
- Nan Wang
- Department of Public Health Sciences, School of Medicine, UC-Davis, CA, United States of America
| | - Hanzhang Xu
- Department of Family Medicine and Community Health, Duke University, Durham, NC, United States of America; Duke University School of Nursing, Duke University, Durham, NC, United States of America; Center for the Study of Aging and Human Development, Duke University, Durham, NC, United States of America.
| | - Jessica S West
- Center for the Study of Aging and Human Development, Duke University, Durham, NC, United States of America; Department of Population Health Sciences, Duke University, Durham, NC, United States of America
| | - Truls Østbye
- Department of Family Medicine and Community Health, Duke University, Durham, NC, United States of America; Duke University School of Nursing, Duke University, Durham, NC, United States of America; Center for the Study of Aging and Human Development, Duke University, Durham, NC, United States of America
| | - Bei Wu
- NYU Rory Meyers College of Nursing, New York, NY, United States of America
| | - Ying Xian
- Department of Neurology, UT Southwestern Medical Center, Dallas, TX, United States of America
| | - Matthew E Dupre
- Center for the Study of Aging and Human Development, Duke University, Durham, NC, United States of America; Department of Population Health Sciences, Duke University, Durham, NC, United States of America; Department of Sociology, Duke University, Durham, NC, United States of America
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Xu H, Pei Y, Dupre ME, Wu B. Existing Datasets to Study the Impact of Internal Migration on Caregiving Arrangements among Older Adults in China. J Aging Soc Policy 2023; 35:575-594. [PMID: 34058961 PMCID: PMC8630093 DOI: 10.1080/08959420.2021.1926866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 08/04/2020] [Indexed: 10/21/2022]
Abstract
Massive rural-to-urban migration in China has a significant impact on informal caregiving arrangements among Chinese older adults. To stimulate research on the intersection of migration and caregiving, we conducted an inventory of longitudinal aging survey datasets from mainland China. Large publicly available datasets that included measures related to migration and caregiving were searched and reviewed for eligibility. Key characteristics of each dataset, including study design, sample size, and measures, were extracted. Seven eligible datasets were identified, and five included nationally representative samples. Measures for migration varied across datasets. Some datasets included information on the migration history of older adults, whereas others focused on the migration of adult children. Similarly, caregiving was measured using different questions in each dataset. Caregiving activities were assessed with regard to their type, source, and amount. High-quality datasets exist to support research on migration and caregiving arrangements among Chinese older adults.
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Affiliation(s)
- Hanzhang Xu
- Department of Family Medicine and Community Health, Duke University Medical Center, P.O. Box 104006, Durham, NC 27710 and Duke University School of Nursing, Duke University, Durham, NC 27710
| | - Yaolin Pei
- Rory Meyers College of Nursing, New York University, New York, NY
| | - Matthew E. Dupre
- Department of Population Health Sciences, Duke University, Durham, NC and Center for the Study of Aging and Human Development, Duke University, Durham, NC and Duke Clinical Research Institute, Duke University, Durham, NC and Department of Sociology, Duke University, Durham, NC
| | - Bei Wu
- Rory Meyers College of Nursing, New York University, New York, NY and Aging Incubator, New York University, New York, NY
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West JS, Smith SL, Dupre ME. The impact of hearing loss on trajectories of depressive symptoms in married couples. Soc Sci Med 2023; 321:115780. [PMID: 36801754 PMCID: PMC10478395 DOI: 10.1016/j.socscimed.2023.115780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 12/29/2022] [Accepted: 02/13/2023] [Indexed: 02/16/2023]
Abstract
Hearing loss is a prevalent chronic stressor among older adults and is associated with numerous adverse health outcomes. The life course principle of linked lives highlights that an individual's stressors can impact the health and well-being of others; however, there are limited large-scale studies examining hearing loss within marital dyads. Using 11 waves (1998-2018) of the Health and Retirement Study (n = 4881 couples), we estimate age-based mixed models to examine how 1) one's own hearing, 2) one's spouse's hearing, or 3) both spouses' hearing influence changes in depressive symptoms. For men, their wives' hearing loss, their own hearing loss, and both spouses having hearing loss are associated with increased depressive symptoms. For women, their own hearing loss and both spouses having hearing loss are associated with increased depressive symptoms, but their husbands' hearing loss is not. The connections between hearing loss and depressive symptoms within couples are a dynamic process that unfolds differently by gender over time.
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Affiliation(s)
- Jessica S West
- Center for the Study of Aging and Human Development, Duke University, Durham, NC, USA; Department of Population Health Sciences, Duke University, Durham, NC, USA.
| | - Sherri L Smith
- Center for the Study of Aging and Human Development, Duke University, Durham, NC, USA; Department of Population Health Sciences, Duke University, Durham, NC, USA; Department of Head and Neck Surgery and Communication Sciences, Duke University, Durham, NC, USA
| | - Matthew E Dupre
- Center for the Study of Aging and Human Development, Duke University, Durham, NC, USA; Department of Population Health Sciences, Duke University, Durham, NC, USA; Department of Sociology, Duke University, Durham, NC, USA
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6
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Farmer HR, Xu H, Granger BB, Thomas KL, Dupre ME. Factors associated with racial differences in all-cause 30-day readmission in adults with cardiovascular disease: an observational study of a large healthcare system. BMJ Open 2022; 12:e051661. [PMID: 36424114 PMCID: PMC9693888 DOI: 10.1136/bmjopen-2021-051661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To examine factors contributing to racial differences in 30-day readmission in patients with cardiovascular disease (CVD). DESIGN Patients were enrolled from 1 January 2015 to 31 August 2017 and data were collected from electronic health records and a standardised interview administered prior to discharge. SETTING Duke Heart Center in the Duke University Health System. PARTICIPANTS Patients aged 18 and older admitted for the treatment of cardiovascular-related conditions (n=734). MAIN OUTCOME AND MEASURES All-cause readmission within 30 days was the main outcome. Multivariate logistic regression models were used to examine whether and to what extent socioeconomic, psychosocial, behavioural and healthcare-related factors contributed to 30-day readmissions in Black and White CVD patients. RESULTS The median age of patients was 66 years and 18.1% (n=133) were readmitted within 30 days after discharge. Black patients were more likely than White patients to be readmitted (OR 1.62; 95% CI 1.18 to 2.23) and the racial difference in readmissions was largely reduced after taking into account differences in a wide range of clinical and non-clinical factors (OR 1.37; 95% CI 0.98 to 1.91). In Black patients, readmission risks were especially high in those who were retired (OR 3.71; 95% CI 1.71 to 8.07), never married (OR 2.21; 95% CI 1.21 to 4.05), had difficulty accessing their routine care (OR 2.88; 95% CI 1.70 to 4.88) or had been hospitalised in the prior year (OR 1.97; 95% CI 1.16 to 3.37). In White patients, being widowed (OR 2.39; 95% CI 1.41 to 4.07) and reporting a higher number of depressive symptoms (OR 1.07; 95% CI 1.00 to 1.13) were the key factors associated with higher risks of readmission. CONCLUSIONS AND RELEVANCE Black patients were more likely than White patients to be readmitted within 30 days after hospitalisation for CVD. The factors contributing to readmission differed by race and offer important clues for identifying patients at high risk of readmission and tailoring interventions to reduce these risks.
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Affiliation(s)
- Heather R Farmer
- Department of Human Development and Family Sciences, University of Delaware, Newark, Delaware, USA
| | - Hanzhang Xu
- Duke University School of Nursing, Durham, North Carolina, USA
| | - Bradi B Granger
- Duke University School of Nursing, Durham, North Carolina, USA
| | - Kevin L Thomas
- Division of Cardiology, Department of Medicine, Duke University, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Matthew E Dupre
- Duke Clinical Research Institute, Durham, North Carolina, USA
- Department of Population Health Sciences, Duke University, Durham, North Carolina, USA
- Department of Sociology, Duke University, Durham, North Carolina, USA
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Abstract
There has been increasing attention to the role of hearing loss as a potentially modifiable risk factor for Alzheimer's disease and related dementias. However, more nationally-representative studies are needed to understand the co-occurring changes in hearing loss and cognitive function in older adults over time, and how hearing aid use might influence this association. The purpose of this report is to examine how age-related changes in hearing loss and hearing aid use are associated with trajectories of cognitive function in a nationally-representative sample of U.S. older adults. We used 11 waves of longitudinal data from the Health and Retirement Study (HRS) from 1998 to 2018 to examine changes in self-reported hearing loss, hearing aid use, and cognitive function in adults 65 and older by race and ethnicity. Results from mixed models showed that greater levels of hearing loss were associated with lower levels of cognitive function at age 65 in non-Hispanic White, non-Hispanic Black, and Hispanic older adults. We also found that the associations diminished across age in White and Black individuals; but remained persistent in Hispanic individuals. The use of hearing aids was not associated with cognitive function in Black older adults but appeared protective for White and Hispanic older adults. Overall, the findings from this report suggest that the timely identification of hearing loss and subsequent acquisition of hearing aids may be important considerations for reducing declines in cognitive function that manifests differently in U.S. population subgroups.
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Affiliation(s)
- Jessica S. West
- Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina, USA
- Department of Population Health Sciences, Duke University, Durham, North Carolina, USA
| | - Sherri L. Smith
- Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina, USA
- Department of Population Health Sciences, Duke University, Durham, North Carolina, USA
- Department of Head and Neck Surgery and Communication Sciences, Duke University Durham, North Carolina, USA
| | - Matthew E. Dupre
- Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina, USA
- Department of Population Health Sciences, Duke University, Durham, North Carolina, USA
- Department of Sociology, Duke University, Durham, North Carolina, USA
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Li M, Wang N, Dupre ME. Association between the self-reported duration and quality of sleep and cognitive function among middle-aged and older adults in China. J Affect Disord 2022; 304:20-27. [PMID: 35176346 DOI: 10.1016/j.jad.2022.02.039] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 12/23/2021] [Accepted: 02/13/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND The World Alzheimer Report showed that 46.8 million people suffered from dementia in 2015. This study examined how the duration and quality of sleep are associated with cognition among older adults in China. METHOD Data were drawn from waves 2011, 2013, and 2015 of the China Health and Retirement Longitudinal Study (CHARLS), including noninstitutionalized adults aged 45 and older (n=10,768). Cognition was measured by interview-based assessments of mental status (TICS-10), episodic memory, and visuospatial abilities. Sleep duration was categorized as long, medium, or short and sleep quality was categorized as good, fair, or poor. RESULTS Sleep duration had an inverted U-shape relationship with cognitive scores (P <.001); and sleep quality had a positive linear relationship with cognitive scores (P <.001). Short and long sleep durations were associated with consistently lower cognition scores with increasing age (both P <.001); and fair and poor quality of sleep were associated with consistently lower levels of cognition (both P <.001). Tests of interactions between sleep duration and sleep quality showed that participants reporting long durations of sleep with poor quality of sleep had the lowest overall cognitive scores. LIMITATIONS Self-reported methods were used to measure sleep quality and duration and thus our findings underscore the need for more evidence-based research to improve prevention efforts and tailor interventions to reduce cognitive decline among Chinese older adults. CONCLUSIONS Suboptimal sleep duration and quality were associated with poor cognition. Cognitive scores were lowest among those who reported long durations of sleep that were of poor quality.
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Affiliation(s)
- Minchao Li
- Center for Disease Control and Prevention of Haining County, Jiaxing, Zhejiang, China
| | - Nan Wang
- Department of Global Health Sciences, School of Medicine, University of California at Davis, CA, United States.
| | - Matthew E Dupre
- Department of Population Health Sciences, Duke University, Durham, NC, United States; Department of Sociology, Duke University, Durham, NC, United States; Duke Clinical Research Institute, Duke University, Durham, NC, United States
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Xu H, Granger BB, Drake CD, Peterson ED, Dupre ME. Effectiveness of Telemedicine Visits in Reducing 30-Day Readmissions Among Patients With Heart Failure During the COVID-19 Pandemic. J Am Heart Assoc 2022; 11:e023935. [PMID: 35229656 PMCID: PMC9075458 DOI: 10.1161/jaha.121.023935] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background The COVID‐19 pandemic resulted in a rapid implementation of telemedicine into clinical practice. This study examined whether early outpatient follow‐up via telemedicine is as effective as in‐person visits for reducing 30‐day readmissions in patients with heart failure. Methods and Results Using electronic health records from a large health system, we included patients with heart failure living in North Carolina (N=6918) who were hospitalized between March 16, 2020 and March 14, 2021. All‐cause readmission within 30 days after discharge was examined using weighted logistic regression models. Overall, 7.6% (N=526) of patients received early telemedicine follow‐up, 38.8% (N=2681) received early in‐person follow‐up, and 53.6% (N=3711) did not receive follow‐up within 14 days of discharge. Compared with patients without early follow‐up, those who received early follow‐up were younger, were more likely to be Medicare beneficiaries, had more comorbidities, and were less likely to live in an disadvantaged neighborhood. Relative to in‐person visits, those with telemedicine follow‐up were of similar age, sex, and race but with generally fewer comorbidities. Overall, the 30‐day readmission rate (19.0%) varied among patients who received telemedicine visits (15.0%), in‐person visits (14.0%), or no follow‐up (23.1%). After covariate adjustment, patients who received either telemedicine (odds ratio [OR], 0.55; 95% CI, 0.44–0.72) or in‐person (OR, 0.52; 95% CI, 0.45–0.60) visits were similarly less likely to be readmitted within 30 days compared with patients with no follow‐up. Conclusions During the COVID‐19 pandemic, the use of telemedicine visits for early follow‐up increased rapidly. Patients with heart failure who received outpatient follow‐up either via telemedicine or in‐person had better outcomes than those who received no follow‐up.
