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Sadiq R, Bukhari MH, Brown TT, Bennett WL, Retnakaran R, Echouffo-Tcheugui JB. Association of cumulative social risk and gestational diabetes mellitus in the US, 2007-2018. Diabetes Res Clin Pract 2023; 203:110840. [PMID: 37482220 PMCID: PMC10592126 DOI: 10.1016/j.diabres.2023.110840] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 06/03/2023] [Accepted: 07/20/2023] [Indexed: 07/25/2023]
Abstract
AIMS Little is known regarding the association of multiple social risk factors and gestational diabetes mellitus (GDM). METHODS We analyzed the 2007-2018 National Health and Nutrition Examination Surveys including 10,439 women aged ≥20 years (8 % with history of GDM). We created a cumulative social risk score (CSR) by adding scores assigned to each of the following: race/ethnicity, citizenship status and country of birth, education, and family income (score of 0 used as reference group). Using logistic regression, we assessed the associations of individual social risk factors (education, income, race/ethnicity and citizenship status) and CSR score with GDM, adjusting for age, parity, insurance status, care access, smoking, diet, physical activity, and body mass index. RESULTS Among individual social risk factors, being a non-U.S. citizen (OR:1.51, 95% CI: 1.06-2.15) or belonging to a minority racial/ethnic group (OR:1.30, 95% CI: 1.04-1.59) was significantly associated with a greater odds of GDM. When examining the combined effects of social risk factors, a CSR score ≥3 was associated with an increased odds of GDM (OR:1.64, 95% CI: 1.22-2.1). CONCLUSIONS Women with a greater burden of social risk factors are more likely to have GDM, thus should be the focus of interventions to prevent and treat GDM.
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Affiliation(s)
- Rabail Sadiq
- Department of Medicine, Division of Endocrinology, Diabetes & Metabolism, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Muhammad H Bukhari
- Department of Medicine, Norwalk Hospital affiliated with Yale University School of Medicine, Norwalk, CT, USA
| | - Todd T Brown
- Department of Medicine, Division of Endocrinology, Diabetes & Metabolism, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Wendy L Bennett
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Ravi Retnakaran
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Ontario, Canada; Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada; Division of Endocrinology, University of Toronto, Toronto, Ontario, Canada
| | - Justin B Echouffo-Tcheugui
- Department of Medicine, Division of Endocrinology, Diabetes & Metabolism, Johns Hopkins School of Medicine, Baltimore, MD, USA.
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Hammoud A, Chen H, Ivanov A, Yeboah J, Nasir K, Cainzos-Achirica M, Bertoni A, Khan SU, Blaha M, Herrington D, Shapiro MD. Implications of Social Disadvantage Score in Cardiovascular Outcomes and Risk Assessment: Findings From the Multi-Ethnic Study of Atherosclerosis. Circ Cardiovasc Qual Outcomes 2023; 16:e009304. [PMID: 37403692 PMCID: PMC10524792 DOI: 10.1161/circoutcomes.122.009304] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 05/03/2023] [Indexed: 07/06/2023]
Abstract
BACKGROUND Social determinants of health contribute to disparate cardiovascular outcomes, yet they have not been operationalized into the current paradigm of cardiovascular risk assessment. METHODS Data from the Multi-Ethnic Study of Atherosclerosis, which includes participants from 6 US field centers, were used to create an index of baseline Social Disadvantage Score (SDS) to explore its association with incident atherosclerotic cardiovascular disease (ASCVD) and all-cause mortality and impact on ASCVD risk prediction. SDS, which ranges from 0 to 4, was calculated by tallying the following social factors: (1) household income less than the federal poverty level; (2) educational attainment less than a high school diploma; (3) single-living status; and (4) experience of lifetime discrimination. Cox models were used to examine the association between SDS and each outcome with adjustment for traditional cardiovascular risk factors. Changes in the discrimination and reclassification of ASCVD risk by incorporating SDS into the pooled cohort equations were examined. RESULTS A total of 6434 participants (mean age, 61.9±10.2 years; female 52.8%; non-white 60.9%) had available SDS 1733 (26.9%) with SDS 0; 2614 (40.6%) with SDS 1; 1515 (23.5%) with SDS 2; and 572 (8.9%) with SDS ≥3. In total, 775 incident ASCVD events and 1573 deaths were observed over a median follow-up of 17.0 years. Increasing SDS was significantly associated with incident ASCVD and all-cause mortality after adjusting for traditional risk factors (ASCVD: per unit increase in SDS hazard ratio, 1.15 [95% CI, 1.07-1.24]; mortality: per unit increase in SDS hazard ratio, 1.13 [95% CI, 1.08-1.19]). Adding SDS to pooled cohort equations components in a Cox model for 10-year ASCVD risk prediction did not significantly improve discrimination (P=0.208) or reclassification (P=0.112). CONCLUSIONS Although SDS is independently associated with incident ASCVD and all-cause mortality, it does not improve 10-year ASCVD risk prediction beyond pooled cohort equations.
