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Jordan OJ, Benitez A, Burnet DL, Quinn MT, Baig AA. The Role of Family in Diabetes Management for Mexican American Adults. HISPANIC HEALTH CARE INTERNATIONAL 2024; 22:109-118. [PMID: 37872697 PMCID: PMC11041087 DOI: 10.1177/15404153231206086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Introduction: The purpose of this study was to characterize how family influences diabetes self-management in Mexican American adults. Methods: Data were analyzed from previously collected data that included 34 semi-structured interviews with Hispanic adults with diabetes and six focus groups with 37 adults with diabetes and family members. Themes related to family and diabetes management were identified and analyzed using a modified template approach. Results: Family-related facilitators to T2DM self-management were (1) provides support, (2) provides motivation, and (3) desire to protect family from diabetes. Family-related challenges were (1) lack of support, (2) family responsibilities, and (3) stress related to family. Diabetes education was shared with family members. Family member perspectives on T2DM included (1) not knowing how to help, (2) effect on emotional wellbeing, (3) diabetes affects the whole family, and (4) family provides support. Conclusion: Most participants with T2DM felt supported by family, but many desired more social support and support surrounding dietary changes from family. Many felt family did not understand what living with diabetes meant for them. Most family members wished to learn more about how to help. Future interventions should include family members and teach them supportive strategies to support beneficial diabetes self-management behaviors.
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Affiliation(s)
- Olivia J. Jordan
- Department of Medicine, Internal Medicine Resident, University of California, Los Angeles, Los Angeles, CA, USA
| | | | - Deborah L. Burnet
- University of Chicago, Section of General Internal Medicine, Chicago, IL, USA
| | - Michael T. Quinn
- University of Chicago, Section of General Internal Medicine, Chicago, IL, USA
| | - Arshiya A. Baig
- University of Chicago, Section of General Internal Medicine, Chicago, IL, USA
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Narain KDC, Patel A, Skootsky S, Mangione CM. Exploring the Relationship Between Medication Adherence and Diabetes Disparities among Hispanic Patients in a Large Health System. J Gen Intern Med 2024; 39:1149-1155. [PMID: 37962729 PMCID: PMC11116283 DOI: 10.1007/s11606-023-08502-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 10/20/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Sub-optimal HbA1c control is a driver of disparities in diabetes outcomes among Hispanic patients. Differences in medication adherence may underlie racial/ethnic differences in HbA1c level. OBJECTIVE To examine the relationship between medication adherence and disparities in HbA1c level among Hispanic patients, relative to other racial/ethnic groups, obtaining care in the University of California Health System (UC Health). DESIGN This study used clinical, administrative, and prescription dispensing data (January-December 2021) derived from the electronic health records of 5 Academic Medical Centers in UC Health, and linear regression models (LRMs) to conduct a cross-sectional analysis of the association between medication adherence, race/ethnicity, and HbA1c level. Adjusted LRMs were run with and without the measure of medication adherence to assess this relationship. PARTICIPANTS Patients with a UC Health primary care physician (PCP), with ≥ 1 PCP visit within the last 3 years, ages 18-75, reporting Asian, Hispanic, or White race/ethnicity, and who had ≥ 2 encounters with an ICD diagnosis of diabetes or had a prescription for a diabetes medication within the last 2 years, as of 12/31/21 (N = 27, 542; Asian = 6253, Hispanic = 7216, White = 14,073). MAIN MEASURES Our measure of medication adherence was the proportion of days covered (PDC) for diabetes medications in 2021. Our outcome was the most recent HbA1c value. KEY RESULTS In the LRM excluding the PDC, Hispanic ethnicity was positively associated with HbA1c level (β = 0.31, p = < 0.001). In the LRM model including PDC, PDC was negatively associated with HbA1c level (β = - 0.18, p = < 0.001). However, the positive relationship between Hispanic ethnicity and HbA1c level did not change (β = 0.31, p = < 0.001). CONCLUSIONS The findings of this study suggest that the relationship between Hispanic ethnicity, HbA1c level, and factors outside of medication adherence should be explored among primary care patients receiving care in Academic Medical Centers.
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Affiliation(s)
- Kimberly Danae Cauley Narain
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
- Center for Health Advancement, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA.