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Affiliation(s)
- Hanzhang Xu
- Department of Family Medicine and Community Health Duke University Durham NC.,Duke University School of Nursing Duke University Durham NC.,Center for the Study of Aging and Human Development Duke University Durham NC
| | | | - Connor D Drake
- Department of Population Health Sciences Duke University Durham NC
| | - Eric D Peterson
- Office of the Provost University of Texas Southwestern Medical Dallas TX.,Department of Internal Medicine University of Texas Southwestern Medical Dallas TX
| | - Matthew E Dupre
- Center for the Study of Aging and Human Development Duke University Durham NC.,Department of Population Health Sciences Duke University Durham NC.,Duke Clinical Research Institute Duke University Durham NC.,Department of Sociology Duke University Durham NC
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Pun PH, Svetkey LP, McNally B, Dupre ME. Facility-Level Factors and Racial Disparities in Cardiopulmonary Resuscitation within US Dialysis Clinics. Kidney360 2022; 3:1021-1030. [PMID: 35845342 PMCID: PMC9255868 DOI: 10.34067/kid.0008092021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 03/09/2022] [Indexed: 01/10/2023]
Abstract
Background Cardiac arrest occurs frequently in outpatient dialysis clinics, and immediate cardiopulmonary resuscitation (CPR) provision improves patient outcomes. However, Black patients in dialysis clinics receive CPR from clinic staff less often compared with White patients. We examined the role of dialysis facility resources and patient factors in the observed racial disparity in CPR receipt and automated external defibrillator application. Methods This was a retrospective cohort study linking the National Cardiac Arrest Registry to Enhance Survival and Medicare Annual Dialysis Facility Report registries from 2013 to 2017. We identified patients experiencing cardiac arrests within US outpatient dialysis clinics via geolocation matching (N=1554). Differences in facility size, quality, staffing, and patient-related factors were summarized and compared according to patient race. Multilevel multivariable logistic regression models including these factors were used to examine the influence of these factors on the observed disparity in CPR rates between Black and White patients. Results Compared with White patients, Black cardiac arrest patients dialyzed in larger facilities (26 versus 21 dialysis stations; P<0.001), facilities with fewer registered nurses per station (0.29 versus 0.33; P<0.001), and facilities with lower quality scores (# citations 6.8 versus 6.3; P=0.04). Facilities treating Black patients cared for a higher proportion of patients with a history of cardiac arrest (41% versus 35%; P<0.001), HIV/hepatitis B, and Medicaid-enrolled patients (15% versus 11%; P<0.001). Even after accounting for these differences and other covariates, the racial disparity for CPR in Black versus White patients persisted (OR=0.45; 95% CI, 0.27 to 0.75). The racial disparity in CPR was greater among older patients compared with younger patients (interaction P=0.04). Conclusions The racial disparity in CPR delivery within dialysis clinics was not explained by differences in facility resources and quality. Reducing this disparity will require a multifaceted approach, including developing dialysis clinic-specific protocols for CPR and addressing potential implicit bias.
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Affiliation(s)
- Patrick H. Pun
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina,Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Laura P. Svetkey
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Bryan McNally
- Department of Emergency Medicine, Emory University, Atlanta, Georgia
| | - Matthew E. Dupre
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina,Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina,Department of Sociology, Duke University, Durham, North Carolina
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11
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Dupre ME, Farmer HR, Xu H, Navar AM, Nanna MG, George LK, Peterson ED. The Cumulative Impact of Chronic Stressors on Risks of Myocardial Infarction in US Older Adults. Psychosom Med 2021; 83:987-994. [PMID: 34297011 PMCID: PMC8578196 DOI: 10.1097/psy.0000000000000976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study aimed to investigate the association between cumulative exposure to chronic stressors and the incidence of myocardial infarction (MI) in US older adults. METHODS Nationally representative prospective cohort data of adults 45 years and older (n = 15,109) were used to investigate the association between the cumulative number of chronic stressors and the incidence of MI in US older adults. Proportional hazards models adjusted for confounding risk factors and differences by sex, race/ethnicity, and history of MI were assessed. RESULTS The median age of participants was 65 years, 714 (4.7%) had a prior MI, and 557 (3.7%) had an MI during follow-up. Approximately 84% of participants reported at least one chronic stressor at baseline, and more than half reported two or more stressors. Multivariable models showed that risks of MI increased incrementally from one chronic stressor (hazard ratio [HR] = 1.28, 95% confidence interval [CI] = 1.20-1.37) to four or more chronic stressors (HR = 2.71, 95% CI = 2.08-3.53) compared with those who reported no stressors. These risks were only partly reduced after adjustments for multiple demographic, socioeconomic, psychosocial, behavioral, and clinical risk factors. In adults who had a prior MI (p value for interaction = .038), we found that risks of a recurrent event increased substantially from one chronic stressor (HR = 1.30, 95% CI = 1.09-1.54) to four or more chronic stressors (HR = 2.85, 95% CI = 1.43-5.69). CONCLUSIONS Chronic life stressors are significant independent risk factors for cardiovascular events in US older adults. The risks associated with multiple chronic stressors were especially high in adults with a previous MI.
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Affiliation(s)
- Matthew E. Dupre
- Department of Population Health Sciences, Duke University, Durham, NC
- Duke Clinical Research Institute, Duke University, Durham, NC
- Department of Sociology, Duke University, Durham, NC
- Center for the Study of Aging and Human Development, Duke University, Durham, NC
| | - Heather R. Farmer
- Department of Human Development and Family Sciences, University of Delaware, DE
| | - Hanzhang Xu
- Department of Family Medicine and Community Health, Duke University, Durham, NC
- Duke School of Nursing, Duke University, Durham, NC
| | - Ann Marie Navar
- Division of Cardiology, Department of Medicine, University of Texas Southwestern, TX
| | - Michael G. Nanna
- Duke Clinical Research Institute, Duke University, Durham, NC
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC
| | - Linda K. George
- Department of Sociology, Duke University, Durham, NC
- Center for the Study of Aging and Human Development, Duke University, Durham, NC
- Department of Psychology and Neuroscience, Duke University, Durham, NC
| | - Eric D. Peterson
- Division of Cardiology, Department of Medicine, University of Texas Southwestern, TX
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Abstract
The world’s population continues to grow, albeit at a slower pace. The decelerating growth is mainly attributable to fertility declines in a growing number of countries. However, there are substantial variations in the future trends of populations across regions and countries, with sub-Saharan African countries being projected to have most of the increase. Population momentum plays an important role in determining the future population growth in many countries and areas where fertility is in a rapid transition. With declines in fertility, the world’s population is unprecedentedly aging, and the numbers of households with smaller sizes are growing. International migration is also on the rise since the beginning of this century. The world’s population is also urbanizing due to increased internal rural to urban migration. Nevertheless, there are uncertainties in future population growth, not only because there are uncertainties in the future trends in fertility, mortality, and migration, but also because there are many other factors that could affect these trajectories. International consensus on climate change and ecosystem protections may trigger population control policies, and the ongoing pandemic is likely to have some impact on mortality, migration, or even fertility.
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Affiliation(s)
- Danan Gu
- United Nations Population Division, New York, USA
| | | | - Matthew E Dupre
- Department of Population Health Sciences & Department of Sociology, Duke University, North Carolina, USA
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Xu H, Farmer HR, Granger BB, Thomas KL, Peterson ED, Dupre ME. Perceived Versus Actual Risks of 30-Day Readmission in Patients With Cardiovascular Disease. Circ Cardiovasc Qual Outcomes 2021; 14:e006586. [PMID: 33430612 DOI: 10.1161/circoutcomes.120.006586] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cardiovascular disease (CVD) is the leading cause of hospitalization in the United States, and patients with CVD are at a high risk of readmission after discharge. We examined whether patients' perceived risk of readmission at discharge was associated with actual 30-day readmissions in patients hospitalized with CVD. METHODS We recruited 730 patients from the Duke Heart Center who were admitted for treatment of CVD between January 1, 2015, and August 31, 2017. A standardized survey was linked with electronic health records to ascertain patients' perceived risk of readmission, and other sociodemographic, psychosocial, behavioral, and clinical data before discharge. All-cause readmission within 30 days after discharge was examined. RESULTS Nearly 1-in-3 patients perceived a high risk of readmission at index admission and those who perceived a high risk had significantly more readmissions within 30 days than patients who perceived low risks of readmission (23.6% versus 15.8%, P=0.016). Among those who perceived a high risk of readmission, non-White patients (odds ratio [OR], 2.07 [95% CI, 1.28-3.36]), those with poor self-rated health (OR, 2.30 [95% CI, 1.38-3.85]), difficulty accessing care (OR, 2.72 [95% CI, 1.24-6.00]), and prior hospitalizations in the past year (OR, 2.13 [95% CI, 1.21-3.74]) were more likely to be readmitted. Among those who perceived a low risk of readmission, patients who were widowed (OR, 2.69 [95% CI, 1.60-4.51]) and reported difficulty accessing care (OR, 1.89 [95% CI, 1.07-3.33]) were more likely to be readmitted. CONCLUSIONS Patients who perceived a high risk of readmission had a higher rate of 30-day readmission than patients who perceived a low risk. These findings have important implications for identifying CVD patients at a high risk of 30-day readmission and targeting the factors associated with perceived and actual risks of readmission.
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Affiliation(s)
- Hanzhang Xu
- Department of Family Medicine and Community Health (H.X.), Duke University, Durham, NC.,Duke University School of Nursing (H.X., B.B.G.), Duke University, Durham, NC.,Center for the Study of Aging and Human Development (H.X., M.E.D.), Duke University, Durham, NC
| | - Heather R Farmer
- Department of Human Development and Family Sciences, University of Delaware, Newark (H.R.F.)
| | - Bradi B Granger
- Duke University School of Nursing (H.X., B.B.G.), Duke University, Durham, NC
| | - Kevin L Thomas
- Duke Clinical Research Institute (K.L.T., E.D.P., M.E.D.), Duke University, Durham, NC.,Division of Cardiology, Department of Medicine (K.L.T.), Duke University, Durham, NC
| | - Eric D Peterson
- Duke Clinical Research Institute (K.L.T., E.D.P., M.E.D.), Duke University, Durham, NC.,Department of Internal Medicine, University of Texas Southwestern Medical Center (E.D.P)
| | - Matthew E Dupre
- Center for the Study of Aging and Human Development (H.X., M.E.D.), Duke University, Durham, NC.,Duke Clinical Research Institute (K.L.T., E.D.P., M.E.D.), Duke University, Durham, NC.,Department of Population Health Sciences (M.E.D.), Duke University, Durham, NC.,Department of Sociology (M.E.D.), Duke University, Durham, NC
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14
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Hofacker SA, Dupre ME, Vellano K, McNally B, Starks MA, Wolf M, Svetkey LP, Pun PH. Association between patient race and staff resuscitation efforts after cardiac arrest in outpatient dialysis clinics: A study from the CARES surveillance group. Resuscitation 2020; 156:42-50. [PMID: 32860854 PMCID: PMC7606705 DOI: 10.1016/j.resuscitation.2020.07.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/17/2020] [Accepted: 07/13/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Cardiac arrest is the leading cause of death among patients receiving hemodialysis. Despite guidelines recommending CPR training and AED presence in dialysis clinics, rates of CPR and AED use by dialysis staff are suboptimal. Given that racial disparities exist in bystander CPR administration in non-healthcare settings, we examined the relationship between patient race/ethnicity and staff-initiated CPR and AED application within dialysis clinics. METHODS We analyzed data prospectively collected in the Cardiac Arrest Registry to Enhance Survival across the U.S. from 2013 to 2017 and the Centers for Medicare & Medicaid Services dialysis facility database to identify outpatient dialysis clinic cardiac arrest events. Using multivariable logistic regression models, we examined relationships between patient race/ethnicity and dialysis staff-initiated CPR and AED application. RESULTS We identified 1568 cardiac arrests occurring in 809 hemodialysis clinics. The racial/ethnic composition of patients was 31.3% white, 32.9% Black, 10.7% Hispanic/Latinx, 2.7% Asian, and 22.5% other/unknown. Overall, 88.0% of patients received CPR initiated by dialysis staff, but rates differed by race: 91% of white patients, 85% of black patients, and 77% of Asian patients (p = 0.005). After adjusting for differences in patient and clinic characteristics, black (OR = 0.41, 95% CI 0.25-0.68) and Asian patients (OR = 0.28, 95% CI 0.12-0.65) were significantly less likely than white patients to receive staff-initiated CPR. No significant difference between staff-initiated CPR rates among white, Hispanic/Latinx, and other/unknown patients was observed. An AED was applied by dialysis staff in 62% of patients. In adjusted models, there was no relationship between patient race/ethnicity and staff AED application. CONCLUSIONS Black and Asian patients are significantly less likely than white patients to receive CPR from dialysis staff. Further understanding of practices in dialysis clinics and increased awareness of this disparity are necessary to improve resuscitation practices.
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Affiliation(s)
| | - Matthew E Dupre
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, United States; Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States; Department of Sociology, Duke University, United States
| | - Kimberly Vellano
- Department of Emergency Medicine, Emory University, Atlanta, GA, United States
| | - Bryan McNally
- Department of Emergency Medicine, Emory University, Atlanta, GA, United States
| | - Monique Anderson Starks
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, United States; Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Myles Wolf
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, United States; Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Laura P Svetkey
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Patrick H Pun
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, United States; Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, NC, United States.
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15
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Zhao Y, Xu X, Dupre ME, Xie Q, Qiu L, Gu D. Individual-level factors attributable to urban-rural disparity in mortality among older adults in China. BMC Public Health 2020; 20:1472. [PMID: 32993592 PMCID: PMC7526413 DOI: 10.1186/s12889-020-09574-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 09/21/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Urban-rural disparity in mortality at older ages is well documented in China. However, surprisingly few studies have systemically investigated factors that contribute to such disparity. This study examined the extent to which individual-level socioeconomic conditions, family/social support, health behaviors, and baseline health status contributed to the urban-rural difference in mortality among older adults in China. METHODS This research used the five waves of the Chinese Longitudinal Healthy Longevity Survey from 2002 to 2014, a nationally representative sample of older adults aged 65 years or older in China (n = 28,235). A series of hazard regression models by gender and age group examined the association between urban-rural residence and mortality and how this association was modified by a wide range of individual-level factors. RESULTS Older adults in urban areas had 11% (relative hazard ratio (HR) = 0.89, p < 0.01) lower risks of mortality than their rural counterparts when only demographic factors were taken into account. Further adjustments for family/social support, health behaviors, and health-related factors individually or jointly had a limited influence on the mortality differential between urban and rural older adults (HRs = 0.89-0.92, p < 0.05 to p < 0.01). However, we found no urban-rural difference in mortality (HR = 0.97, p > 0.10) after adjusting for individual socioeconomic factors. Similar results were found in women and men, and among the young-old and the oldest-old populations. CONCLUSIONS The urban-rural disparity in mortality among older adults in China was largely attributable to differences in individual socioeconomic resources (i.e., education, income, and access to healthcare) regardless of gender and age group.