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Affiliation(s)
- Aziz Hammoud
- Section on Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Haiying Chen
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Alexander Ivanov
- Section on Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Joseph Yeboah
- Section on Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Khurram Nasir
- Department of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX
| | - Miguel Cainzos-Achirica
- Department of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX
| | - Alain Bertoni
- Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Safi U. Khan
- Section of Hospital Medicine, Department of Medicine, West Virginia University School of Medicine, Morgantown, WV
| | - Michael Blaha
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, MD
| | - David Herrington
- Section on Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Michael D. Shapiro
- Section on Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
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Berkowitz J, Khetpal V, Echouffo-Tcheugui JB, Bambs CE, Aiyer A, Kip KE, Reis SE, Erqou S. Associations between cumulative social risk, psychosocial risk, and ideal cardiovascular health: Insights from the HeartSCORE study. Am J Prev Cardiol 2022; 11:100367. [PMID: 35923764 PMCID: PMC9340530 DOI: 10.1016/j.ajpc.2022.100367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 05/16/2022] [Accepted: 07/16/2022] [Indexed: 11/21/2022] Open
Abstract
Higher social risk is associated with achievement of fewer ideal cardiovascular health factors. The association was modestly attenuated after adjusting for depression, stress, and perceived discrimination. Psychosocial factors may mediate part of the association between social risk and achievement of ideal cardiovascular health.
Background Limited studies have assessed the effects of psychosocial risk factors on achievement of ideal cardiovascular health (CVH). Methods Using the Heart Strategies Concentrating on Risk Evaluation (HeartSCORE) cohort, we examined the cross-sectional associations of cumulative social risk (CSR) and three psychosocial factors (depression, stress, perceived discrimination) with ideal CVH. CSR was calculated by assigning one point for each of: low family income, low education level, minority race (Black), and single-living status. Ideal CVH was calculated by assigning one point for ideal levels of each factor in American Heart Association's Life's Simple 7. Ideal CVH was dichotomized into fewer versus higher by combining participants achieving <3 versus ≥3 factors. Logistic regression models were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) of having fewer ideal CVH factors. Psychosocial factors were assessed as mediators of the association between CSR and ideal CVH. Results We included 2000 participants (mean age 59.1 [7.5] years, 34.6% male, 42.7% Black, and 29.1% with low income), among whom 60.6% had <3 ideal CVH factors. The odds of having fewer ideal CVH factors increased significantly with increasing CSR scores from 1 to 2, to ≥3 compared to individuals with CSR score of zero, after adjusting for age and sex (OR [95% CIs]: 1.77 [1.41 - 2.22]; 2.09 [1.62 - 2.69] 2.67 [1.97 - 3.62], respectively). Taking the components of ideal CVH separately, higher CSR was directly associated with odds of being in ‘non-ideal’ category for six of the seven factors, but was inversely associated with probability of being in ‘non-ideal’ category for cholesterol. The association was modestly attenuated after adjusting for depression, stress, and perceived discrimination (corresponding OR [95% CI]: 1.69 [1.34 - 2.12], 1.96 [1.51 - 2.55], 2.34 [1.71 - 3.20]). The psychosocial factors appeared to mediate between 10% and 20% of relationship between CSR and ideal CVH. Conclusions Increased CSR was associated with lower probability of achieving ideal CVH factors. A modest amount of the effect of CSR on ideal CVH appeared to be mediated by depression, stress and perceived discrimination. Public health strategies aimed at improving ideal cardiovascular health may benefit from including interventions targeting social and psychosocial risk factors.