| | - Ayan Patel
- Center for Data-Driven Insights & Innovation, University of California Health, Oakland, CA, USA
| | - Samuel Skootsky
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Population Health, University of California Health, Oakland, CA, USA
| | - Carol M Mangione
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Fielding School of Public Health, University of California, Los Angeles, CA, USA
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Zogg CK, Falvey JR, Kodadek LM, Staudenmayer KL, Davis KA. The interaction between geriatric and neighborhood vulnerability: Delineating prehospital risk among older adult emergency general surgery patients. J Trauma Acute Care Surg 2024; 96:400-408. [PMID: 37962136 PMCID: PMC10922165 DOI: 10.1097/ta.0000000000004191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
BACKGROUND When presenting for emergency general surgery (EGS) care, older adults frequently experience increased risk of adverse outcomes owing to factors related to age ("geriatric vulnerability") and the social determinants of health unique to the places in which they live ("neighborhood vulnerability"). Little is known about how such factors collectively influence adverse outcomes. We sought to explore how the interaction between geriatric and neighborhood vulnerability influences EGS outcomes among older adults. METHODS Older adults, 65 years or older, hospitalized with an AAST-defined EGS condition were identified in the 2016 to 2019, 2021 Florida State Inpatient Database. Latent variable models combined the influence of patient age, multimorbidity, and Hospital Frailty Risk Score into a single metric of "geriatric vulnerability." Variations in geriatric vulnerability were then compared across differences in "neighborhood vulnerability" as measured by variations in Area Deprivation Index, Social Vulnerability Index, and their corresponding subthemes (e.g., access to transportation). RESULTS A total of 448,968 older adults were included. For patients living in the least vulnerable neighborhoods, increasing geriatric vulnerability resulted in up to six times greater risk of death (30-day risk-adjusted hazards ratio [HR], 6.32; 95% confidence interval [CI], 4.49-8.89). The effect was more than doubled among patients living in the most vulnerable neighborhoods, where increasing geriatric vulnerability resulted in up to 15 times greater risk of death (30-day risk-adjusted HR, 15.12; 95% CI, 12.57-18.19). When restricted to racial/ethnic minority patients, the multiplicative effect was four-times as high, resulting in corresponding 30-day HRs for mortality of 11.53 (95% CI, 4.51-29.44) versus 40.67 (95% CI, 22.73-72.78). Similar patterns were seen for death within 365 days. CONCLUSION Both geriatric and neighborhood vulnerability have been shown to affect prehospital risk among older patients. The results of this study build on that work, presenting the first in-depth look at the powerful multiplicative interaction between these two factors. The results show that where a patient resides can fundamentally alter expected outcomes for EGS care such that otherwise less vulnerable patients become functionally equivalent to those who are, at baseline, more aged, more frail, and more sick. LEVEL OF EVIDENCE Prognostic and Epidemiological; Level III.
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Affiliation(s)
- Cheryl K. Zogg
- Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Jason R. Falvey
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD
- Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, MD
| | - Lisa M. Kodadek
- Department of Surgery, Yale School of Medicine, New Haven, CT
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Pelayo C, Mora Pinzón M, Lock LJ, Fowlkes C, Stevens CL, Hoang J, Garcia JL, Jacobson NA, Channa R, Liu Y. Factors Influencing Eye Screening Adherence Among Latinx Patients With Diabetes: A Qualitative Study. Transl Vis Sci Technol 2023; 12:8. [PMID: 38060234 PMCID: PMC10709803 DOI: 10.1167/tvst.12.12.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 11/07/2023] [Indexed: 12/08/2023] Open
Abstract
Purpose Latinx populations have the highest rates of visual impairment and blindness of any ethnic group in the United States, with most cases of diabetic retinopathy remaining undiagnosed. We aimed to identify factors influencing adherence with diabetic eye screening in Latinx communities. Methods We conducted semistructured individual interviews with adult Latinx patients in Dane County, WI. Interviews were transcribed verbatim, translated from Spanish to English, and analyzed using QSR NVivo software. We performed both inductive open coding and deductive coding using the National Institute on Minority Health and Health Disparities Research Framework, as well as the Campbell and Egede Model. Results All participants (n = 20) self-identified as Latinx and were diagnosed with type 2 diabetes. The mean age was 61.5 years (range 33-79 years). Most participants were uninsured (60%), self-reported low or moderate health literacy (60%), and preferred to speak Spanish during their clinic appointments (75%). Individual-level barriers to diabetic eye screening included limited eye health literacy, lack of insurance coverage, and low self-efficacy with diabetes management. Health system-level facilitators included a recommendation to obtain eye screening from a primary care provider and the use of nonwritten forms of patient education. Community-level barriers included social isolation, concerns about inconveniencing others, machismo, and immigration status. Conclusions We identified several health system- and community-level factors, in addition to individual-level factors, influencing adherence with diabetic eye screening in Latinx communities. Translational Relevance Strategies addressing these factors may enhance the effectiveness of interventions to prevent blindness from diabetes and contribute to advancing health equity in Latinx communities.