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Affiliation(s)
- Yuan Zhao
- Ginling College & School of Geographic Sciences, Nanjing Normal University, Nanjing, China
| | - Xin Xu
- International Center on Aging and Health & School of Geographic Sciences, Nanjing Normal University, Nanjing, China
| | - Matthew E Dupre
- Department of Population Health Sciences & Department of Sociology, Duke University, Durham, NC, USA
| | - Qianqian Xie
- School of Geographic Sciences, Nanjing Normal University, Nanjing, China
| | - Li Qiu
- Independent Researcher, New York, NY, USA
| | - Danan Gu
- Independent Researcher, New York, NY, USA.
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16
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Hao L, Xu X, Dupre ME, Guo A, Zhang X, Qiu L, Zhao Y, Gu D. Adequate access to healthcare and added life expectancy among older adults in China. BMC Geriatr 2020; 20:129. [PMID: 32272883 PMCID: PMC7146971 DOI: 10.1186/s12877-020-01524-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 03/19/2020] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Adequate access to healthcare is associated with lower risks of mortality at older ages. However, it is largely unknown how many more years of life can be attributed to having adequate access to healthcare compared with having inadequate access to healthcare. METHOD A nationwide longitudinal survey of 27,794 older adults aged 65+ in mainland China from 2002 to 2014 was used for analysis. Multivariate hazard models and life table techniques were used to estimate differences in life expectancy associated with self-reported access to healthcare (adequate vs. inadequate). The findings were assessed after adjusting for a wide range of demographic factors, socioeconomic status, family/social support, health practices, and health conditions. RESULTS At age 65, adequate access to healthcare increased life expectancy by approximately 2.0-2.5 years in men and women and across urban-rural areas compared with those who reported inadequate access to healthcare. At age 85, the corresponding increase in life expectancy was 1.0-1.2 years. After adjustment for multiple confounding factors, the increase in life expectancy was reduced to approximately 1.1-1.5 years at age 65 and 0.6-0.8 years at age 85. In women, the net increase in life expectancy attributable to adequate access to healthcare was 6 and 8% at ages 65 and 85, respectively. In men, the net increases in life expectancy were generally greater (10 and 14%) and consistent after covariate adjustments. In contrast, the increase in life expectancy was slightly lower in rural areas (2.0 years at age 65 and 1.0 years at age 85) than in urban areas (2.1 years at age 65 and 1.1 years age 85) when no confounding factors were taken into account. However, the increase in life expectancy was greater in rural areas (1.0 years at age 65 and 0.6 years at age 85) than in urban areas (0.4 years at age 65 and 0.2 years at age 85) after accounting for socioeconomic and other factors. CONCLUSIONS Adequate access to healthcare was associated with longer life expectancy among older adults in China. These findings have important implications for efforts to improve access to healthcare among older populations in China.
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Affiliation(s)
- Lisha Hao
- School of Geographic Sciences, Nanjing Normal University, Nanjing, China
| | - Xin Xu
- School of Geographic Sciences, Nanjing Normal University, Nanjing, China
| | - Matthew E Dupre
- Department of Population Health Sciences, Department of Sociology, & Duke Clinical Research Institute, Duke University, Durham, NC, USA.
| | - Aimei Guo
- Ginling College, Nanjing Normal University, Nanjing, China
| | - Xufan Zhang
- Ginling College, Nanjing Normal University, Nanjing, China
| | | | - Yuan Zhao
- Ginling College & School of Geographic Sciences, Nanjing Normal University, Nanjing, China
| | - Danan Gu
- Independent Researcher, New York, USA.
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17
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Farmer HR, Farmer HR, Wray LA, Xu H, Xian Y, Pagidipati N, Peterson ED, Dupre ME. RACIAL DIFFERENCES IN ELEVATED C-REACTIVE PROTEIN AMONG U.S. OLDER ADULTS. Innov Aging 2019. [PMCID: PMC6845172 DOI: 10.1093/geroni/igz038.3018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
C-reactive protein (CRP) is a marker of inflammation linked to numerous acute and chronic conditions. Studies have not considered racial differences in elevated CRP among older adults at the national level. We investigate racial differences in elevated CRP and the socioeconomic, psychosocial, behavioral, and physiological factors that contribute to these differences overall and by gender using a nationally-representative prospective cohort of 14,700 non-Hispanic black and white participants in the Health and Retirement Study followed from 2006 to 2014. Random effects logistic regression models showed that blacks were more likely to have elevated levels of CRP than whites. In men, the racial differences in elevated CRP were attributed to a combination of socioeconomic, psychosocial, and behavioral factors. In women, the racial differences in elevated CRP were primarily attributable to physiological factors. The findings from this work have potentially important implications for clinical practice and interventions targeting vulnerable segments of the population.
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Affiliation(s)
| | | | - Linda A Wray
- Pennsylvania State University, University Park, Pennsylvania, United States
| | - Hanzhang Xu
- Duke University, Durham, North Carolina, United States
| | - Ying Xian
- Duke University, Durham, North Carolina, United States
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18
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Malta Hansen C, Kragholm K, Dupre ME, Pearson DA, Tyson C, Monk L, Rea TD, Starks MA, Nelson D, Jollis JG, McNally B, Corbett CM, Granger CB. Association of Bystander and First-Responder Efforts and Outcomes According to Sex: Results From the North Carolina HeartRescue Statewide Quality Improvement Initiative. J Am Heart Assoc 2019; 7:e009873. [PMID: 30371210 PMCID: PMC6222952 DOI: 10.1161/jaha.118.009873] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The Institute of Medicine has called for actions to understand and target sex‐related differences in care and outcomes for out‐of‐hospital cardiac arrest patients. We assessed changes in bystander and first‐responder interventions and outcomes for males versus females after statewide efforts to improve cardiac arrest care. Methods and Results We identified out‐of‐hospital cardiac arrests from North Carolina (2010–2014) through the CARES (Cardiac Arrest Registry to Enhance Survival) registry. Outcomes for men versus women were examined through multivariable logistic regression analyses adjusted for (1) nonmodifiable factors (age, witnessed status, and initial heart rhythm) and (2) nonmodifiable plus modifiable factors (bystander cardiopulmonary resuscitation and defibrillation before emergency medical services), including interactions between sex and time (ie, year and year2). Of 8100 patients, 38.1% were women. From 2010 to 2014, there was an increase in bystander cardiopulmonary resuscitation (men, 40.5%–50.6%; women, 35.3%–51.8%; P for each <0.0001) and in the combination of bystander cardiopulmonary resuscitation and first‐responder defibrillation (men, 15.8%–23.0%, P=0.007; women, 8.5%–23.7%, P=0.004). From 2010 to 2014, the unadjusted predicted probability of favorable neurologic outcome was higher and increased more for men (men, from 6.5% [95% confidence interval (CI), 5.1–8.0] to 9.7% [95% CI, 8.1–11.3]; women, from 6.3% [95% CI, 4.4–8.3] to 7.4% [95% CI, 5.5–9.3%]); while adjusted for nonmodifiable factors, it was slightly higher but with a nonsignificant increase for women (from 9.2% [95% CI, 6.8–11.8] to 10.2% [95% CI, 8.0–12.5]; men, from 5.8% [95% CI, 4.6–7.0] to 8.4% [95% CI, 7.1–9.7]). Adding bystander cardiopulmonary resuscitation and defibrillation before EMS (modifiable factors) did not substantially change the results. Conclusions Bystander and first‐responder interventions increased for men and women, but outcomes improved significantly only for men. Additional strategies may be necessary to improve survival among female cardiac arrest patients.
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Affiliation(s)
- Carolina Malta Hansen
- 1 Duke Clinical Research Institute Duke University Durham NC.,2 Division of Endocrinology and Nephrology North Zealand Hospital Copenhagen University Copenhagen Denmark.,3 Emergency Medical Services Capital Region of Denmark Copenhagen University Copenhagen Denmark
| | | | - Matthew E Dupre
- 1 Duke Clinical Research Institute Duke University Durham NC.,4 Department of Population Health Sciences Duke University Durham NC
| | | | - Clark Tyson
- 1 Duke Clinical Research Institute Duke University Durham NC.,6 Ctr for Educational Excellence Duke University Durham NC
| | - Lisa Monk
- 1 Duke Clinical Research Institute Duke University Durham NC
| | - Thomas D Rea
- 7 Department of Medicine University of Washington Seattle WA
| | | | | | - James G Jollis
- 1 Duke Clinical Research Institute Duke University Durham NC
| | - Bryan McNally
- 9 Emory University School of Medicine Atlanta GA.,10 Rollins School of Public Health Atlanta GA
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19
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Xu H, Dupre ME, Wu B. TRAJECTORIES OF SUBJECTIVE MEMORY IMPAIRMENT AND OBJECTIVE COGNITIVE DECLINE IN U.S. OLDER ADULTS. Innov Aging 2019. [PMCID: PMC6846146 DOI: 10.1093/geroni/igz038.743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
We examined the dual trajectories of subjective memory impairment (SMI) and objective cognitive decline and their associated factors in U.S. older adults. We used data from the Health and Retirement Study which includes a nationally representative sample of 19,408 Americans age 65 and older from 1998 to 2016. Trajectories of SMI and objective cognitive decline were simultaneously characterized using a group-based trajectory model and multinomial logistic regressions were used to assess factors associated with the dual-trajectory typologies. Four dual-trajectories were identified: “minimal SMI and stable-low cognitive decline” (33.1% of respondents); “minimal SMI with accelerated cognitive decline” (28.2%); “significant SMI with moderate cognitive decline” (21.0%); and “moderate SMI with steady cognitive decline” (17.6%). Being male, minority, low educated, living alone, and having comorbidities were associated with trajectories featuring greater SMI or more rapid deterioration in cognition. The results suggest complex co-occurring changes in subjective memory and objective cognition in older adults.
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Affiliation(s)
- Hanzhang Xu
- Duke University, Durham, North Carolina, United States
| | - Matthew E Dupre
- Duke University School of Medicine, durham, North Carolina, United States
| | - Bei Wu
- new York University Rory Meyers College of Nursing, New York, New York, United States
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20
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Farmer HR, Wray LA, Xian Y, Xu H, Pagidipati N, Peterson ED, Dupre ME. Racial Differences in Elevated C-Reactive Protein Among US Older Adults. J Am Geriatr Soc 2019; 68:362-369. [PMID: 31633808 DOI: 10.1111/jgs.16187] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 08/16/2019] [Indexed: 01/26/2023]
Abstract
OBJECTIVES To investigate racial differences in elevated C-reactive protein (CRP) and the potential factors contributing to these differences in US older men and women. DESIGN Nationally representative cohort study. SETTING Health and Retirement Study, 2006 to 2014. PARTICIPANTS Noninstitutionalized non-Hispanic black and white older adults living in the United States (n = 13 517). MEASUREMENTS CRP was categorized as elevated (>3.0 mg/L) and nonelevated (≤3.0 mg/L) as the primary outcome. Measures for demographic background, socioeconomic status, psychosocial factors, health behaviors, and physiological health were examined as potential factors contributing to race differences in elevated CRP. RESULTS Median CRP levels (interquartile range) were 1.67 (3.03) mg/L in whites and 2.62 (4.95) mg/L in blacks. Results from random effects logistic regression models showed that blacks had significantly greater odds of elevated CRP than whites (odds ratio = 2.58; 95% confidence interval [CI] = 2.20-3.02). Results also showed that racial difference in elevated CRP varied significantly by sex (predicted probability [PP] [white men] = 0.28 [95% CI = 0.27-0.30]; PP [black men] = 0.38 [95% CI = 0.35-0.41]; PP [white women] = 0.35 [95% CI = 0.34-0.36]; PP [black women] = 0.49 [95% CI = 0.47-0.52]) and remained significant after risk adjustment. In men, the racial differences in elevated CRP were attributable to a combination of socioeconomic (12.3%) and behavioral (16.5%) factors. In women, the racial differences in elevated CRP were primarily attributable to physiological factors (40.0%). CONCLUSION In the US older adult population, blacks were significantly more likely to have elevated CRP than whites; and the factors contributing to these differences varied in men and women. J Am Geriatr Soc 68:362-369, 2020.