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Affiliation(s)
- Julia Berkowitz
- Department of Medicine, the Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Vishal Khetpal
- Department of Medicine, the Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Justin B Echouffo-Tcheugui
- Department of Medicine, Division of Endocrinology, Diabetes & Metabolism, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Claudia E Bambs
- Department of Public Health, and Advanced Center for Chronic Diseases-ACCDiS, School of Medicine, Pontificia Universidad Católica de Chile, United States
| | - Aryan Aiyer
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Kevin E. Kip
- UPMC Health Services Division, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Steven E. Reis
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Sebhat Erqou
- Department of Medicine, the Warren Alpert Medical School of Brown University, Providence, RI, United States
- Division of Cardiology, Department of Medicine, Providence VA Medical Center, Providence, RI, United States
- Corresponding author at: Providence VA Medical Center, 830 Chalkstone Avenue, Providence, RI 02908, United States.
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Haddadin F, Beydoun H, Sabharwal B, Rzechorzek W, Khandaker M, Munoz Estrella A, Weininger D, Yue B, De La Villa R, Tamis-Holland JE. Differences in Social Hardships in Women and Men with Acute Myocardial Infarction: Impact on 30-Day Readmission. WOMEN'S HEALTH REPORTS 2022; 3:437-442. [PMID: 35559357 PMCID: PMC9081060 DOI: 10.1089/whr.2021.0150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 02/04/2022] [Indexed: 11/13/2022]
Abstract
Background: Studies have shown that women with acute myocardial infarction (AMI) have a higher prevalence of unfavorable social variables then men and have a worse outcome. Less is known regarding the impact of these social variables on 30-day readmission after AMI. Materials and Methods: We analyzed adult patients with AMI enrolled in a Quality Improvement Program intended to improve the peri-discharge care of patients with an AMI, and decrease all-cause 30-day unplanned readmissions. We compared clinical and social variables by gender. Multivariate logistic regression, with separate adjustment for clinical and for social variable, was used to measure adjusted odds for readmission by gender. Results: Among 208 patients included in our project 68 (32.7%) were women. Only 30.9% of women were married or had domestic partner at the time of the interview and only 16.2% were employed. Nearly half of women (48.5%) needed help with medical care, and 39.7% of women did not speak English as their first language. These variables were significantly different by gender. Rates of 30-day readmissions were higher in women than men (22.1% vs. 7.8%, p = 0.024). After adjusting for clinical variables this difference by gender in 30-day readmissions remained significant (odds ratio [OR] 3.34 95% confidence interval [CI] 1.1–11.1, p = 0.049). However, when adjusting for social variables, this difference was no longer noted (OR 0.87 95% CI 0.27–2.78, p = 0.822). Conclusion: Women with AMI are more likely than men to have unfavorable social factors that can impact recovery from AMI and women have a higher 30-day readmission rate. The higher 30-day readmissions in women appears to be influenced by these social factors. Health care interventions aimed at reducing 30-day readmission after AMI should focus on eliciting a detailed social history and providing aid for those requiring additional social support at home.