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Affiliation(s)
- Christian Pelayo
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Maria Mora Pinzón
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Loren J. Lock
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Christiana Fowlkes
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Chloe L. Stevens
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Johnson Hoang
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Juan L. Garcia
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Nora A. Jacobson
- Institute for Clinical and Translational Research, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Roomasa Channa
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Yao Liu
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Narain KDC, Moreno G, Bell DS, Chen L, Tseng CH, Follett RW, Skootsky S, Mangione CM. Pharmacist-Led Diabetes Control Intervention and Health Outcomes in Hispanic Patients With Diabetes. JAMA Netw Open 2023; 6:e2335409. [PMID: 37768663 PMCID: PMC10539985 DOI: 10.1001/jamanetworkopen.2023.35409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 08/18/2023] [Indexed: 09/29/2023] Open
Abstract
Importance Among patients with type 2 diabetes (T2D), Hispanic individuals are more likely than non-Hispanic White individuals to develop diabetes-related complications. Objective To examine the association of a pharmacist-led intervention (UCMyRx) with hemoglobin A1c (HbA1c) and systolic blood pressure (SBP) among Hispanic patients with T2D. Design, Setting, and Participants This quality improvement study used electronic health record data and a difference-in-differences study design to evaluate the association of UCMyRx exposure with changes in HbA1c concentration and SBP among Hispanic patients with T2D, relative to usual care, at University of California, Los Angeles primary care clinics between February and April of 2023. The study population included patients with an International Classification of Diseases, Ninth Revision/International Statistical Classification of Diseases and Related Health Problems, Tenth Revision diagnosis of T2D, self-reporting Hispanic ethnicity, age 18 years or older, with 1 or more visits with a UCMyRx pharmacist (treatment) or 2 or more visits, 2 or more years apart, during the study window (comparison). Additionally, patients had to have the following observations during the study window (March 2, 2013-December 31, 2018): (1) a HbA1c 8% or higher, anywhere between 365 days before and 14 days after the index date (date of the first UCMyRx visit or a randomly generated index date) and a follow-up HbA1c measure within 120 to 365 days after the index date (n = 396) and/or (2) a SBP 140 mm Hg or higher between 365 days before and 14 days after the index date, and a follow-up SBP measure within 120 to 450 days after the index date (n = 795). Exposure Pharmacists review laboratory results/vital signs, perform medication reconciliation, and develop personally tailored interventions to address adherence barriers and increase guideline-concordant care. Main Outcomes and Measures Pre- to post-index date changes in HbA1c and SBP. Results Of the 931 unique patients with T2D analyzed, the mean (SD) age was 64 (14.1) years, and 552 (59.3%) were female. In adjusted analyses, having 1 or more UCMyRx visits was associated with a reduction in HbA1c concentration (β = -0.46%; 95% CI, -0.84% to -0.07%) but no change in SBP (β = -1.71 mm Hg; 95% CI, -4.00 to 0.58 mm Hg). Conclusions and Relevance In this quality improvement study of UCMyRx among Hispanic patients with T2D, a negative association was observed between UCMyRx exposure and HbA1c concentration but not SBP. Pharmacist-led intervention may be a strategy for improving outcomes among Hispanic patients with T2D.
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Affiliation(s)
- Kimberly Danae Cauley Narain
- Division of General Internal Medicine and Health Services Research, Department of Medicine, University of California, Los Angeles
- Center for Health Advancement, Fielding School of Public Health, University of California, Los Angeles
| | - Gerardo Moreno
- Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - Douglas S. Bell
- Division of General Internal Medicine and Health Services Research, Department of Medicine, University of California, Los Angeles
- Clinical and Translational Science Institute, University of California, Los Angeles
| | - Lillian Chen
- Department of Medicine Statistics Core, David Geffen School of Medicine, University of California, Los Angeles
| | - Chi-Hong Tseng
- Division of General Internal Medicine and Health Services Research, Department of Medicine, University of California, Los Angeles
| | - Robert W. Follett
- Clinical and Translational Science Institute, University of California, Los Angeles
| | - Samuel Skootsky
- Division of General Internal Medicine and Health Services Research, Department of Medicine, University of California, Los Angeles
- Population Health, University of California Health, Oakland
| | - Carol M. Mangione
- Division of General Internal Medicine and Health Services Research, Department of Medicine, University of California, Los Angeles
- Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles
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Toney AM, Pineros-Leano M, Pérez-Flores NJ, Gomez D, Aguayo L. 'It is in our hands-Why wait until you are sick?': Perceptions about diabetes prevention of Latina mothers in Mexico and the United States. Diabet Med 2023; 40:e15060. [PMID: 36751972 PMCID: PMC10655807 DOI: 10.1111/dme.15060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 01/12/2023] [Accepted: 02/01/2023] [Indexed: 02/09/2023]
Abstract
AIMS This study aimed to understand the perceptions driving type 2 diabetes mellitus prevention and management behaviours of Mexican and Latina mothers in Mexico and the United States. METHODS Low-income Mexican mothers in San Luis Potosí, Mexico and Latina mothers in Illinois, United States, were recruited by the Holistic Obesity Prevention Study (HOPS). Verbatim transcripts of the semistructured interviews conducted in Spanish (n = 24) and English (n = 1) were analysed using the Health Belief Model (HBM) framework. RESULTS Of the 25 participants, 22 (88%) indicated 'knowing someone with diabetes'-specifically a father (n = 8), mother (n = 6) or grandparent (n = 7). Using the HBM, themes showed that mothers perceived: that Type 2 diabetes can happen to anyone, are attributable to genetic predisposition and may be driven by strong emotions (perceived susceptibility). Type 2 diabetes introduces severe comorbidities and emotional difficulties for people and their families (perceived severity). Adopting a healthier diet, exercising and staying in good spirits were recognized as benefits of Type 2 diabetes prevention (perceived benefits). The costs of food, challenges of exercising, dieting, modifying habits and time limitations were recognized as perceived costs. Cues to action included doctors' recommendations (external) and fear (internal). Mothers acknowledged they could live a healthy life by controlling their weight, exercising, adhering to treatments/medications and having the determination to carry-on (self-efficacy). CONCLUSIONS Mothers sought to prevent Type 2 diabetes and live healthy lives, particularly, after receiving a diagnosis of gestational diabetes or when learning about their children's risks for Type 2 diabetes but perceived significant barriers to Type 2 diabetes prevention.