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Affiliation(s)
- Heather R Farmer
- Department of Population Health Sciences, Duke University, Durham, North Carolina.,Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina
| | - Linda A Wray
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, Pennsylvania
| | - Ying Xian
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.,Department of Neurology, Duke University Medical Center, Durham, North Carolina
| | - Hanzhang Xu
- Department of Family Medicine and Community Health, Duke University Medical Center, Durham, North Carolina.,Duke School of Nursing, Duke University Medical Center, Durham, North Carolina
| | - Neha Pagidipati
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.,Division of Cardiology, Department of Medicine, Duke University, Durham, North Carolina
| | - Eric D Peterson
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.,Division of Cardiology, Department of Medicine, Duke University, Durham, North Carolina
| | - Matthew E Dupre
- Department of Population Health Sciences, Duke University, Durham, North Carolina.,Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina.,Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.,Department of Sociology, Duke University, Durham, North Carolina
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21
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Fordyce CB, Hansen CM, Kragholm K, Dupre ME, Jollis JG, Roettig ML, Becker LB, Hansen SM, Hinohara TT, Corbett CC, Monk L, Nelson RD, Pearson DA, Tyson C, van Diepen S, Anderson ML, McNally B, Granger CB. Association of Public Health Initiatives With Outcomes for Out-of-Hospital Cardiac Arrest at Home and in Public Locations. JAMA Cardiol 2019; 2:1226-1235. [PMID: 28979980 DOI: 10.1001/jamacardio.2017.3471] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Importance Little is known about the influence of comprehensive public health initiatives according to out-of-hospital cardiac arrest (OHCA) location, particularly at home, where resuscitation efforts and outcomes have historically been poor. Objective To describe temporal trends in bystander cardiopulmonary resuscitation (CPR) and first-responder defibrillation for OHCAs stratified by home vs public location and their association with survival and neurological outcomes. Design, Setting, and Participants This observational study reviewed 8269 patients with OHCAs (5602 [67.7%] at home and 2667 [32.3%] in public) for whom resuscitation was attempted using data from the Cardiac Arrest Registry to Enhance Survival (CARES) from January 1, 2010, through December 31, 2014. The setting was 16 counties in North Carolina. Exposures Patients were stratified by home vs public OHCA. Public health initiatives to improve bystander and first-responder interventions included training members of the general population in CPR and in the use of automated external defibrillators, teaching first responders about team-based CPR (eg, automated external defibrillator use and high-performance CPR), and instructing dispatch centers on recognition of cardiac arrest. Main Outcomes and Measures Association of resuscitation efforts with survival and neurological outcomes from 2010 through 2014. Results Among home OHCA patients (n = 5602), the median age was 64 years, and 62.2% were male; among public OHCA patients (n = 2667), the median age was 68 years, and 61.5% were male. After comprehensive public health initiatives, the proportion of patients receiving bystander CPR increased at home (from 28.3% [275 of 973] to 41.3% [498 of 1206], P < .001) and in public (from 61.0% [275 of 451] to 70.5% [424 of 601], P = .01), while first-responder defibrillation increased at home (from 42.2% [132 of 313] to 50.8% [212 of 417], P = .02) but not significantly in public (from 33.1% [58 of 175] to 37.8% [93 of 246], P = .17). Survival to discharge improved for arrests at home (from 5.7% [60 of 1057] to 8.1% [100 of 1238], P = .047) and in public (from 10.8% [50 of 464] to 16.2% [98 of 604], P = .04). Compared with emergency medical services-initiated CPR and resuscitation, patients with home OHCA were significantly more likely to survive to hospital discharge if they received bystander-initiated CPR and first-responder defibrillation (odds ratio, 1.55; 95% CI, 1.01-2.38). Patients with arrests in public were most likely to survive if they received both bystander-initiated CPR and defibrillation (odds ratio, 4.33; 95% CI, 2.11-8.87). Conclusions and Relevance After coordinated and comprehensive public health initiatives, more patients received bystander CPR and first-responder defibrillation at home and in public, which was associated with improved survival.
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Affiliation(s)
- Christopher B Fordyce
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, Canada.,Duke Clinical Research Institute, Durham, North Carolina
| | | | - Kristian Kragholm
- Duke Clinical Research Institute, Durham, North Carolina.,Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.,Department of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark
| | - Matthew E Dupre
- Duke Clinical Research Institute, Durham, North Carolina.,Department of Sociology, Duke University, Durham, North Carolina
| | - James G Jollis
- Division of Cardiology, Department of Medicine, The University of North Carolina at Chapel Hill
| | | | - Lance B Becker
- Department of Emergency Medicine, Northwell Health, Hofstra Northwell School of Medicine at Hofstra University, Manhasset, New York
| | - Steen M Hansen
- Duke Clinical Research Institute, Durham, North Carolina
| | | | | | - Lisa Monk
- Duke Clinical Research Institute, Durham, North Carolina
| | - R Darrell Nelson
- Wake Forest University Health Sciences, Winston-Salem, North Carolina
| | - David A Pearson
- Department of Emergency Medicine, Carolinas Medical Center, Charlotte, North Carolina
| | - Clark Tyson
- Duke Clinical Research Institute, Durham, North Carolina
| | - Sean van Diepen
- Department of Critical Care, University of Alberta, Edmonton, Alberta, Canada.,Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | | | - Bryan McNally
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia
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Pun PH, Dupre ME, Tyson C, Al-Khatib SM, Granger CB. Authors' Reply. J Am Soc Nephrol 2019; 30:1137-1138. [PMID: 31061137 DOI: 10.1681/asn.2019040353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Patrick H Pun
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Matthew E Dupre
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Clark Tyson
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Sana M Al-Khatib
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Christopher B Granger
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
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Pun PH, Dupre ME, Starks MA, Tyson C, Vellano K, Svetkey LP, Hansen S, Frizzelle BG, McNally B, Jollis JG, Al-Khatib SM, Granger CB. Outcomes for Hemodialysis Patients Given Cardiopulmonary Resuscitation for Cardiac Arrest at Outpatient Dialysis Clinics. J Am Soc Nephrol 2019; 30:461-470. [PMID: 30733235 PMCID: PMC6405155 DOI: 10.1681/asn.2018090911] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Accepted: 11/28/2018] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Out-of-hospital cardiac arrest, the leading cause of death among patients on hemodialysis, occurs frequently within outpatient dialysis centers. Practice guidelines recommend resuscitation training for all dialysis clinic staff and on-site defibrillator availability, but the extent of staff involvement in cardiopulmonary resuscitation (CPR) efforts and its association with outcomes is unknown. METHODS We used data from the Cardiac Arrest Registry to Enhance Survival and the Centers for Medicare & Medicaid Services dialysis facility database to identify patients who had cardiac arrest within outpatient dialysis clinics between 2010 and 2016 in the southeastern United States. We compared outcomes of patients who received dialysis staff-initiated CPR with those who did not until the arrival of emergency medical services (EMS). RESULTS Among 398 OHCA events in dialysis clinics, 66% of all patients presented with a nonshockable initial rhythm. Dialysis staff initiated CPR in 81.4% of events and applied defibrillators before EMS arrival in 52.3%. Staff were more likely to initiate CPR among men and witness cardiac arrests, and were more likely to provide CPR within larger dialysis clinics. Staff-initiated CPR was associated with a three-fold increase in the odds of hospital discharge and favorable neurologic status on discharge. There was no overall association between staff-initiated defibrillator use and outcomes, but there was a nonsignificant trend toward improved survival to hospital discharge in the subgroup with shockable initial cardiac arrest rhythms. CONCLUSIONS Dialysis staff-initiated CPR was associated with a large increase in survival but was only performed in 81% of cardiac arrest events. Further investigations should focus on understanding the potential facilitators and barriers to CPR in the dialysis setting.
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Affiliation(s)
- Patrick H. Pun
- Duke Clinical Research Institute,,Division of Nephrology, Department of Medicine, and
| | - Matthew E. Dupre
- Duke Clinical Research Institute,,Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | | | | | - Kimberly Vellano
- Department of Emergency Medicine, Emory University, Atlanta, Georgia
| | | | - Steen Hansen
- Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark; and
| | - Brian G. Frizzelle
- Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina
| | - Bryan McNally
- Department of Emergency Medicine, Emory University, Atlanta, Georgia
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Liu Z, Han L, Feng Q, Dupre ME, Gu D, Allore HG, Gill TM, Payne CF. Are China's oldest-old living longer with less disability? A longitudinal modeling analysis of birth cohorts born 10 years apart. BMC Med 2019; 17:23. [PMID: 30704529 PMCID: PMC6357399 DOI: 10.1186/s12916-019-1259-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 01/14/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND China has transitioned from being one of the fastest-growing populations to among the most rapidly aging countries worldwide. In particular, the population of oldest-old individuals, those aged 80+, is projected to quadruple by 2050. The oldest-old represent a uniquely important group-they have high demand for personal assistance and the highest healthcare costs of any age group. Understanding trends in disability and longevity among the oldest-old-that is, whether successive generations are living longer and with less disability-is of great importance for policy and planning purposes. METHODS We utilized data from successive birth cohorts (n = 20,520) of the Chinese oldest-old born 10 years apart (the earlier cohort was interviewed in 1998 and the later cohort in 2008). Disability was defined as needing personal assistance in performing one or more of five essential activities (bathing, transferring, dressing, eating, and toileting) or being incontinent. Participants were followed for age-specific disability transitions and mortality (in 2000 and 2002 for the earlier cohort and 2011 and 2014 for the later cohort), which were then used to generate microsimulation-based multistate life tables to estimate partial life expectancy (LE) and disability-free LE (DFLE), stratified by sex and age groups (octogenarians, nonagenarians, and centenarians). We additionally explored sociodemographic heterogeneity in LE and DFLE by urban/rural residence and educational attainment. RESULTS More recently born Chinese octogenarians (born 1919-1928) had a longer partial LE between ages 80 and 89 than octogenarians born 1909-1918, and octogenarian women experienced an increase in partial DFLE of 0.32 years (P = 0.004) across the two birth cohorts. Although no increases in partial LE were observed among nonagenarians or centenarians, partial DFLE increased across birth cohorts, with a gain of 0.41 years (P < 0.001) among nonagenarians and 0.07 years (P = 0.050) among centenarians. Subgroup analyses revealed that gains in partial LE and DFLE primarily occurred among the urban resident population. CONCLUSIONS Successive generations of China's oldest-old are living with less disability as a whole, and LE is expanding among octogenarians. However, we found a widening urban-rural disparity in longevity and disability, highlighting the need to improve policies to alleviate health inequality throughout the population.
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Affiliation(s)
- Zuyun Liu
- Department of Pathology, Yale School of Medicine, New Haven, CT, USA
| | - Ling Han
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Qiushi Feng
- Department of Sociology, National University of Singapore, Singapore, Singapore
| | - Matthew E Dupre
- Department of Population Health Sciences, Duke University, Durham, NC, USA.,Department of Sociology, Duke University, Durham, NC, USA
| | - Danan Gu
- Independent Researcher, New York, NY, USA
| | - Heather G Allore
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Thomas M Gill
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Collin F Payne
- School of Demography, Research School of Social Sciences, Australian National University, 9 Fellows Road, Acton, ACT, Canberra, 2601, Australia.
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Zhang X, Dupre ME, Qiu L, Zhou W, Zhao Y, Gu D. Age and sex differences in the association between access to medical care and health outcomes among older Chinese. BMC Health Serv Res 2018; 18:1004. [PMID: 30594183 PMCID: PMC6310939 DOI: 10.1186/s12913-018-3821-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 12/17/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Whether the association between access to medical care and health outcomes differs by age and gender among older adults in China is unclear. We aimed to investigate the associations between self-reported inadequate access to care and multiple health outcomes among older men and women in mainland China. METHODS Based on four latest waves available so far from a national longitudinal study in mainland China in 2005-2014, we used multilevel random-effect logistic models to estimate the contemporaneous relationships between inadequate access to care and disabilities in instrumental activities of daily living (IADL) and cognitive impairment in men and women at ages 65-74, 75-84, 85-94, and 95+, separately. We also used multilevel hazard models to investigate the relationships between reported access to care and mortality in 2005-2014. Nested models were used to adjust for survey design, sociodemographic background, enrollment in health insurance, and health behaviors. RESULTS Approximately 6.5% of older adults in China reported inadequate access to care in the period of 2005-2014; and the percentages increased with age and were higher among women at older ages (≥75 years). Overall, older adults with self-reported inadequate access to care had greater odds of IADL and ADL disabilities and cognitive impairment than those with adequate access to healthcare. The elevated odds ratios (ORs) in men were higher in middle-old (75-84) and old-old (85-94) age groups compared to other age groups; whereas the elevated ORs in women were higher in young-old (65-74) and middle-old (75-84) age groups. The relationship between access to care and the health outcomes was generally weakest at the oldest-old ages (95+). Inadequate access to care was also linked with higher mortality risk, primarily in adults aged 75-84, and it was somewhat more pronounced in women than in men. CONCLUSIONS Increased odds of physical disability and cognitive impairment and increased risk of mortality are linked with inadequate access to care. The associations were generally stronger in women than in men and varied across age groups. The findings of the present study have important implications for further improving access to health care and improving health outcomes of older adults in China.
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Affiliation(s)
- Xufan Zhang
- Ginling Colleague, Nanjing Normal University, Nanjing, China
| | - Matthew E. Dupre
- Department of Population Health Sciences and Department of Sociology, Duke University, Durham, NC USA
| | - Li Qiu
- Independent Researcher, New York, NY USA
| | - Wei Zhou
- Ginling Colleague, Nanjing Normal University, Nanjing, China
| | - Yuan Zhao
- School of Geographical Science Ginling College, Nanjing Normal University, and Jiangsu Center for Collaborative Innovation in Geographical Information Resource Development and Application Nanjing, Nanjing, China
| | - Danan Gu
- United Nations Population Division, Two UN Plaza, New York, NY DC2-1910 USA
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Xu H, Vorderstrasse AA, McConnell ES, Dupre ME, Østbye T, Wu B. Migration and cognitive function: a conceptual framework for Global Health Research. Glob Health Res Policy 2018; 3:34. [PMID: 30519639 PMCID: PMC6267896 DOI: 10.1186/s41256-018-0088-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 11/01/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Migration is a fundamental demographic process that has been observed globally. It is suggested that migration is an issue of global health importance that can have an immediate and lasting impact on an individual's health and well-being. There is now an increasing body of evidence linking migration with cognitive function in older adults. In this paper, we synthesized the current evidence to develop a general conceptual framework to understand the factors contributing to the association between migration and cognitive function. METHODS A comprehensive review of the literature was conducted on the associations between migration and cognition among middle-aged and older adults. RESULTS Five potential mechanisms were identified from the literature: 1) socioeconomic status-including education, occupation, and income; 2) psychosocial factors-including social networks, social support, social stressors, and discrimination; 3) behavioral factors-including smoking, drinking, and health service utilization; 4) physical and psychological health status-including chronic conditions, physical function, and depression; and 5) environmental factors-including both physical and social environment. Several underlying factors were also identified-including early-life conditions, gender, and genetic factors. CONCLUSIONS The factors linking migration and cognitive function are multidimensional and complex. This conceptual framework highlights potential implications for global health policies and planning on healthy aging and migrant health. Additional studies are needed to further examine these mechanisms to extend and refine our general conceptual framework.