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Affiliation(s)
- Faris Haddadin
- Section of Cardiology, Baylor College of Medicine, Houston, Texas, USA
| | - Hassan Beydoun
- Department of Cardiology, University of Arizona COM-Phoenix, Phoenix, Arizona, USA
| | - Basera Sabharwal
- Department of Cardiology, Icahn School of Medicine at Mount Sinai Morningside, New York, New York, USA
| | - Wojciech Rzechorzek
- Department of Cardiovascular Medicine, Westchester Medical Center, New York Medical College, Valhalla, New York, USA
| | - Mariam Khandaker
- Department of Cardiology, University of Miami/Jackson Memorial Hospital, Miami, Florida, USA
| | - Alba Munoz Estrella
- Department of Cardiology, Icahn School of Medicine at Mount Sinai Morningside, New York, New York, USA
| | - David Weininger
- Department of Cardiovascular Medicine, Westchester Medical Center, New York Medical College, Valhalla, New York, USA
| | - Bing Yue
- Department of Cardiology, Icahn School of Medicine at Mount Sinai Morningside, New York, New York, USA
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Zhang W, Ahmad MI, Soliman EZ. The role of traditional risk factors in explaining the social disparities in cardiovascular death: The national health and Nutrition Examination Survey III (NHANES III). Am J Prev Cardiol 2020; 4:100094. [PMID: 34327470 PMCID: PMC8315458 DOI: 10.1016/j.ajpc.2020.100094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 09/30/2020] [Accepted: 10/03/2020] [Indexed: 11/19/2022] Open
Abstract
Objective ─ To assess the role of traditional risk factors in explaining the association between cumulative social risk exposure and disparities in CVD death among US adults. Methods ─ The study included 15,906 participants from the Third National Health and Nutrition Examination Survey III who were CVD-free at enrollment. Baseline social risk factors (minority race, poverty-income ratio<1, education<12 grade, and living single) were used to create a cumulative social risk score (0 to ≥3). CVD death served as the primary outcome. We assessed the contribution of each major CVD risk factor to the link between cumulative social risk exposure and CVD death. Results ─ During a median follow-up of 14 years, 1309 CVD deaths occurred. Participants with elevated cumulative social risk score were at increased risk of CVD death, with hazard ratio 1.19(95%CI 1.01–1.41), 1.52(95%CI 1.28–1.79), and 1.46 (95%CI 1.23–1.74) in individuals with score 1, 2 and ≥ 3 respectively, compared with individuals with score of 0. Traditional CVD risk factors explained about one third of the disparities in CVD death in individuals with the elevated social risk exposure. Among the one third effect by combined CVD risk factors, current smoking contributed the largest proportion, accounting for approximately one half of the combined risk factors effect, followed by obesity and diabetes. Conclusions ─Among the traditional risk factors, control of smoking appears to be the greatest opportunity to attenuate the social disparities in CVD death. While these findings call for further studies to identify other pathways that explain the elevated CVD mortality in socially disadvantaged population.
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Key Words
- ACC, American College of Cardiology
- AHA, American Heart Association
- BP, blood pressure
- CI, confidence interval
- CVD, cardiovascular disease
- Cardiovascular death
- Cumulative social risk exposure
- DM, diabetes mellitus
- HLD, hyperlipidemia
- HTN, hypertension
- HbA1c, hemoglobin A1c (glycosylated hemoglobin)
- NHANES III, National Health and Nutrition Examination Survey III
- Social disparity
- Third national health and nutrition examination survey
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Affiliation(s)
- Wei Zhang
- Department of Internal Medicine, Section on Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- Corresponding author. Department of Internal Medicine, Section on Cardiovascular Medicine, Wake Forest School of Medicine, Medical Center Blvd, Winston Salem, NC, 27157, USA.