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Affiliation(s)
- Ashley Mulcahy Toney
- UTHealth Center for Community Health Impact, University of Texas Health Science Center at Houston, School of Public Health, El Paso, Texas, USA
| | | | | | - Diana Gomez
- School of Social Work, Boston College, Chestnut Hill, Massachusetts, USA
| | - Liliana Aguayo
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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Rodriguez JA, Seiglie JA, Caballero AE. What Does a New Health Technology Landscape Mean for Hispanic/Latino People With Diabetes? Clin Diabetes 2023; 41:289-291. [PMID: 37092153 PMCID: PMC10115760 DOI: 10.2337/cd22-0087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Affiliation(s)
- Jorge A. Rodriguez
- Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Jacqueline Anne Seiglie
- Harvard Medical School, Boston, MA
- Diabetes Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Augusto Enrique Caballero
- Harvard Medical School, Boston, MA
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital, Boston, MA
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Mitchell SE, Bragg A, De La Cruz BA, Winter MR, Reichert MJ, Laird L, Moldovan IA, Parker KN, Martin-Howard J, Gardiner P. Effectiveness of an immersive telemedicine platform for delivering diabetes medical group visits for African American/ Black and Hispanic/ Latina women with uncontrolled diabetes: The Women in Control 2.0 non-inferiority randomized clinical trial (Preprint). J Med Internet Res 2022; 25:e43669. [PMID: 37163341 DOI: 10.2196/43669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 01/12/2023] [Accepted: 03/10/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND Medically underserved people with type 2 diabetes mellitus face limited access to group-based diabetes care, placing them at risk for poor disease control and complications. Immersive technology and telemedicine solutions could bridge this gap. OBJECTIVE The purpose of this study was to compare the effectiveness of diabetes medical group visits (DMGVs) delivered in an immersive telemedicine platform versus an in-person (IP) setting and establish the noninferiority of the technology-enabled approach for changes in hemoglobin A1c (HbA1c) and physical activity (measured in metabolic equivalent of task [MET]) at 6 months. METHODS This study is a noninferiority randomized controlled trial conducted from February 2017 to December 2019 at an urban safety net health system and community health center. We enrolled adult women (aged ≥18 years) who self-reported African American or Black race or Hispanic or Latina ethnicity and had type 2 diabetes mellitus and HbA1c ≥8%. Participants attended 8 weekly DMGVs, which included diabetes self-management education, peer support, and clinician counseling using a culturally adapted curriculum in English or Spanish. In-person participants convened in clinical settings, while virtual world (VW) participants met remotely via an avatar-driven, 3D VW linked to video teleconferencing. Follow-up occurred 6 months post enrollment. Primary outcomes were mean changes in HbA1c and physical activity at 6 months, with noninferiority margins of 0.7% and 12 MET-hours, respectively. Secondary outcomes included changes in diabetes distress and depressive symptoms. RESULTS Of 309 female participants (mean age 55, SD 10.6 years; n=195, 63% African American or Black; n=105, 34% Hispanic or Latina; n=151 IP; and n=158 in VW), 207 (67%) met per-protocol criteria. In the intention-to-treat analysis, we confirmed noninferiority for primary outcomes. We found similar improvements in mean HbA1c by group at 6 months (IP: -0.8%, SD 1.9%; VW: -0.5%, SD 1.8%; mean difference 0.3, 97.5% CI -∞ to 0.3; P<.001). However, there were no detectable improvements in physical activity (IP: -6.5, SD 43.6; VW: -9.6, SD 44.8 MET-hours; mean difference -3.1, 97.5% CI -6.9 to ∞; P=.02). The proportion of participants with significant diabetes distress and depressive symptoms at 6 months decreased in both groups. CONCLUSIONS In this noninferiority randomized controlled trial, immersive telemedicine was a noninferior platform for delivering diabetes care, eliciting comparable glycemic control improvement, and enhancing patient engagement, compared to IP DMGVs. TRIAL REGISTRATION ClinicalTrials.gov NCT02726425; https://clinicaltrials.gov/ct2/show/NCT02726425.