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Affiliation(s)
- Hanzhang Xu
- 1School of Nursing, Duke University, Durham, NC USA
- 2Department of Community and Family Medicine, Duke University, Durham, NC USA
| | | | - Eleanor S McConnell
- 1School of Nursing, Duke University, Durham, NC USA
- 4Geriatric Research, Education and Clinical Center, Durham Department of Veterans Affairs Healthcare System, Durham, NC USA
| | - Matthew E Dupre
- 5Department of Population Health Sciences, Duke University, Durham, NC USA
- 6Duke Clinical Research Institute, Duke University, Durham, NC USA
- 7Department of Sociology, Duke University, Durham, NC USA
| | - Truls Østbye
- 1School of Nursing, Duke University, Durham, NC USA
- 2Department of Community and Family Medicine, Duke University, Durham, NC USA
- 6Duke Clinical Research Institute, Duke University, Durham, NC USA
- 8Duke Global Health Institute, Duke University, Durham, NC USA
| | - Bei Wu
- 3New York University Rory Meyers College of Nursing, New York, NY USA
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27
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Hansen SM, Hansen CM, Fordyce CB, Dupre ME, Monk L, Tyson C, Torp-Pedersen C, McNally B, Vellano K, Jollis J, Granger CB. Association Between Driving Distance From Nearest Fire Station and Survival of Out-of-Hospital Cardiac Arrest. J Am Heart Assoc 2018; 7:e008771. [PMID: 30571383 PMCID: PMC6404193 DOI: 10.1161/jaha.118.008771] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Firefighter first responders dispatched in parallel with emergency medical services (EMS) personnel for out‐of‐hospital cardiac arrests (OHCA) can provide early defibrillation to improve survival. We examined whether survival following first responder defibrillation differed according to driving distance from nearest fire station to OHCA site. Methods and Results From the CARES (Cardiac Arrest Registry to Enhance Survival) registry, we identified non‐EMS witnessed OHCAs of presumed cardiac cause from 2010 to 2014 in Durham, Mecklenburg, and Wake counties, North Carolina. We used logistic regression to estimate the association between calculated driving distances (≤1, 1–1.5, 1.5–2, and >2 miles) and survival to hospital discharge following first responder defibrillation compared with defibrillation by EMS personnel. In total, 5020 OHCAs were included in the study. First responders more often applied the first automated external defibrillators at the shortest distances (≤1 mile) versus longest distances (>2 miles) (53.4% versus 46.6%, respectively, P<0.001). When compared with EMS defibrillation, first responder defibrillation within 1 mile and 1 to 1.5 miles of the nearest fire station was associated with increased survival to hospital discharge (odds ratio 2.01 [95% confidence interval 1.46–2.78] and odds ratio 1.61 [95% confidence interval 1.10–2.35], respectively). However, at the longest distances (1.5–2.0 and >2.0 miles), survival following first responder defibrillation did not differ from EMS defibrillation (odds ratio 0.77 [95% confidence interval 0.48–1.21] and odds ratio 0.97 [95% confidence interval 0.67–1.41], respectively). Conclusions Shorter driving distance from nearest fire station to OHCA location was associated with improved survival following defibrillation by first responders. These results suggest that the location of first responder units should be considered when organizing prehospital systems of OHCA care.
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Affiliation(s)
- Steen M Hansen
- 1 Duke Clinical Research Institute Duke University Durham NC.,3 Department of Clinical Epidemiology Aalborg University Hospital Aalborg Denmark
| | | | - Christopher B Fordyce
- 4 Division of Cardiology University of British Columbia Vancouver British Columbia Canada
| | - Matthew E Dupre
- 1 Duke Clinical Research Institute Duke University Durham NC.,2 Department of Population Health Sciences Duke University Durham NC
| | - Lisa Monk
- 1 Duke Clinical Research Institute Duke University Durham NC
| | - Clark Tyson
- 1 Duke Clinical Research Institute Duke University Durham NC
| | | | - Bryan McNally
- 5 Emory University School of Medicine Atlanta GA.,6 Rollins School of Public Health Emory University Atlanta GA
| | | | - James Jollis
- 1 Duke Clinical Research Institute Duke University Durham NC
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Xu H, Østbye T, Dupre ME, Vorderstrasse AA, McConnell ES, Wu B. GENDER DIFFERENCES IN THE ASSOCIATION BETWEEN MIGRATION AND COGNITION: A CROSS-COUNTRY COMPARISON. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- H Xu
- Duke University, DURHAM, North Carolina, United States
| | - T Østbye
- Department of Community and Family Medicine, Duke University, Durham, NC, USA; School of Nursing, Duke University, Durham, NC, USA; Duke Global Health Institute, Duke University, Durham, NC, USA
| | - M E Dupre
- Department of Population Health Sciences, Duke University, Durham, NC, USA; Duke Clinical Research Institute, Duke University, Durham, NC, USA; Department of Sociology, Duke University, Durham, NC, USA
| | - A A Vorderstrasse
- New York University Rory Meyers College of Nursing, New York, NY, USA
| | - E S McConnell
- School of Nursing, Duke University, Durham, NC, USA; Geriatric Research, Education and Clinical Center, Durham Department of Veterans Affairs Healthcare System, Durham, NC, USA
| | - B Wu
- New York University Rory Meyers College of Nursing, New York, NY, USA
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Abstract
OBJECTIVES To assess the association between rural and urban residential mobility and cognitive function among middle-aged and older adults in China. METHOD We used data from the World Health Organization Study on global AGEing and adult health that included adults age 50+ from China ( N = 12,410). We used multivariate linear regressions to examine how residential mobility and age at migration were associated with cognitive function. RESULTS Urban and urban-to-urban residents had the highest level of cognitive function, whereas rural and rural-to-rural residents had the poorest cognitive function. Persons who migrated to/within rural areas before age 20 had poorer cognitive function than those who migrated during later adulthood. Socioeconomic factors played a major role in accounting for the disparities in cognition; however, the association remained significant after inclusion of all covariates. DISCUSSION Residential mobility and age at migration have significant implications for cognitive function among middle-aged and older adults in China.
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Affiliation(s)
- Hanzhang Xu
- 1 School of Nursing, Duke University, Durham, NC, USA.,2 Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Matthew E Dupre
- 3 Department of Population Health Sciences, Duke University, Durham, NC, USA.,4 Department of Sociology, Duke University, Durham, NC, USA.,5 Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Truls Østbye
- 1 School of Nursing, Duke University, Durham, NC, USA.,2 Duke Global Health Institute, Duke University, Durham, NC, USA.,5 Duke Clinical Research Institute, Duke University, Durham, NC, USA.,6 Department of Community and Family Medicine, Duke University, Durham, NC, USA
| | | | - Bei Wu
- 7 New York University Rory Meyers College of Nursing, New York City, NY, USA
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Dupre ME, Xu H, Granger BB, Lynch SM, Nelson A, Churchill E, Willis JM, Curtis LH, Peterson ED. Access to routine care and risks for 30-day readmission in patients with cardiovascular disease. Am Heart J 2018; 196:9-17. [PMID: 29421019 PMCID: PMC5919257 DOI: 10.1016/j.ahj.2017.10.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 10/02/2017] [Indexed: 01/19/2023]
Abstract
BACKGROUND Studies have shown that access to routine medical care is associated with the prevention, diagnosis, and treatment of chronic diseases. However, studies have not examined whether patient-reported difficulties in access to care are associated with rehospitalization in patients with cardiovascular disease. METHODS Electronic medical records and a standardized survey were used to examine cardiovascular patients admitted to a large medical center from January 1, 2015 through January 10, 2017 (n=520). All-cause readmission within 30 days of discharge was the primary outcome for analysis. Logistic regression models were used to examine the association between access to care and 30-day readmission while adjusting for patient demographics, socioeconomic status, healthcare utilization, and health status. RESULTS Nearly 1-in-6 patients (15.7%) reported difficulty in accessing routine medical care; and those who were younger, male, non-white, uninsured, with heart failure, and had low social support were significantly more likely to report difficulty. Patients who reported difficulty in accessing care had significantly higher rates of 30-day readmission than patients who did not report difficulty (33.3% vs. 17.9%; P=.001); and the risks remained largely unchanged after accounting for nearly two dozen covariates (unadjusted odds ratio [OR]=2.29; 95% CI, 1.46-3.60 vs. adjusted OR=2.17; 95% CI, 1.29-3.66). Risks for readmission were especially high for patients who reported issues with transportation (OR=3.24; 95% CI, 1.28-8.16) and scheduling appointments (OR=3.56; 95% CI, 1.43-8.84), but not for other reasons (OR=1.47; 95% CI, 0.61-3.54). CONCLUSIONS Cardiovascular patients who reported difficulty in accessing routine care had substantial risks of readmission within 30 days after discharge. These findings have important implications for identifying high-risk patients and developing interventions to improve access to routine medical care.
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Affiliation(s)
- Matthew E Dupre
- Duke Clinical Research Institute, Duke University, Durham, NC; Department of Population Health Sciences, Duke University, Durham, NC; Department of Sociology, Duke University, Durham, NC.
| | - Hanzhang Xu
- Duke School of Nursing, Duke University Medical Center, Durham, NC
| | - Bradi B Granger
- Duke School of Nursing, Duke University Medical Center, Durham, NC
| | - Scott M Lynch
- Department of Sociology, Duke University, Durham, NC
| | - Alicia Nelson
- Department of Population Health Sciences, Duke University, Durham, NC
| | - Erik Churchill
- Duke Office of Clinical Research, Duke University Medical Center, Durham, NC
| | - Janese M Willis
- Department of Population Health Sciences, Duke University, Durham, NC
| | - Lesley H Curtis
- Duke Clinical Research Institute, Duke University, Durham, NC; Department of Population Health Sciences, Duke University, Durham, NC
| | - Eric D Peterson
- Duke Clinical Research Institute, Duke University, Durham, NC; Department of Medicine, Division of Cardiology, Duke University, Durham, NC
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Dupre ME, Gu D, Xu H, Willis J, Curtis LH, Peterson ED. Racial and Ethnic Differences in Trajectories of Hospitalization in US Men and Women With Heart Failure. J Am Heart Assoc 2017; 6:e006290. [PMID: 29146613 PMCID: PMC5721744 DOI: 10.1161/jaha.117.006290] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 09/28/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Prior studies have documented racial and ethnic disparities in hospitalization among patients with heart failure (HF). However, racial/ethnic differences in trajectories of hospitalization following the diagnosis of HF have not been well characterized. This study examined racial/ethnic differences in individual-level trajectories of hospitalization in older adults with diagnosed HF. METHODS AND RESULTS Data from a nationally representative prospective cohort of US men and women aged 45 years and older were used to examine the number of hospitalizations reported every 24 months. Participants who were non-Hispanic white, non-Hispanic black, and Hispanic with a reported diagnosis of HF (n=3011) were followed from 1998 to 2014. Results showed a quadratic change in the number of reported hospitalizations following HF diagnosis, with an average of 2.36 (95% confidence interval [CI], 2.19-2.53; P<0.001) hospitalizations within 24 months that decreased by 0.35 (95% CI, -0.45 to -0.25; P<0.001) every 24 months and subsequently increased by 0.03 (95% CI, 0.02-0.05; P<0.001) thereafter. In men, there were no racial/ethnic differences in hospitalizations reported at the time of diagnosis; however, Hispanic men had significant declines in hospitalizations after diagnosis (Hispanic×time=-0.52; 95% CI, -0.99 to -0.05 [P=0.031]) followed by a sizeable increase in hospitalizations at later stages of disease (Hispanic×time2=0.06; 95% CI, 0.00-0.12 [P=0.047]). In women, hospitalizations were consistently high following their diagnosis and black women had significantly more hospitalizations throughout follow-up than white women (black=0.28; 95% CI, 0.00-0.55 [P=0.048]). Racial/ethnic disparities varied by geography and the differences remained significant after adjusting for multiple sociodemographic, psychosocial, behavioral, and physiological factors. CONCLUSIONS There were significant racial/ethnic differences in trajectories of hospitalization following the diagnosis of HF in US men and women. Racial/ethnic disparities varied by place of residence and the differences persisted after adjustment for multiple risk factors. The findings have important implications that may be crucial to planning the immediate and long-term delivery of care in patients with HF to reduce potentially preventable hospitalizations.
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Affiliation(s)
- Matthew E Dupre
- Duke Clinical Research Institute, Duke University, Durham, NC
- Department of Population Health Sciences, Duke University, Durham, NC
- Department of Sociology, Duke University, Durham, NC
| | - Danan Gu
- Population Division, United Nations, New York, NY
| | - Hanzhang Xu
- Duke School of Nursing, Duke University Medical Center, Durham, NC
| | - Janese Willis
- Department of Community and Family Medicine, Duke University, Durham, NC
| | - Lesley H Curtis
- Duke Clinical Research Institute, Duke University, Durham, NC
- Department of Population Health Sciences, Duke University, Durham, NC
| | - Eric D Peterson
- Duke Clinical Research Institute, Duke University, Durham, NC
- Division of Cardiology, Department of Medicine, Duke University, Durham, NC
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32
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Dupre ME, Nelson A, Lynch SM, Granger BB, Xu H, Churchill E, Willis JM, Curtis LH, Peterson ED. Socioeconomic, Psychosocial and Behavioral Characteristics of Patients Hospitalized With Cardiovascular Disease. Am J Med Sci 2017; 354:565-572. [PMID: 29208253 DOI: 10.1016/j.amjms.2017.07.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 06/13/2017] [Accepted: 07/24/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Recent studies have drawn attention to nonclinical factors to better understand disparities in the development, treatment and prognosis of patients with cardiovascular disease. However, there has been limited research describing the nonclinical characteristics of patients hospitalized for cardiovascular care. METHODS Data for this study come from 520 patients admitted to the Duke Heart Center from January 1, 2015 through January 10, 2017. Electronic medical records and a standardized survey administered before discharge were used to ascertain detailed information on patients' demographic (age, sex, race, marital status and living arrangement), socioeconomic (education, employment and health insurance), psychosocial (health literacy, health self-efficacy, social support, stress and depressive symptoms) and behavioral (smoking, drinking and medication adherence) attributes. RESULTS Study participants were of a median age of 65 years, predominantly male (61.4%), non-Hispanic white (67.1%), hospitalized for 5.11 days and comparable to all patients admitted during this period. Results from the survey showed significant heterogeneity among patients in their demographic, socioeconomic and behavioral characteristics. We also found that the patients' levels of psychosocial risks and resources were significantly associated with many of these nonclinical characteristics. Patients who were older, women, nonwhite and unmarried had generally lower levels of health literacy, self-efficacy and social support, and higher levels of stress and depressive symptoms than their counterparts. CONCLUSIONS Patients hospitalized with cardiovascular disease have diverse nonclinical profiles that have important implications for targeting interventions. A better understanding of these characteristics will enhance the personalized delivery of care and improve outcomes in vulnerable patient groups.