| | - Muhammad Imtiaz Ahmad
- Department of Internal Medicine, Section on Hospital Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Elsayed Z. Soliman
- Department of Internal Medicine, Section on Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- Department of Epidemiology and Prevention, Epidemiological Cardiology Research Center (EPICARE), Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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Patel N, Ahmad MI, Zhang W, Soliman EZ. Interrelations of Cumulative Social Risk, Silent Myocardial Infarction, and Mortality in the General Population. Am J Cardiol 2020; 125:1823-1828. [PMID: 32327189 DOI: 10.1016/j.amjcard.2020.03.026] [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: 01/24/2020] [Revised: 03/13/2020] [Accepted: 03/19/2020] [Indexed: 11/26/2022]
Abstract
Cumulative social risk (CSR), defined as experiencing more than one social risk factor, is associated with a significant increase in cardiovascular mortality. However, it is unclear whether CSR is associated with prevalent silent myocardial infarction (SMI), and whether their joint presence is predictive of mortality more than the presence of CSR in isolation. This analysis included 6,708 participants from the third National Health and Nutrition Examination Survey who were free of clinical cardiovascular disease at the time of enrollment. Baseline social risk factors (poverty-income ratio <1, minority race, education <12 grade, and living single) were used to create the CSR score with values ranging from 0 to ≥3. SMI was defined as electrocardiographic evidence of MI in the absence of clinical MI. In a multivariable-adjusted logistic regression model, baseline CSR ≥ 3 (vs 0) was associated with a higher prevalence of SMI (odds ratio [95% confidence interval]: 2.21 [1.16 to 4.23]). Over a median follow-up of 14 years, there were 2,151 all-cause deaths. Compared with CSR of 0 and no SMI, the risk of mortality with CSR was higher in the presence of SMI than without SMI (multivariable adjusted Hazard Ratios [95% confidence intervals] with vs without SMI were 1.76 [1.13 to 2.75] vs 1.27 [1.10 to 1.46] for CSR≥ 3; 2.06 [1.31 to 3.24] vs 1.21 [1.06 to 1.39] for CSR = 2; and 2.02 [1.31 to 3.12] vs 1.33 [0.63 to 2.82] for CSR = 1, respectively). In conclusion, exposure to CSR is associated with increased risk of SMI, and concomitant presence of SMI with CSR is associated with a higher risk of mortality than presence of CSR alone.
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Lee HH, Kang AW, Lee H, Cha Y, Operario D. Cumulative Social Risk and Cardiovascular Disease Among Adults in South Korea: A Cross-Sectional Analysis of a Nationally Representative Sample. Prev Chronic Dis 2020; 17:E39. [PMID: 32463785 PMCID: PMC7279061 DOI: 10.5888/pcd17.190382] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION The Framingham risk score (FRS) is widely used to predict cardiovascular disease (CVD), but it neglects to account for social risk factors. Our study examined whether use of a cumulative social risk score in addition to the FRS improves prediction of CVD among South Korean adults. METHODS We used nationally representative data on 19,147 adults aged 19 or older from the Korea National Health and Nutrition Examination Survey 2013-2016. We computed a cumulative social risk score (range, 0-3) based on 3 social risk factors: low household income, low level of education, and single-living status. CVD outcomes were stroke, myocardial infarction, and angina. Weighted logistic regression examined the associations between cumulative social risk, FRS, and CVD. McFadden pseudo-R2 and area under receiver operating characteristic curve (AUC) assessed model performance. We conducted mediation analyses to quantify the association between cumulative social risk score and CVD outcomes that is not mediated by the FRS. RESULTS A unit increase in social risk was associated with 89.4% higher risk of stroke diagnosis, controlling for the FRS (P < .001). The FRS explained 8.0% of stroke diagnosis (R2) with fair discrimination (AUC = 0.728), and adding the cumulative social risk score enhanced R2 and AUC by 2.4% and 0.039. In the association between cumulative social risk and stroke, the proportion not mediated by the FRS was 65% (P < .001). We observed similar trends in myocardial infarction and angina, such that an increase in social risk was associated with increased relative risk of disease and improved disease diagnosis, and a large proportion of the association was not mediated by the FRS. CONCLUSION Controlling for the FRS, cumulative social risks predicted stroke, myocardial infarction, and angina among adults in South Korea. Future research is needed to examine non-FRS mediators between cumulative social risk and CVD.