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Datta R, Lucas JA, Marino M, Aceves B, Ezekiel-Herrera D, Vasquez Guzman CE, Giebultowicz S, Chung-Bridges K, Kaufmann J, Bazemore A, Heintzman J. Diabetes Screening and Monitoring Among Older Mexican-Origin Populations in the U.S. Diabetes Care 2022; 45:1568-1573. [PMID: 35587616 PMCID: PMC9274220 DOI: 10.2337/dc21-2483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 04/17/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The purpose of the study is to examine diabetes screening and monitoring among Latino individuals as compared with non-Latino White individuals and to better understand how we can use neighborhood data to address diabetes care inequities. RESEARCH DESIGN AND METHODS This is a retrospective observational study linked with neighborhood-level Latino subgroup data obtained from the American Community Survey. We used generalized estimating equation negative binomial and logistic regression models adjusted for patient-level covariates to compare annual rates of glycated hemoglobin (HbA1c) monitoring for those with diabetes and odds of HbA1c screening for those without diabetes by ethnicity and among Latinos living in neighborhoods with low (0.0-22.0%), medium (22.0-55.7%), and high (55.7-98.0%) population percent of Mexican origin. RESULTS Latino individuals with diabetes had 18% higher rates of HbA1c testing than non-Latino White individuals with diabetes (adjusted rate ratio [aRR] 1.18 [95% CI 1.07-1.29]), and Latinos without diabetes had 25% higher odds of screening (adjusted odds ratio 1.25 [95% CI 1.15-1.36]) than non-Latino White individuals without diabetes. In the analyses in which neighborhood-level percent Mexican population was the main independent variable, all Latinos without diabetes had higher odds of HbA1c screening compared with non-Latino White individuals, yet only those living in low percent Mexican-origin neighborhoods had increased monitoring rates (aRR 1.31 [95% CI 1.15-1.49]). CONCLUSIONS These findings reveal novel variation in health care utilization according to Latino subgroup neighborhood characteristics and could inform the delivery of diabetes care for a growing and increasingly diverse Latino patient population. Clinicians and researchers whose work focuses on diabetes care should take steps to improve equity in diabetes and prevent inequity in treatment.
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Affiliation(s)
- Roopradha Datta
- Department of Family Medicine, Oregon Health & Science University, Portland, OR
| | - Jennifer A Lucas
- Department of Family Medicine, Oregon Health & Science University, Portland, OR
| | - Miguel Marino
- Department of Family Medicine, Oregon Health & Science University, Portland, OR
| | - Benjamin Aceves
- Social Interventions Research and Evaluation Network, University of California, San Francisco, San Francisco, CA
| | | | | | | | | | - Jorge Kaufmann
- Department of Family Medicine, Oregon Health & Science University, Portland, OR
| | - Andrew Bazemore
- American Board of Family Medicine, Lexington, KY.,Center for Professionalism and Value in Health Care, Washington, DC
| | - John Heintzman
- Department of Family Medicine, Oregon Health & Science University, Portland, OR.,OCHIN Inc., Portland, OR
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Parra OD, Kohler LN, Landes L, Soto AA, Garcia D, Mullins J, Molina P, Pereira E, Spegman DJ, Soltani L, Mandarino LJ. Biobanking in Latinos: current status, principles for conduct, and contribution of a new biobank, El Banco por Salud, designed to improve the health of Latino patients of Mexican ancestry with type 2 diabetes. BMJ Open Diabetes Res Care 2022; 10:e002709. [PMID: 35504695 PMCID: PMC9066498 DOI: 10.1136/bmjdrc-2021-002709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 03/19/2022] [Indexed: 11/03/2022] Open
Abstract
Underserved Latino communities experience a greater burden of type 2 diabetes mellitus (T2DM) than the general population. Predictors of glycemic control are likely to include both biological/genetic and social determinants of health (SDOH). A variety of approaches have been used with cohorts of Latino patients to study aspects of this health disparity, and those are reviewed briefly here. Such projects range from cohorts that are studies for a primary purpose, for example, to discover genetic variation associated with T2DM or to examine a particular aspect of SDOH that might be involved. Other studies have been conducted more as infrastructure that is broadly based in order to provide a resource that can be used by many investigators to address a variety of questions. From our experience and those of others, we propose a set of principles to ensure that needs of the community are identified and taken into account during the conduct of these studies. As an example of the implementation of these principles, we also describe a new biobank El Banco por Salud (El Banco), which was designed to improve access to studies designed to improve glycemic control and health in Latinos in partnership with Federally Qualified Health Centers in Arizona.