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Affiliation(s)
- Matthew E Dupre
- Duke Clinical Research Institute, Duke University, Durham, North Carolina; Department of Population Health Sciences, Duke University, Durham, North Carolina; Department of Sociology, Duke University, Durham, North Carolina.
| | - Alicia Nelson
- Department of Community and Family Medicine, Duke University, Durham, North Carolina
| | - Scott M Lynch
- Department of Sociology, Duke University, Durham, North Carolina
| | - Bradi B Granger
- Duke School of Nursing, Duke University Medical Center, Durham, North Carolina
| | - Hanzhang Xu
- Duke School of Nursing, Duke University Medical Center, Durham, North Carolina
| | - Erik Churchill
- Duke Office of Clinical Research, Duke University Medical Center, Durham, North Carolina
| | - Janese M Willis
- Department of Community and Family Medicine, Duke University, Durham, North Carolina
| | - Lesley H Curtis
- Duke Clinical Research Institute, Duke University, Durham, North Carolina; Department of Population Health Sciences, Duke University, Durham, North Carolina
| | - Eric D Peterson
- Duke Clinical Research Institute, Duke University, Durham, North Carolina; Department of Medicine, Duke University, Durham, North Carolina
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Zhang X, Dupre ME, Qiu L, Zhou W, Zhao Y, Gu D. Urban-rural differences in the association between access to healthcare and health outcomes among older adults in China. BMC Geriatr 2017; 17:151. [PMID: 28724355 PMCID: PMC5516359 DOI: 10.1186/s12877-017-0538-9] [Citation(s) in RCA: 118] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 07/06/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Studies have shown that inadequate access to healthcare is associated with lower levels of health and well-being in older adults. Studies have also shown significant urban-rural differences in access to healthcare in developing countries such as China. However, there is limited evidence of whether the association between access to healthcare and health outcomes differs by urban-rural residence at older ages in China. METHODS Four waves of data (2005, 2008/2009, 2011/2012, and 2014) from the largest national longitudinal survey of adults aged 65 and older in mainland China (n = 26,604) were used for analysis. The association between inadequate access to healthcare (y/n) and multiple health outcomes were examined-including instrumental activities of daily living (IADL) disability, ADL disability, cognitive impairment, and all-cause mortality. A series of multivariate models were used to obtain robust estimates and to account for various covariates associated with access to healthcare and/or health outcomes. All models were stratified by urban-rural residence. RESULTS Inadequate access to healthcare was significantly higher among older adults in rural areas than in urban areas (9.1% vs. 5.4%; p < 0.01). Results from multivariate models showed that inadequate access to healthcare was associated with significantly higher odds of IADL disability in older adults living in urban areas (odds ratio [OR] = 1.58-1.79) and rural areas (OR = 1.95-2.30) relative to their counterparts with adequate access to healthcare. In terms of ADL disability, we found significant increases in the odds of disability among rural older adults (OR = 1.89-3.05) but not among urban older adults. Inadequate access to healthcare was also associated with substantially higher odds of cognitive impairment in older adults from rural areas (OR = 2.37-3.19) compared with those in rural areas with adequate access to healthcare; however, no significant differences in cognitive impairment were found among older adults in urban areas. Finally, we found that inadequate access to healthcare increased overall mortality risks in older adults by 33-37% in urban areas and 28-29% in rural areas. However, the increased risk of mortality in urban areas was not significant after taking into account health behaviors and baseline health status. CONCLUSIONS Inadequate access to healthcare was significantly associated with higher rates of disability, cognitive impairment, and all-cause mortality among older adults in China. The associations between access to healthcare and health outcomes were generally stronger among older adults in rural areas than in urban areas. Our findings underscore the importance of providing adequate access to healthcare for older adults-particularly for those living in rural areas in developing countries such as China.
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Affiliation(s)
- Xufan Zhang
- Ginling College & International Center for Aging and Health, Nanjing Normal University, Nanjing, China
| | - Matthew E Dupre
- Duke Clinical Research Institute & Department of Sociology, Duke University, Durham, NC, USA
| | - Li Qiu
- Independent Researcher, New York, NY, USA
| | - Wei Zhou
- Ginling College & International Center for Aging and Health, Nanjing Normal University, Nanjing, China
| | - Yuan Zhao
- Ginling College, School of Geography Science & International Center for Aging and Health and Nanjing Normal University, Nanjing, China
| | - Danan Gu
- United Nations Population Division, Two UN Plaza, New York, NY, DC2-1910, USA.
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Dupre ME, Nelson A, Lynch SM, Granger BB, Xu H, Willis JM, Curtis LH, Peterson ED. Identifying Nonclinical Factors Associated With 30-Day Readmission in Patients with Cardiovascular Disease: Protocol for an Observational Study. JMIR Res Protoc 2017; 6:e118. [PMID: 28619703 PMCID: PMC5491895 DOI: 10.2196/resprot.7434] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 04/18/2017] [Accepted: 05/05/2017] [Indexed: 12/17/2022] Open
Abstract
Background Cardiovascular disease (CVD) is the leading cause of hospitalization in older adults and high readmission rates have attracted considerable attention as actionable targets to promote efficiency in care and to reduce costs. Despite a plethora of research over the past decade, current strategies to predict readmissions have been largely ineffective and efforts to identify novel clinical predictors have been largely unsuccessful. Objective The objective of this study is to examine a wide array of socioeconomic, psychosocial, behavioral, and clinical factors to predict risks of 30-day hospital readmission in cardiovascular patients. Methods The study includes patients (aged 18 years and older) admitted for the treatment of cardiovascular-related illnesses at the Duke Heart Center, which is among the nation’s largest and top-ranked cardiovascular care hospitals. The study uses a novel standardized survey to ascertain data on a comprehensive array of patient characteristics that will be linked to their electronic medical records. A series of univariate and multivariate models will be used to estimate the associations between the patient-level factors and 30-day readmissions. The performance of the risk models will be examined based on 2 components of accuracy—model calibration and discrimination—to determine how closely the predicted outcome agrees with the observed (actual) outcome and how well the model distinguishes patients who were readmitted and those who were not. The purpose of this paper is to present the protocol for the implementation of this study. Results The study was launched in February 2014 and is actively recruiting patients from the Heart Center. Approximately 550 patients have been enrolled to date and the study is expected to continue recruitment until February 2018. Preliminary results show that participants in the study were aged 63.6 years on average (SD 14.0), predominately male (61.2%), and primarily non-Hispanic white (64.6%) or non-Hispanic black (31.7%). The demographic characteristics of study participants were not significantly different from all patients admitted to the Heart Center during this period with an average age of 65.0 years (SD 15.3) and predominately male (58.6%), non-Hispanic white (62.9%) or non-Hispanic black (31.8%) The integration of the interview data with clinical data from the patient electronic medical records is currently underway. The study has received funding and ethical approval. Conclusions Many US hospitals continue to struggle with high readmission rates in patients with cardiovascular disease. The primary objective of this study is to collect and integrate a comprehensive array of patient attributes to develop a powerful yet parsimonious model to stratify risks of rehospitalization in cardiovascular patients. The results of this research also have the potential to identify actionable targets for tailored interventions to improve patient outcomes.
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Affiliation(s)
- Matthew E Dupre
- Duke Clinical Research Institute, Duke University, Durham, NC, United States.,Department of Sociology, Duke University, Durham, NC, United States.,Department of Community and Family Medicine, Duke University, Durham, NC, United States
| | - Alicia Nelson
- Department of Community and Family Medicine, Duke University, Durham, NC, United States
| | - Scott M Lynch
- Department of Sociology, Duke University, Durham, NC, United States
| | - Bradi B Granger
- Duke University School of Nursing, Duke University, Durham, NC, United States
| | - Hanzhang Xu
- Duke University School of Nursing, Duke University, Durham, NC, United States
| | - Janese M Willis
- Department of Community and Family Medicine, Duke University, Durham, NC, United States
| | - Lesley H Curtis
- Duke Clinical Research Institute, Duke University, Durham, NC, United States
| | - Eric D Peterson
- Duke Clinical Research Institute, Duke University, Durham, NC, United States
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Zhao Y, Dupre ME, Qiu L, Gu D. Changes in perceived uselessness and risks for mortality: evidence from a National sample of older adults in China. BMC Public Health 2017; 17:561. [PMID: 28599631 PMCID: PMC5466746 DOI: 10.1186/s12889-017-4479-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 05/30/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Self-perception of uselessness is associated with increased mortality risk in older adults. However, it is unknown whether and to what extent changes in perceived uselessness are associated with mortality risk. METHODS Using four waves of national longitudinal data of older adults from China (2005, 2008, 2011, and 2014), this study examines the association between changes in perceived uselessness and risk of subsequent mortality. Perceived uselessness is classified into three major categories: high levels (always/often), moderate levels (sometimes), and low levels (seldom/never). Five categories are used to measure change over three-year intervals: (1) persistently high levels, (2) increases to moderate/high levels, (3) persistent moderate levels, (4) decreases to moderate/low levels, and (5) persistently low levels. Cox proportional hazard models were used to estimate mortality risk associated with changes in levels of perceived uselessness. RESULTS Compared to those with persistently low levels of perceived uselessness, those with persistently high levels of feeling useless had 80% increased hazard ratio (HR) in mortality [HR =1.80, 95% CIs: 1.57-2.08, p < 0.001]; and those with increasing levels, persistently moderate levels, and decreasing levels of perceived uselessness had 42% [HR = 1.42, 95% CIs: 1.27-159, p < 0.001], 50% [HR = 1.50, 95% CIs: 1.32-1.71, p < 0.001], and 23% [HR = 1.23, 95% CIs: 1.09-1.37, p < 0.001] increased hazard ratio in mortality, respectively, when background characteristics were taken into account. The associations were partially attenuated when socioeconomic, family/social support, behavioral, and health-related covariates were individually taken into account. Older adults with persistently high and moderate levels of perceived uselessness still exhibited significantly higher risks of mortality (16% [HR = 1.16, 95% CIs: 1.00-1.135, p < 0.05] and 22% [HR = 1.16, 95% CIs: 1.06-1.139, p < 0.015], respectively) after adjusting for all covariates, although no significant mortality risks were found for either increasing to moderate/high levels or decreasing to moderate/low levels of perceived uselessness. CONCLUSIONS Persistently high and moderate levels of perceived uselessness are associated with significant increases in mortality risk. These findings have important implications for promoting successful aging in China.
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Affiliation(s)
- Yuan Zhao
- International Center for Aging and Health, Ginling College and School of Geography Science, Nanjing Normal University, Nanjing, China
| | - Matthew E Dupre
- Duke Clinical Research Institute & Department of Sociology, Duke University, Durham, NC, USA
| | - Li Qiu
- New York, New York, NY, USA
| | - Danan Gu
- United Nations Population Division, Two UN Plaza, DC2, New York, NY, -1910, USA.