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Affiliation(s)
- Harold H Lee
- Deparment of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 401 Park Dr, 428F, Boston, MA 02215.
| | - Augustine W Kang
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Hyunjoon Lee
- Department of Computer Science, Brown University, Providence, Rhode Island
| | - Yoojin Cha
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Don Operario
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island
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Canterbury A, Echouffo-Tcheugui JB, Shpilsky D, Aiyer A, Reis SE, Erqou S. Association between cumulative social risk, particulate matter environmental pollutant exposure, and cardiovascular disease risk. BMC Cardiovasc Disord 2020; 20:76. [PMID: 32046641 PMCID: PMC7014734 DOI: 10.1186/s12872-020-01329-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 01/06/2020] [Indexed: 11/16/2022] Open
Abstract
Background Long-term exposure to pollution has been shown to increase risk of cardiovascular disease (CVD) and mortality, and may contribute to the increased risk of CVD among individuals with higher social risk. Methods Data from the community-based Heart Strategies Concentrating on Risk Evaluation (HeartSCORE) study were used to quantify Cumulative Social Risk (CSR) by assigning a score of 1 for the presence of each of 4 social risk factors: racial minority, single living, low income, and low educational status. 1-year average air pollution exposure to PM2.5 was estimated using land-use regression models. Associations with clinical outcomes were assessed using Cox models, adjusting for traditional CVD risk factors. The primary clinical outcome was combined all-cause mortality and nonfatal CVD events. Results Data were available on 1933 participants (mean age 59 years, 66% female, 44% Black). In a median follow up time of 8.3 years, 137 primary clinical outcome events occurred. PM2.5 exposure increased with higher CSR score. PM2.5 was independently associated with clinical outcome (adjusted hazard ratio [HR]: 1.19 [95% CI: 1.00, 1.41]). Participants with ≥2 CSR factors had an adjusted HR of 2.34 (1.48–3.68) compared to those with CSR = 0. The association was attenuated after accounting for PM2.5 (HR: 2.16; [1.34, 3.49]). Mediation analyses indicate that PM2.5 explained 13% of the risk of clinical outcome in individuals with CSR score ≥ 2. Conclusion In a community-based cohort study, we found that the association of increasing CSR with higher CVD and mortality risks is partially accounted for by exposure to PM2.5 environmental pollutants.
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Affiliation(s)
- Ann Canterbury
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Daniel Shpilsky
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Aryan Aiyer
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Steven E Reis
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sebhat Erqou
- Department of Medicine, VA Providence Medical Center, Providence, RI, USA. .,Department of Medicine, Alpert Medical School of Brown University, 830 Chalkstone Avenue, Providence, RI, USA.
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Erqou S, Echouffo-Tcheugui JB, Kip KE, Aiyer A, Reis SE. Association of cumulative social risk with mortality and adverse cardiovascular disease outcomes. BMC Cardiovasc Disord 2017; 17:110. [PMID: 28482797 PMCID: PMC5422978 DOI: 10.1186/s12872-017-0539-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Accepted: 04/18/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Quantifying the cumulative effect of social risk factors on cardiovascular disease (CVD) risk can help to better understand the sources of disparities in health outcomes. METHOD AND RESULTS Data from the Heart Strategies Concentrating on Risk Evaluation (HeartSCORE) study were used to create an index of cumulative social risk (CSR) and quantify its association with incident CVD and all-cause mortality. CSR was defined by assigning a score of 1 for the presence of each of 4 social factors: i) racial minority status (Black race), ii) single living status, iii) low income, and iv) low educational level. Hazard ratios (HRs) were computed using Cox-regression models, adjusted for CVD risk factors. Over a median follow-up period of 8.3 years, 127 incident events were observed. The incidence of the primary outcome for subgroups of participants with 0, 1, and ≥2 CSR scores was 5.31 (95% CI, 3.40-7.22), 10.32 (7.16-13.49) and 17.80 (12.94-22.67) per 1000 person-years, respectively. Individuals with CSR score of 1 had an adjusted HR of 1.85 (1.15-2.97) for incident primary outcomes, compared to those with score of 0. The corresponding HR for individuals with CSR score of 2 or more was 2.58 (1.60-4.17). CONCLUSION An accumulation of social risk factors independently increased the likelihood of CVD events and deaths in a cohort of White and Black individuals.