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Affiliation(s)
- Oscar D Parra
- Department of Medicine, University of Arizona Medical Center-University Campus, Tucson, Arizona, USA
| | - Lindsay N Kohler
- Health Promotion Sciences, The University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, Arizona, USA
- Mel and Edith Zuckerman College of Public Health, University of Arizona Medical Center-University Campus, Tucson, Arizona, USA
| | - Lori Landes
- El Rio Community Health Centers, Tucson, Arizona, USA
- Department of Family Medicine and Population Health, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA
| | - Alexis A Soto
- Department of Medicine, University of Arizona Medical Center-University Campus, Tucson, Arizona, USA
| | - Diana Garcia
- Department of Medicine, University of Arizona Medical Center-University Campus, Tucson, Arizona, USA
| | | | - Patty Molina
- Mariposa Community Health Centers, Nogales, Arizona, USA
| | - Eladio Pereira
- Mariposa Community Health Centers, Nogales, Arizona, USA
| | | | - Lisa Soltani
- El Rio Community Health Centers, Tucson, Arizona, USA
| | - Lawrence J Mandarino
- Department of Medicine, University of Arizona Medical Center-University Campus, Tucson, Arizona, USA
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Aceves B, Ezekiel-Herrera D, Marino M, Datta R, Lucas J, Giebultowicz S, Heintzman J. Disparities in HbA1c testing between aging US Latino and non-Latino white primary care patients. Prev Med Rep 2022; 26:101739. [PMID: 35295668 PMCID: PMC8918837 DOI: 10.1016/j.pmedr.2022.101739] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 01/19/2022] [Accepted: 02/16/2022] [Indexed: 01/12/2023] Open
Abstract
US Latinos disproportionately face diabetes-related disparities compared to non-Latino Whites. A number of barriers, including linguistic and cultural discordance, have been consistently linked to these disparities. Glycated hemoglobin (HbA1c) testing is used to assess glycemic control among individuals living with diabetes. This study aimed to compare HbA1c levels and corresponding testing rates among non-Latino Whites and Latinos with both English and Spanish preference from a national cohort of primary care patients within community health centers. We analyzed electronic health records from patients who turned 50 years of age (n = 66,921) and were diagnosed with diabetes during or prior to the study period. They also must have been under observation for at least one year from January 1, 2013 to December 31, 2017. We calculated the rates of HbA1c tests each person received over the number of years observed and used covariate-adjusted negative binomial regression to estimate incidence rate ratios for Spanish preferring Latinos and English preferring Latinos compared to non-Latino Whites. Spanish preferring Latinos (rate ratio = 1.23, 95% CI = 1.16-1.30), regardless of HbA1c level, had higher testing rates than non-Latino Whites and English preferring Latinos. English preferring Latinos with controlled HbA1c levels had higher rates of HbA1c testing compared to non-Latino whites. Overall, the Latinos with Spanish preference maintained higher HbA1c testing rates and had disproportionately higher rates of uncontrolled HbA1c levels compared to non-Latino whites. Future efforts should focus on understanding effective approaches to increasing engagement among Spanish preferring Latinos and addressing organizational-level barriers, given HbA1c disparities.
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Affiliation(s)
- Benjamin Aceves
- Social Interventions Research and Evaluation Network, University of California, San Francisco, United States
| | - David Ezekiel-Herrera
- Department of Family Medicine, Oregon Health & Science University, United States
- Corresponding author: 3181 SW Sam Jackson Park Rd, Portland, OR 97239, United States.
| | - Miguel Marino
- Department of Family Medicine, Oregon Health & Science University, United States
| | - Roopradha Datta
- Department of Family Medicine, Oregon Health & Science University, United States
| | - Jennifer Lucas
- Department of Family Medicine, Oregon Health & Science University, United States
| | | | - John Heintzman
- Department of Family Medicine, Oregon Health & Science University, United States
- OCHIN, Inc, United States
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12
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Slater A, Cantero PJ, Alvarez G, Cervantes BS, Bracho A, Billimek J. Latino Health Access: Comparative Effectiveness of a Community-Initiated Promotor/a-Led Diabetes Self-management Education Program. FAMILY & COMMUNITY HEALTH 2022; 45:34-45. [PMID: 34783689 PMCID: PMC9831659 DOI: 10.1097/fch.0000000000000311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Community-initiated health interventions fill important gaps in access to health services. This study examines the effectiveness of a community-initiated health intervention to improve diabetes management in an underserved community of color using a retrospective observational study, comparing a study intervention, the Latino Health Access Diabetes Self-Management Program (LHA-DSMP), with usual care. The LHA-DSMP is a 12-session community health worker (promotor/a) intervention developed and implemented by a community-based organization in a medically underserved area. Usual care was delivered at a federally qualified health center in the same geographic area. Participants were 688 predominantly Spanish-speaking Latinx adults with type 2 diabetes. The main outcome was change in glycemic control (glycosylated hemoglobin [HbA1c]) from baseline to follow-up. At 14-week follow-up, mean (95% CI) HbA1c decrease was -1.1 (-1.3 to -0.9; P < .001) in the LHA-DSMP cohort compared with -0.3 (-0.4 to -0.2; P < .001) in the comparison cohort. Controlling for baseline differences between cohorts, the adjusted difference-in-differences value in HbA1c was -0.6 (-0.8 to -0.3; P < .001) favoring the LHA-DSMP. A community-initiated promotor/a-led educational program for diabetes self-management is associated with clinically significant improvement in blood sugar control, superior to what was observed with usual medical care.