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Kragholm K, Malta Hansen C, Dupre ME, Xian Y, Strauss B, Tyson C, Monk L, Corbett C, Fordyce CB, Pearson DA, Fosbøl EL, Jollis JG, Abella BS, McNally B, Granger CB. Direct Transport to a Percutaneous Cardiac Intervention Center and Outcomes in Patients With Out-of-Hospital Cardiac Arrest. Circ Cardiovasc Qual Outcomes 2017; 10:CIRCOUTCOMES.116.003414. [DOI: 10.1161/circoutcomes.116.003414] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 05/02/2017] [Indexed: 01/13/2023]
Affiliation(s)
- Kristian Kragholm
- From the Duke Clinical Research Institute, Durham, NC (K.K., C.M.H., M.E.D., Y.X., C.T., L.M., C.B.F., E.L.F., J.G.J., C.B.G.); Departments of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (K.K.); Department of Community and Family Medicine (M.E.D.), Nicholas School of the Environment (B.S.), Duke University, Durham, NC; Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.); Center for Educational Excellence, Durham, NC (C.T.); New Hanover
| | - Carolina Malta Hansen
- From the Duke Clinical Research Institute, Durham, NC (K.K., C.M.H., M.E.D., Y.X., C.T., L.M., C.B.F., E.L.F., J.G.J., C.B.G.); Departments of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (K.K.); Department of Community and Family Medicine (M.E.D.), Nicholas School of the Environment (B.S.), Duke University, Durham, NC; Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.); Center for Educational Excellence, Durham, NC (C.T.); New Hanover
| | - Matthew E. Dupre
- From the Duke Clinical Research Institute, Durham, NC (K.K., C.M.H., M.E.D., Y.X., C.T., L.M., C.B.F., E.L.F., J.G.J., C.B.G.); Departments of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (K.K.); Department of Community and Family Medicine (M.E.D.), Nicholas School of the Environment (B.S.), Duke University, Durham, NC; Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.); Center for Educational Excellence, Durham, NC (C.T.); New Hanover
| | - Ying Xian
- From the Duke Clinical Research Institute, Durham, NC (K.K., C.M.H., M.E.D., Y.X., C.T., L.M., C.B.F., E.L.F., J.G.J., C.B.G.); Departments of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (K.K.); Department of Community and Family Medicine (M.E.D.), Nicholas School of the Environment (B.S.), Duke University, Durham, NC; Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.); Center for Educational Excellence, Durham, NC (C.T.); New Hanover
| | - Benjamin Strauss
- From the Duke Clinical Research Institute, Durham, NC (K.K., C.M.H., M.E.D., Y.X., C.T., L.M., C.B.F., E.L.F., J.G.J., C.B.G.); Departments of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (K.K.); Department of Community and Family Medicine (M.E.D.), Nicholas School of the Environment (B.S.), Duke University, Durham, NC; Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.); Center for Educational Excellence, Durham, NC (C.T.); New Hanover
| | - Clark Tyson
- From the Duke Clinical Research Institute, Durham, NC (K.K., C.M.H., M.E.D., Y.X., C.T., L.M., C.B.F., E.L.F., J.G.J., C.B.G.); Departments of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (K.K.); Department of Community and Family Medicine (M.E.D.), Nicholas School of the Environment (B.S.), Duke University, Durham, NC; Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.); Center for Educational Excellence, Durham, NC (C.T.); New Hanover
| | - Lisa Monk
- From the Duke Clinical Research Institute, Durham, NC (K.K., C.M.H., M.E.D., Y.X., C.T., L.M., C.B.F., E.L.F., J.G.J., C.B.G.); Departments of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (K.K.); Department of Community and Family Medicine (M.E.D.), Nicholas School of the Environment (B.S.), Duke University, Durham, NC; Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.); Center for Educational Excellence, Durham, NC (C.T.); New Hanover
| | - Claire Corbett
- From the Duke Clinical Research Institute, Durham, NC (K.K., C.M.H., M.E.D., Y.X., C.T., L.M., C.B.F., E.L.F., J.G.J., C.B.G.); Departments of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (K.K.); Department of Community and Family Medicine (M.E.D.), Nicholas School of the Environment (B.S.), Duke University, Durham, NC; Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.); Center for Educational Excellence, Durham, NC (C.T.); New Hanover
| | - Christopher B. Fordyce
- From the Duke Clinical Research Institute, Durham, NC (K.K., C.M.H., M.E.D., Y.X., C.T., L.M., C.B.F., E.L.F., J.G.J., C.B.G.); Departments of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (K.K.); Department of Community and Family Medicine (M.E.D.), Nicholas School of the Environment (B.S.), Duke University, Durham, NC; Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.); Center for Educational Excellence, Durham, NC (C.T.); New Hanover
| | - David A. Pearson
- From the Duke Clinical Research Institute, Durham, NC (K.K., C.M.H., M.E.D., Y.X., C.T., L.M., C.B.F., E.L.F., J.G.J., C.B.G.); Departments of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (K.K.); Department of Community and Family Medicine (M.E.D.), Nicholas School of the Environment (B.S.), Duke University, Durham, NC; Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.); Center for Educational Excellence, Durham, NC (C.T.); New Hanover
| | - Emil L. Fosbøl
- From the Duke Clinical Research Institute, Durham, NC (K.K., C.M.H., M.E.D., Y.X., C.T., L.M., C.B.F., E.L.F., J.G.J., C.B.G.); Departments of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (K.K.); Department of Community and Family Medicine (M.E.D.), Nicholas School of the Environment (B.S.), Duke University, Durham, NC; Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.); Center for Educational Excellence, Durham, NC (C.T.); New Hanover
| | - James G. Jollis
- From the Duke Clinical Research Institute, Durham, NC (K.K., C.M.H., M.E.D., Y.X., C.T., L.M., C.B.F., E.L.F., J.G.J., C.B.G.); Departments of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (K.K.); Department of Community and Family Medicine (M.E.D.), Nicholas School of the Environment (B.S.), Duke University, Durham, NC; Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.); Center for Educational Excellence, Durham, NC (C.T.); New Hanover
| | - Benjamin S. Abella
- From the Duke Clinical Research Institute, Durham, NC (K.K., C.M.H., M.E.D., Y.X., C.T., L.M., C.B.F., E.L.F., J.G.J., C.B.G.); Departments of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (K.K.); Department of Community and Family Medicine (M.E.D.), Nicholas School of the Environment (B.S.), Duke University, Durham, NC; Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.); Center for Educational Excellence, Durham, NC (C.T.); New Hanover
| | - Bryan McNally
- From the Duke Clinical Research Institute, Durham, NC (K.K., C.M.H., M.E.D., Y.X., C.T., L.M., C.B.F., E.L.F., J.G.J., C.B.G.); Departments of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (K.K.); Department of Community and Family Medicine (M.E.D.), Nicholas School of the Environment (B.S.), Duke University, Durham, NC; Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.); Center for Educational Excellence, Durham, NC (C.T.); New Hanover
| | - Christopher B. Granger
- From the Duke Clinical Research Institute, Durham, NC (K.K., C.M.H., M.E.D., Y.X., C.T., L.M., C.B.F., E.L.F., J.G.J., C.B.G.); Departments of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (K.K.); Department of Community and Family Medicine (M.E.D.), Nicholas School of the Environment (B.S.), Duke University, Durham, NC; Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.); Center for Educational Excellence, Durham, NC (C.T.); New Hanover
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Xu H, Dupre ME, Gu D, Wu B. The impact of residential status on cognitive decline among older adults in China: Results from a longitudinal study. BMC Geriatr 2017; 17:107. [PMID: 28506252 PMCID: PMC5430605 DOI: 10.1186/s12877-017-0501-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 05/09/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Residential status has been linked to numerous determinants of health and well-being. However, the influence of residential status on cognitive decline remains unclear. The purpose of this research was to assess the changes of cognitive function among older adults with different residential status (urban residents, rural-to-urban residents, rural residents, and urban-to-rural residents), over a 12-year period. METHODS We used five waves of data (2002, 2005, 2008/2009, 2011/2012, and 2014) from the Chinese Longitudinal Healthy Longevity Survey with 17,333 older adults age 65 and over who were interviewed up to five times. Cognitive function was measured by the Mini Mental State Examination (MMSE). Multilevel models were used regarding the effects of residential status after adjusting for demographic characteristics, socioeconomic factors, family support, health behaviors, and health status. RESULTS After controlling for covariates, significant differences in cognitive function were found across the four groups: rural-to-urban and rural residents had a higher level of cognition than urban residents at baseline. On average, cognitive function decreased over the course of the study period. Rural-to-urban and rural residents demonstrated a faster decline in cognitive function than urban residents. CONCLUSIONS This study suggests that residential status has an impact on the rate of changes in cognition among older adults in China. Results from this study provide directions for future research that addresses health disparities, particularly in countries that are undergoing significant socioeconomic transitions.
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Affiliation(s)
- Hanzhang Xu
- Duke University School of Nursing, Durham, NC USA
- Duke Global Health Institute, Duke University Medical Center, Durham, NC USA
| | - Matthew E. Dupre
- Department of Community and Family Medicine, Duke University Medical Center, Durham, NC USA
- Department of Sociology, Duke University, Durham, NC USA
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC USA
| | - Danan Gu
- United Nations Population Division, New York, NY USA
| | - Bei Wu
- New York University Rory Meyers College of Nursing, New York, NY USA
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Gu D, Dupre ME, Qiu L. Self-perception of uselessness and mortality among older adults in China. Arch Gerontol Geriatr 2017; 68:186-194. [DOI: 10.1016/j.archger.2016.10.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 10/24/2016] [Accepted: 10/29/2016] [Indexed: 01/24/2023]
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Abstract
BACKGROUND Stroke is among the leading causes of disability and death in the United States, and nearly 7 million adults are currently alive after experiencing a stroke. Although the risks associated with having a stroke are well established, we know surprisingly little about how marital status influences survival in adults with this condition. This study is the first prospective investigation of how marital history is related to survival after stroke in the United States. METHODS AND RESULTS Data from a nationally representative sample of older adults who experienced a stroke (n=2351) were used to examine whether and to what extent current marital status and past marital losses were associated with risks of dying after the onset of disease. Results showed that the risks of dying following a stroke were significantly higher among the never married (hazard ratio [HR], 1.71; 95% CI, 1.31–2.24), remarried (HR, 1.23; 95% CI, 1.06–1.44), divorced (HR, 1.23; 95% CI, 1.01–1.49), and widowed (HR, 1.25; 95% CI, 1.10–1.43) relative to those who remained continuously married. We also found that having multiple marital losses was especially detrimental to survival-regardless of current marital status and accounting for multiple socioeconomic, psychosocial, behavioral, and physiological risk factors. CONCLUSIONS Marital history is significantly associated with survival after stroke. Additional studies are needed to further examine the mechanisms contributing to the associations and to better understand how this information can be used to personalize care and aggressively treat vulnerable segments of the population.
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Affiliation(s)
- Matthew E Dupre
- Duke Clinical Research Institute, Duke University, Durham, NC
- Department of Community and Family Medicine, Duke University, Durham, NC
- Department of Sociology, Duke University, Durham, NC
| | - Renato D Lopes
- Duke Clinical Research Institute, Duke University, Durham, NC
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC
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Abstract
Heart disease is the leading cause of death in the United States and nearly one million Americans will have a heart attack this year. Although the risks associated with a heart attack are well established, we know surprisingly little about how marital factors contribute to survival in adults afflicted with heart disease. This study uses a life course perspective and longitudinal data from the Health and Retirement Study to examine how various dimensions of marital life influence survival in U.S. older adults who suffered a heart attack (n = 2197). We found that adults who were never married (odds ratio [OR] = 1.73), currently divorced (OR = 1.70), or widowed (OR = 1.34) were at significantly greater risk of dying after a heart attack than adults who were continuously married; and the risks were not uniform over time. We also found that the risk of dying increased by 12% for every additional marital loss and decreased by 7% for every one-tenth increase in the proportion of years married. After accounting for more than a dozen socioeconomic, psychosocial, behavioral, and physiological factors, we found that current marital status remained the most robust indicator of survival following a heart attack. The implications of the findings are discussed in the context of life course inequalities in chronic disease and directions for future research.
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Affiliation(s)
- Matthew E Dupre
- Department of Sociology, Duke University, Durham, NC, USA; Department of Community and Family Medicine, Duke University, Durham, NC, USA; Duke Clinical Research Institute, Duke University, Durham, NC, USA.
| | - Alicia Nelson
- Department of Community and Family Medicine, Duke University, Durham, NC, USA
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Abstract
Stroke is among the leading causes of disability and death in the United States, and racial differences are greater for stroke than for all other major chronic diseases. Considering the equally sizeable racial disparities in marital life and associated risks across adulthood, the current study hypothesizes that black-white differences in marital history play an important role in the large racial inequalities in the incidence of stroke. The major objective are to (i) demonstrate how marital history is associated with the incidence of stroke, (ii) examine how marital factors mediate and/or moderate racial disparities in stroke, and (iii) examine the factors that may explain the associations. Using retrospective and prospective data from the Health and Retirement Study (n = 23,289), the results show that non-Hispanic (NH) blacks have significantly higher rates of marital instability, greater numbers of health-risk factors, and substantially higher rates of stroke compared with NH whites. Contrary to the cumulative disadvantage hypothesis, findings from discrete-time-hazard models show that the effects of marital history are more pronounced for NH whites than for NH blacks. Risks for stroke were significantly higher in NH whites who were currently divorced, remarried, and widowed, as well as in those with a history of divorce or widowhood, compared with NH whites who were continuously married. In NH blacks, risks for stroke were elevated only in those who had either never married or had been widowed-with no significant risks attributable to divorce. The potential mechanisms underlying the associations are assessed, and the implications of the findings are discussed.
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Dupre ME, Moody J, Nelson A, Willis JM, Fuller L, Smart AJ, Easterling D, Silberberg M. Place-Based Initiatives to Improve Health in Disadvantaged Communities: Cross-Sector Characteristics and Networks of Local Actors in North Carolina. Am J Public Health 2016; 106:1548-55. [PMID: 27459443 DOI: 10.2105/ajph.2016.303265] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To examine the leadership attributes and collaborative connections of local actors from the health sector and those outside the health sector in a major place-based health initiative. METHODS We used survey data from 340 individuals in 4 Healthy Places North Carolina counties from 2014 to assess the leadership attributes (awareness, attitudes, and capacity) and network connections of local actors by their organizational sector. RESULTS Respondents' leadership attributes-scored on 5-point Likert scales-were similar across Healthy Places North Carolina counties. Although local actors reported high levels of awareness and collaboration around community health improvement, we found lower levels of capacity for connecting diversity, identifying barriers, and using resources in new ways to improve community health. Actors outside the health sector had generally lower levels of capacity than actors in the health sector. Those in the health sector exhibited the majority of network ties in their community; however, they were also the most segregated from actors in other sectors. CONCLUSIONS More capacity building around strategic action-particularly in nonhealth sectors-is needed to support efforts in making widespread changes to community health.