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Affiliation(s)
- Sebhat Erqou
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA USA
| | | | - Kevin E. Kip
- College of Nursing, University of South Florida, Tampa, FL USA
| | - Aryan Aiyer
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA USA
| | - Steven E. Reis
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA USA
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Loprinzi PD, Davis RE. Socioecological Risk Predictors of Physical Activity and Associated Mortality. Am J Health Promot 2016; 32:106-111. [PMID: 27553059 DOI: 10.1177/0890117116662943] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To assess (1) the cumulative effect of socioecological factors (social risk) on objectively measured physical activity, (2) the cumulative socioecological risk on all-cause mortality, (3) the potential interaction effects of social risk factors on physical activity and mortality, and (4) whether physical activity mediates the relationship between social risk and mortality. DESIGN Cross-sectional and prospective. SETTING Laboratory- and survey-based testing of the general US population. PARTICIPANTS Five thousand five hundred seventy-four adult participants of the National Health and Nutrition Examination Survey 2003 to 2006. MEASURES Social risk was assessed from 4 variables, namely poverty level, education, minority status, and social living status. Moderate-to-vigorous physical activity (MVPA) was assessed via accelerometry. Mortality was assessed via linkage with the National Death Index, with follow-up through 2011. ANALYSIS Negative binomial regression and Cox proportional hazard model. RESULTS Compared to those with 0 social risk factors, those with 1 and 2+ social risk factors engaged in 11% and 10% less MVPA, respectively. Those with 1 (vs 0) social risk factor had a 2.0-fold increase in mortality risk, and those with 2+ (vs 0) social risk factors had a 2.3-fold increase in mortality risk. Interaction effects for various socioecological factors on both MVPA and mortality were observable. CONCLUSION Cumulative social risk is associated with less MVPA and increased all-cause mortality risk. Given the interaction effects of socioecological factors, targeted interventions in identified populations may be needed.
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Affiliation(s)
- Paul D Loprinzi
- 1 Jackson Heart Study Vanguard Center of Oxford, The University of Mississippi, Oxford, MS, USA.,2 Center for Health Behavior Research, The University of Mississippi, Oxford, MS, USA.,3 Department of Health, Exercise Science and Recreation Management, The University of Mississippi, Oxford, MS, USA
| | - Robert E Davis
- 2 Center for Health Behavior Research, The University of Mississippi, Oxford, MS, USA.,3 Department of Health, Exercise Science and Recreation Management, The University of Mississippi, Oxford, MS, USA
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Loprinzi PD, Davis RE. Psycho-socioeconomic bio-behavioral associations on all-cause mortality: cohort study. Health Promot Perspect 2016; 6:66-70. [PMID: 27386420 PMCID: PMC4932224 DOI: 10.15171/hpp.2016.12] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 04/22/2016] [Indexed: 11/09/2022] Open
Abstract
Background: The purpose of this study was to examine the cumulative effects of psychological,socioeconomic, biological and behavioral parameters on mortality. Methods: A prospective design was employed. Data from the 2005-2006 National Health and Nutrition Examination Survey (NHANES) were used (analyzed in 2015); follow-up mortality status evaluated in 2011. Psychological function was assessed from the Patient Health Questionnaire-9 (PHQ-9) as a measure of depression. Socioeconomic risk was assessed from poverty level, education, minority status, and social living status. Biological parameters included cholesterol, weight status, diabetes, hypertension and systemic inflammation. Behavioral parameters assessed included physical activity (accelerometry), dietary behavior, smoking status (cotinine) and sleep. These 14 psycho-socioeconomic bio-behavioral (PSBB) parameters allowed for the calculation of an overall PSBB Index, ranging from 0-14. Results: Among the evaluated 2530 participants, 161 died over the unweighted median follow-up period of 70.0 months. After adjustment, for every 1 increase in the overall PSBB index score,participants had a 15% reduced risk of all-cause mortality (HR = 0.85; 95% CI: 0.76-0.96). After adjustment, the Behavioral Index (HR = 0.73; 95% CI: 0.60-0.88) and the Socioeconomic Index(HR = 0.82; 95% CI: 0.68-0.99) were significant, but the Psychological Index (HR = 0.67; 95%CI: 0.29-1.51) and the Biological Index (HR = 1.03; 95% CI: 0.89-1.18) were not. Conclusion: Those with a worse PSBB score had an increased risk of all-cause mortality.Promotion of concurrent health behaviors may help to promote overall well-being and prolong survival.