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Affiliation(s)
- Allison Slater
- Program in Medical Education for the Latino Community (PRIME-LC), School of Medicine (Dr Slater and Dr Billimek), Health Policy Research Institute (Mr Cervantes and Dr Billimek), and Department of Family Medicine (Dr Billimek), University of California, Irvine; and Latino Health Access, Santa Ana, California (Drs Cantero and Bracho and Mr Alvarez)
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13
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Cartwright K. Social determinants of the Latinx diabetes health disparity: A Oaxaca-Blinder decomposition analysis. SSM Popul Health 2021; 15:100869. [PMID: 34401459 PMCID: PMC8350406 DOI: 10.1016/j.ssmph.2021.100869] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 07/07/2021] [Accepted: 07/08/2021] [Indexed: 11/15/2022] Open
Abstract
Latinx people living in the U.S. report a disproportionately high prevalence of diabetes. This project builds on the existing social determinants of diabetes literature by examining factors associated with a greater likelihood of diabetes and investigates factors correlated with the Latinx/non-Latinx disparity. This project studies the adult sample (18 and older) from the 2010–2018 IPUMS Health: National Health Interview Survey (NHIS) data. Logistic regression analyses are used to examine the patterns between reporting Latinx identity and reporting diabetes with additional subgroup analyses of the Latinx and non-Latinx groups. Then, Oaxaca-Blinder decomposition is used to examine the patterns explaining the difference in self-reported diabetes between the Latinx and non-Latinx population for the whole sample and by age group. The logistic regression analyses show that after adjusting for age and other key social determinants of health, Latinx individuals are approximately 64.5% (OR 1.645, [95% CI, 1.536–1.760]) more likely to report being diagnosed with diabetes than non-Latinx individuals. Individual characteristics of age, race, and smoking behaviors are identified as suppressors of the gap, and conversely, characteristics of income, education, and BMI all contribute to the Latinx diabetes disparity gap. The Oaxaca-Blinder decomposition results show that the measured social determinants of health characteristics explain a meaningful amount of the Latinx diabetes gap. Importantly, differences in education and income (which are more immediately actionable policy areas) make larger contributions to the gap than BMI or other health behaviors. The Latinx diabetes disparity should always presented after adjusting for age. In the age-adjusted model, Latinx adults are 64.5% more likely to report diabetes. Oaxaca-Blinder decomposition analysis shows how factors such as income, education, and BMI drive the diabetes disparity. Income and education are identified as modifiable factors to be prioritized in policy interventions aimed at reducing the diabetes disparity.
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14
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Smith-Miller CA, Berry DC, Miller CT. Gender Differences and Their Influences on T2DM Self-Management Among Spanish-Speaking Latinx Immigrants. HISPANIC HEALTH CARE INTERNATIONAL 2021; 20:44-55. [PMID: 33906459 DOI: 10.1177/15404153211011727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Evidence suggests that gender may influence many aspects of type 2 diabetes (T2DM) self-management (SM) and we posit that limited English language-proficient Latinx immigrants face additional challenges. METHODS Instruments and semi-structured interviews were used to examine gender differences on health literacy, diabetes knowledge, health-promoting behaviors, diabetes, eating and exercise self-efficacy (SE), and T2DM SM practices among a cohort of limited English language-proficient Latinx immigrants. Statistical and qualitative analysis procedures were performed comparing males and females. RESULTS Thirty persons participated. Males tended to be older, have higher educational achievement, and more financial security than females. Physiologic measures tended worse among female participants. Health literacy and exercise SE scores were similar, but females scored lower on Eating and Diabetes SE. Forty-seven percent (n= 9) of the women reported a history of gestational diabetes mellitus and a majority of men (n = 7) cited difficulty with excessive alcohol. CONSUMPTION Males appeared to receive more SM support compared to females. Females more frequently noted how family obligations and a lack of support impeded their SM. Work environments negatively influenced SM practices. CONCLUSION Men and women have unique SM challenges and as such require individualized strategies and support to improve T2DM management.
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Affiliation(s)
- Cheryl A Smith-Miller
- UNC Medical Center, Nursing Quality and Research, Chapel Hill, NC, USA.,Office of Human Research Ethics, University of North Carolina-Chapel Hill, NC, USA.,School of Nursing, University of North Carolina-Chapel Hill, NC, USA
| | - Diane C Berry
- Co-Director Interventions for Preventing and Managing Chronic Illness (T32-NIH/NINR); Optimizing Outcomes in Women with Gestational Diabetes and their Infants (NIH/NIDDK); Diabetes Group Visits (Kate B. Reynolds), School of Nursing, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Cass T Miller
- Environmental Sciences and Engineering, UNC Gillings School of Global Public Health, University of North Carolina-Chapel Hill, NC, USA
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Joachim-Célestin M, Gamboa-Maldonado T, Dos Santos H, Montgomery SB. Delivering the Same Intervention to Hispanic/Latinos With Pre-diabetes and Diabetes. Early Evidence of Success in a Longitudinal Mixed Method Study. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2021; 58:469580211055595. [PMID: 34825596 PMCID: PMC8673885 DOI: 10.1177/00469580211055595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Despite nationwide efforts to address the diabetes epidemic and reduce prevalence disparities, higher rates persist among the poor, especially those with limited literacy. Currently, individuals with abnormal glycemia who have pre-diabetes and diabetes qualify for different programs. However, evidence suggests that, for low-income Hispanic/Latinos, offering a single intervention to all those with abnormal glycemia may provide a more culturally acceptable and effective approach. Our objective was to explore the feasibility of such an intervention led by community health workers (CHWs) among low-income Hispanic/Latinos with diabetes and at risk for diabetes. METHODS Using a quasi-experimental mixed method design, we assessed weight, glycosylated hemoglobin, diabetes knowledge, and behavior changes of Hispanic/Latinos participants with pre-diabetes and diabetes living in Southern California. Biometric measurements, blood tests, and surveys were collected at baseline and 3 months post-intervention. Interviews and focus group discussions provided qualitative data. RESULTS Although the program was less costly, results exceeded those reported for low-income H/L attending the National Diabetes Prevention Program and did not differ between pre-diabetes and diabetes groups. Instead, including individuals at different stages of the dysglycemic spectrum seemed to have enhanced the intervention. Physician referral and attendance of family/friends were associated with better outcomes. CONCLUSION Our findings indicate that a joint prevention/self-management intervention led by CHWs for low-income Hispanic/Latinos with diabetes and with pre-diabetes is feasible and cost-effective, providing results that could help reduce the success gap. Incorporating suggestions and replicating this study on a larger scale could help determine whether or not results are reproducible.