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Affiliation(s)
- Matthew E Dupre
- Matthew E. Dupre, Alicia Nelson, Janese M. Willis, and Mina Silberberg are with the Department of Community and Family Medicine, Division of Community Health, Duke University, Durham, NC. James Moody is with the Department of Sociology, Duke University. Lori Fuller and Allen J. Smart are with Kate B. Reynolds Charitable Trust, Winston-Salem, NC. Doug Easterling is with the Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem
| | - James Moody
- Matthew E. Dupre, Alicia Nelson, Janese M. Willis, and Mina Silberberg are with the Department of Community and Family Medicine, Division of Community Health, Duke University, Durham, NC. James Moody is with the Department of Sociology, Duke University. Lori Fuller and Allen J. Smart are with Kate B. Reynolds Charitable Trust, Winston-Salem, NC. Doug Easterling is with the Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem
| | - Alicia Nelson
- Matthew E. Dupre, Alicia Nelson, Janese M. Willis, and Mina Silberberg are with the Department of Community and Family Medicine, Division of Community Health, Duke University, Durham, NC. James Moody is with the Department of Sociology, Duke University. Lori Fuller and Allen J. Smart are with Kate B. Reynolds Charitable Trust, Winston-Salem, NC. Doug Easterling is with the Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem
| | - Janese M Willis
- Matthew E. Dupre, Alicia Nelson, Janese M. Willis, and Mina Silberberg are with the Department of Community and Family Medicine, Division of Community Health, Duke University, Durham, NC. James Moody is with the Department of Sociology, Duke University. Lori Fuller and Allen J. Smart are with Kate B. Reynolds Charitable Trust, Winston-Salem, NC. Doug Easterling is with the Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem
| | - Lori Fuller
- Matthew E. Dupre, Alicia Nelson, Janese M. Willis, and Mina Silberberg are with the Department of Community and Family Medicine, Division of Community Health, Duke University, Durham, NC. James Moody is with the Department of Sociology, Duke University. Lori Fuller and Allen J. Smart are with Kate B. Reynolds Charitable Trust, Winston-Salem, NC. Doug Easterling is with the Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem
| | - Allen J Smart
- Matthew E. Dupre, Alicia Nelson, Janese M. Willis, and Mina Silberberg are with the Department of Community and Family Medicine, Division of Community Health, Duke University, Durham, NC. James Moody is with the Department of Sociology, Duke University. Lori Fuller and Allen J. Smart are with Kate B. Reynolds Charitable Trust, Winston-Salem, NC. Doug Easterling is with the Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem
| | - Doug Easterling
- Matthew E. Dupre, Alicia Nelson, Janese M. Willis, and Mina Silberberg are with the Department of Community and Family Medicine, Division of Community Health, Duke University, Durham, NC. James Moody is with the Department of Sociology, Duke University. Lori Fuller and Allen J. Smart are with Kate B. Reynolds Charitable Trust, Winston-Salem, NC. Doug Easterling is with the Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem
| | - Mina Silberberg
- Matthew E. Dupre, Alicia Nelson, Janese M. Willis, and Mina Silberberg are with the Department of Community and Family Medicine, Division of Community Health, Duke University, Durham, NC. James Moody is with the Department of Sociology, Duke University. Lori Fuller and Allen J. Smart are with Kate B. Reynolds Charitable Trust, Winston-Salem, NC. Doug Easterling is with the Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem
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Fordyce CB, Hansen CM, Kragholm K, Jollis JG, Roettig ML, Dupre ME, Becker LB, Corbett CC, Monk L, Nelson RD, Pearson DA, Tyson C, Van Diepen S, Anderson ML, McNally B, Granger CB. STATEWIDE INITIATIVES IMPROVE THE CARE AND OUTCOMES OF PATIENTS WITH OUT-OF-HOSPITAL CARDIAC ARREST AT HOME AND IN PUBLIC LOCATIONS: RESULTS FROM THE HEARTRESCUE PROJECT. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)30807-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Rao MP, Dupre ME, Pokorney SD, Hansen CM, Tyson C, Monk L, Pearson DA, Nelson RD, Myers B, Jollis JG, Granger CB. Therapeutic Hypothermia for Patients with Out-of-Hospital Cardiac Arrest in North Carolina. PREHOSP EMERG CARE 2016; 20:630-6. [DOI: 10.3109/10903127.2016.1142627] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Shin JH, Dupre ME, Østbye T, Murphy G, Silberberg M. The Relationship of Socioeconomic and Behavioral Risk Factors With Trends of Overweight in Korea. J Prev Med Public Health 2015; 48:310-8. [PMID: 26639745 PMCID: PMC4676646 DOI: 10.3961/jpmph.15.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 11/09/2015] [Indexed: 12/24/2022] Open
Abstract
Objectives: Previous studies have shown that overweight (including obesity) has increased significantly in Korea in recent decades. However, it remains unclear whether this change has been uniform among all Koreans and to what extent socioeconomic and behavioral factors have contributed to this increase. Methods: Changes in overweight were estimated using data from the 1998, 2001, 2005, 2007-2009, and 2010-2012 Korea National Health and Nutrition Examination Survey (n=55 761). Results: Overweight increased significantly among men but not among women between 1998 and 2012. Changes in socioeconomic and behavioral factors over the time period were not associated with overall trends for both men and women. However, we found significant differences in the prevalence of overweight relative to key risk factors. For men, overweight increased at a significantly greater rate among the non-exercising (predicted probability [PP] from 0.23 to 0.32] and high-calorie (PP from 0.18 to 0.37) groups compared to their active and lower-calorie counterparts, respectively. For women, overweight increased only among the non-exercising (PP from 0.27 to 0.28) and low-income (PP from 0.31 to 0.36) groups during this period. Conclusions: These findings suggest that programs aimed at reducing overweight should target Korean men and women in specific socioeconomic and behavioral risk groups differentially.
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Affiliation(s)
- Jin Hee Shin
- Department of Community and Family Medicine, Duke University Medical Center, Durham, NC, USA
| | - Matthew E Dupre
- Department of Community and Family Medicine, Duke University Medical Center, Durham, NC, USA.,Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Truls Østbye
- Department of Community and Family Medicine, Duke University Medical Center, Durham, NC, USA.,Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Gwen Murphy
- Department of Community and Family Medicine, Duke University Medical Center, Durham, NC, USA
| | - Mina Silberberg
- Department of Community and Family Medicine, Duke University Medical Center, Durham, NC, USA
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Hansen CM, Kragholm K, Granger CB, Pearson DA, Tyson C, Monk L, Corbett C, Nelson RD, Dupre ME, Fosbøl EL, Strauss B, Fordyce CB, McNally B, Jollis JG. The role of bystanders, first responders, and emergency medical service providers in timely defibrillation and related outcomes after out-of-hospital cardiac arrest: Results from a statewide registry. Resuscitation 2015; 96:303-9. [DOI: 10.1016/j.resuscitation.2015.09.002] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 08/17/2015] [Accepted: 09/08/2015] [Indexed: 10/23/2022]
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Malta Hansen C, Kragholm K, Pearson DA, Tyson C, Monk L, Myers B, Nelson D, Dupre ME, Fosbøl EL, Jollis JG, Strauss B, Anderson ML, McNally B, Granger CB. Association of Bystander and First-Responder Intervention With Survival After Out-of-Hospital Cardiac Arrest in North Carolina, 2010-2013. JAMA 2015. [PMID: 26197186 DOI: 10.1001/jama.2015.7938] [Citation(s) in RCA: 290] [Impact Index Per Article: 32.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Out-of-hospital cardiac arrest is associated with low survival, but early cardiopulmonary resuscitation (CPR) and defibrillation can improve outcomes if more widely adopted. OBJECTIVE To examine temporal changes in bystander and first-responder resuscitation efforts before arrival of the emergency medical services (EMS) following statewide initiatives to improve bystander and first-responder efforts in North Carolina from 2010-2013 and to examine the association between bystander and first-responder resuscitation efforts and survival and neurological outcome. DESIGN, SETTINGS, AND PARTICIPANTS We studied 4961 patients with out-of-hospital cardiac arrest for whom resuscitation was attempted and who were identified through the Cardiac Arrest Registry to Enhance Survival (2010-2013). First responders were dispatched police officers, firefighters, rescue squad, or life-saving crew trained to perform basic life support until arrival of the EMS. EXPOSURES Statewide initiatives to improve bystander and first-responder interventions included training members of the general population in CPR and in use of automated external defibrillators (AEDs), training first responders in team-based CPR including AED use and high-performance CPR, and training dispatch centers in recognition of cardiac arrest. MAIN OUTCOMES AND MEASURES The proportion of bystander and first-responder resuscitation efforts, including the combination of efforts between bystanders and first responders, from 2010 through 2013 and the association between these resuscitation efforts and survival and neurological outcome. RESULTS The combination of bystander CPR and first-responder defibrillation increased from 14.1% (51 of 362; 95% CI, 10.9%-18.1%) in 2010 to 23.1% (104 of 451; 95% CI, 19.4%-27.2%) in 2013 (P < .01). Survival with favorable neurological outcome increased from 7.1% (82 of 1149; 95% CI, 5.8%-8.8%) in 2010 to 9.7% (129 of 1334; 95% CI, 8.2%-11.4%) in 2013 (P = .02) and was associated with bystander-initiated CPR. Adjusting for age and sex, bystander and first-responder interventions were associated with higher survival to hospital discharge. Survival following EMS-initiated CPR and defibrillation was 15.2% (30 of 198; 95% CI, 10.8%-20.9%) compared with 33.6% (38 of 113; 95% CI, 25.5%-42.9%) following bystander-initiated CPR and defibrillation (odds ratio [OR], 3.12; 95% CI, 1.78-5.46); 24.2% (83 of 343; 95% CI, 20.0%-29.0%) following bystander CPR and first-responder defibrillation (OR, 1.70; 95% CI, 1.06-2.71); and 25.2% (109 of 432; 95% CI, 21.4%-29.6%) following first-responder CPR and defibrillation (OR, 1.77; 95% CI, 1.13-2.77). CONCLUSIONS AND RELEVANCE Following a statewide educational intervention on rescusitation training, the proportion of patients receiving bystander-initiated CPR and defibrillation by first responders increased and was associated with greater likelihood of survival. Bystander-initiated CPR was associated with greater likelihood of survival with favorable neurological outcome.
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Affiliation(s)
| | | | | | - Clark Tyson
- Duke Clinical Research Institute, Durham, North Carolina3Center for Educational Excellence, Durham, North Carolina
| | - Lisa Monk
- Duke Clinical Research Institute, Durham, North Carolina
| | | | | | - Matthew E Dupre
- Duke Clinical Research Institute, Durham, North Carolina6Department of Community and Family Medicine, Duke University, Durham, North Carolina
| | - Emil L Fosbøl
- Duke Clinical Research Institute, Durham, North Carolina7The Heart Center, University Hospital of Copenhagen, Rigshospitalet, Denmark
| | - James G Jollis
- Duke Clinical Research Institute, Durham, North Carolina
| | - Benjamin Strauss
- Nicholas School of the Environment, Duke University, Durham, North Carolina
| | | | - Bryan McNally
- Emory University School of Medicine, Atlanta, Georgia10Rollins School of Public Health, Emory University, Atlanta, Georgia
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Abstract
BACKGROUND Divorce is a major life stressor that can have economic, emotional, and physical health consequences. However, the cumulative association between divorce and risks for acute myocardial infarction (AMI) is unknown. This study investigated the association between lifetime exposure to divorce and the incidence of AMI in US adults. METHODS AND RESULTS We used nationally representative data from a prospective cohort of ever-married adults aged 45 to 80 years (n=15,827) who were followed biennially from 1992 to 2010. Approximately 14% of men and 19% of women were divorced at baseline and more than one third of the cohort had ≥1 divorce in their lifetime. In 200,524 person-years of follow-up, 8% (n=1211) of the cohort had an AMI and age-specific rates of AMI were consistently higher in those who were divorced compared with those who were continuously married (P<0.05). Results from competing-risk hazard models showed that AMI risks were significantly higher in women who had 1 divorce (hazard ratio, 1.24; 95% confidence interval, 1.01-1.55), ≥2 divorces (hazard ratio, 1.77; 95% confidence interval, 1.30-2.41), and among the remarried (hazard ratio, 1.35; 95% confidence interval, 1.07-1.70) compared with continuously married women after adjusting for multiple risk factors. Multivariable-adjusted risks were elevated only in men with a history of ≥2 divorces (hazard ratio, 1.30; 95% confidence interval, 1.02-1.66) compared with continuously married men. Men who remarried had no significant risk for AMI. Interaction terms for sex were not statistically significant. CONCLUSIONS Divorce is a significant risk factor for AMI. The risks associated with multiple divorces are especially high in women and are not reduced with remarriage.
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Affiliation(s)
- Matthew E Dupre
- From the Duke Clinical Research Institute (M.E.D., E.D.P.), Department of Community and Family Medicine (M.E.D.), Department of Sociology (M.E.D., L.K.G.), Duke Law School (G.L.), and Division of Cardiology, Department of Medicine, Duke University Medical Center (E.D.P.), Duke University, Durham, NC.
| | - Linda K George
- From the Duke Clinical Research Institute (M.E.D., E.D.P.), Department of Community and Family Medicine (M.E.D.), Department of Sociology (M.E.D., L.K.G.), Duke Law School (G.L.), and Division of Cardiology, Department of Medicine, Duke University Medical Center (E.D.P.), Duke University, Durham, NC
| | - Guangya Liu
- From the Duke Clinical Research Institute (M.E.D., E.D.P.), Department of Community and Family Medicine (M.E.D.), Department of Sociology (M.E.D., L.K.G.), Duke Law School (G.L.), and Division of Cardiology, Department of Medicine, Duke University Medical Center (E.D.P.), Duke University, Durham, NC
| | - Eric D Peterson
- From the Duke Clinical Research Institute (M.E.D., E.D.P.), Department of Community and Family Medicine (M.E.D.), Department of Sociology (M.E.D., L.K.G.), Duke Law School (G.L.), and Division of Cardiology, Department of Medicine, Duke University Medical Center (E.D.P.), Duke University, Durham, NC
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Dupre ME, Silberberg M, Willis JM, Feinglos MN. Education, glucose control, and mortality risks among U.S. older adults with diabetes. Diabetes Res Clin Pract 2015; 107:392-9. [PMID: 25649910 DOI: 10.1016/j.diabres.2014.12.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 10/09/2014] [Accepted: 12/26/2014] [Indexed: 10/24/2022]
Abstract
AIMS Studies have shown that diabetes mellitus disproportionately afflicts persons of low socioeconomic status and that the burden of disease is greatest among the disadvantaged. However, our understanding of educational differences in the control of diabetes and its impact on survival is limited. This study investigated the associations among education, hemoglobin A1c (HbA1c), and subsequent mortality in adults with diabetes. METHODS Prospective cohort data from the 2006, 2008, and 2010 Health and Retirement Study were linked with biomarker data for U.S. older adults with diabetes (n=3312). Weighted distributions were estimated for all subjects at baseline and by the American Diabetes Association's general guidelines for HbA1c control (<7.0% [53 mmol/mol] vs. ≥7.0% [53 mmol/mol]). Proportional hazard models were used to estimate educational differences in all-cause mortality by HbA1c level with sequential adjustments for contributing risk factors. RESULTS Mortality risks associated with HbA1c≥7.0% [53 mmol/mol] were significantly greater in lower-educated adults than higher-educated adults (P<0.001). We found that the hazard ratios (HR) associated with HbA1c ≥7.0% [53 mmol/mol] were highest among low-educated adults (HR=2.18, 95% CI: 1.62, 2.94) and that a combination of socioeconomic, psychosocial, and behavioral factors accounted for most, but not all, of the associations. CONCLUSIONS Educational differences in HbA1c control have significant implications for mortality and efforts to reduce these disparities should involve more vigilant screening and monitoring of lower-educated adults with diabetes.
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Affiliation(s)
- Matthew E Dupre
- Duke Clinical Research Institute, Duke University, Durham, NC, USA; Department of Community and Family Medicine, Division of Community Health, Duke University, Durham, NC, USA; Department of Sociology, Duke University, Durham, NC, USA.
| | - Mina Silberberg
- Department of Community and Family Medicine, Division of Community Health, Duke University, Durham, NC, USA
| | - Janese M Willis
- Department of Community and Family Medicine, Division of Community Health, Duke University, Durham, NC, USA
| | - Mark N Feinglos
- Department of Medicine, Division of Endocrinology, Metabolism, and Nutrition, Duke University, Durham, NC, USA
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