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Affiliation(s)
- Paul D Loprinzi
- Jackson Heart Study Vanguard Center of Oxford, Center for Health Behavior Research, Physical Activity Epidemiology Laboratory, Department of Health, Exercise Science and Recreation Management, The University of Mississippi, University, MS 38677, USA
| | - Robert E Davis
- Center for Health Behavior Research, Physical Activity Epidemiology Laboratory, Department of Health, Exercise Science and Recreation Management, The University of Mississippi, University, MS 38677, USA
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Caleyachetty R, Tehranifar P, Genkinger JM, Echouffo-Tcheugui JB, Muennig P. Cumulative social risk exposure and risk of cancer mortality in adulthood. BMC Cancer 2015; 15:945. [PMID: 26675142 PMCID: PMC4682241 DOI: 10.1186/s12885-015-1997-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 12/11/2015] [Indexed: 01/08/2023] Open
Abstract
Background Adults in the United States (U.S) can be simultaneously exposed to more than one social risk factor over their lifetime. However, cancer epidemiology tends to focus on single social risk factors at a time. We examined the prospective association between cumulative social risk exposure and deaths from cancer in a nationally representative sample of U.S. adults. Methods The study included 8745 adults (aged ≥ 40 years) in the NHANES Survey III Mortality Study over a median follow-up of 13.5 years (1988-1994 enrollment dates and 1988 through 2006 for mortality data). Social risk factors (low family income, low education level, minority race, and single-living status) were summed to create a cumulative social risk score (0 to ≥3). We used Cox proportional hazard models to estimate age- and sex-adjusted hazard ratios (HRs) and 95 % confidence intervals (95 % CI) for the association between cumulative social risk with deaths from all-cancers combined, tobacco-related cancers, and screening-detectable cancers. Results Deaths from all-cancers combined (P for trend = 0.001), tobacco-related cancers (P for trend = <0.001), and lung cancer (P for trend = 0.01) increased with an increasing number of social risk factors. As compared with adults with no social risk factors, those exposed to ≥3 social risk factors were at increased risk of deaths from all-cancers combined (HR = 1.8, 95 % CI = 1.3-2.4), tobacco-related cancers (HR = 2.6, 95 % CI: 1.6-4.0), and lung cancer (HR = 2.3, 95 % CI = 1.3-4.1). Conclusions U.S. adults confronted by higher amounts of cumulative social risk appear to have increased mortality from all-cancers combined, tobacco-related cancers, and lung cancer. An enhanced understanding of the cumulative effect of social risk factors may be important for targeting interventions to address social disparities in cancer mortality.
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Affiliation(s)
- Rishi Caleyachetty
- Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, NY, USA. .,MRC University Unit for Lifelong Health and Ageing, University College London, London, UK.
| | - Parisa Tehranifar
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.
| | - Jeanine M Genkinger
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.
| | - Justin B Echouffo-Tcheugui
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - Peter Muennig
- Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, NY, USA.
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