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Affiliation(s)
- Maud Joachim-Célestin
- Loma Linda University School of Behavioral Health, Loma Linda, CA, USA
- Loma Linda University School of Medicine, Loma Linda, CA, USA
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16
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Clark TL, Gallo L, Euyoque JA, Philis-Tsimikas A, Fortmann A. Does Diabetes Distress Influence Clinical Response to an mHealth Diabetes Self-Management Education and Support Intervention? DIABETES EDUCATOR 2020; 46:289-296. [PMID: 32228288 DOI: 10.1177/0145721720913276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this study was to examine whether baseline levels of diabetes distress (DD) impacted clinical benefit from a mobile health (mHealth) diabetes self-management education and support (DSME/S) intervention ("Dulce Digital"). METHODS This secondary analysis included the full sample of 126 Hispanic adults (mean age = 48.43 years, SD = 9.80) with type 2 diabetes and glycosylated hemoglobin A1C >7.5% enrolled from a Federally Qualified Health Center in a randomized, nonblinded clinical trial that compared Dulce Digital to usual care. Dulce Digital participants received educational/motivational, medication reminders, and blood glucose monitoring prompt text messages over 6 months. RESULTS Baseline levels of DD prospectively moderated the effect of Dulce Digital (vs usual care) on glycemic control over 6 months, such that Dulce Digital participants with higher DD experienced relatively greater benefit from the intervention. The effect of the intervention on A1C change was 178% larger among individuals experiencing moderate/high versus no/low DD. CONCLUSIONS Although research has found DD to be associated with poorer self-management and clinical outcomes, individuals already distressed about their diabetes may benefit from a lower-burden mHealth DSME/S approach.
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Affiliation(s)
- Taylor L Clark
- San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, California
| | - Linda Gallo
- Department of Psychology, San Diego State University, San Diego, California
| | - Johanna A Euyoque
- Scripps Whittier Diabetes Institute, Scripps Health, San Diego, California
| | | | - Addie Fortmann
- Scripps Whittier Diabetes Institute, Scripps Health, San Diego, California
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17
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Azeez O, Kulkarni A, Kuklina EV, Kim SY, Cox S. Hypertension and Diabetes in Non-Pregnant Women of Reproductive Age in the United States. Prev Chronic Dis 2019; 16:E146. [PMID: 31651378 PMCID: PMC6824149 DOI: 10.5888/pcd16.190105] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Introduction Diagnosis and control of chronic conditions have implications for women’s health and are major contributing factors to maternal and infant morbidity and mortality. This study estimated the prevalence of hypertension and diabetes in non-pregnant women of reproductive age in the United States, the proportion who were unaware of their condition or whose condition was not controlled, and differences in the prevalence of these conditions by selected characteristics. Methods We used data from the 2011–2016 National Health and Nutrition Examination Survey to estimate overall prevalence of hypertension and diabetes among women of reproductive age (aged 20–44 y), the proportion who were unaware of having hypertension or diabetes, and the proportion whose diabetes or hypertension was not controlled. We used logistic regression models to calculate adjusted prevalence ratios to assess differences by selected characteristics. Results The estimated prevalence of hypertension was 9.3% overall. Among those with hypertension, 16.9% were unaware of their hypertension status and 40.7% had uncontrolled hypertension. Among women with diabetes, almost 30% had undiagnosed diabetes, and among those with diagnosed diabetes, the condition was not controlled in 51.5%. Conclusion This analysis improves our understanding of the prevalence of hypertension and diabetes among women of reproductive age and may facilitate opportunities to improve awareness and control of these conditions, reduce disparities in women’s health, and improve birth outcomes.
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Affiliation(s)
- Olumayowa Azeez
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, US Department of Health and Human Services, 200 Independence Ave, SW, Room 732F, Washington, DC 20201.
| | - Aniket Kulkarni
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Elena V Kuklina
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Shin Y Kim
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Shanna Cox
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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