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Zhu AL, Le AD, Li Y, Palaniappan LP, Srinivasan M, Shah NS, Wong SS, Valero-Elizondo J, Elfassy T, Yang E. Social Determinants of Cardiovascular Risk Factors Among Asian American Subgroups. J Am Heart Assoc 2024; 13:e032509. [PMID: 38567660 DOI: 10.1161/jaha.123.032509] [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: 09/03/2023] [Accepted: 01/30/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Social determinants of health (SDOH) play a significant role in the development of cardiovascular risk factors. We investigated SDOH associations with cardiovascular risk factors among Asian American subgroups. METHODS AND RESULTS We utilized the National Health Interview Survey, a nationally representative survey of US adults, years 2013 to 2018. SDOH variables were categorized into economic stability, neighborhood and social cohesion, food security, education, and health care utilization. SDOH score was created by categorizing 27 SDOH variables as 0 (favorable) or 1 (unfavorable). Self-reported cardiovascular risk factors included diabetes, high cholesterol, high blood pressure, obesity, insufficient physical activity, suboptimal sleep, and nicotine exposure. Among 6395 Asian adults aged ≥18 years, 22.1% self-identified as Filipino, 21.6% as Asian Indian, 21.0% as Chinese, and 35.3% as other Asian. From multivariable-adjusted logistic regression models, each SD increment of SDOH score was associated with higher odds of diabetes among Chinese (odds ratio [OR], 1.45; 95% CI, 1.04-2.03) and Filipino (OR, 1.24; 95% CI, 1.02-1.51) adults; high blood pressure among Filipino adults (OR, 1.28; 95% CI, 1.03-1.60); insufficient physical activity among Asian Indian (OR, 1.42; 95% CI, 1.22-1.65), Chinese (OR, 1.58; 95% CI, 1.33-1.88), and Filipino (OR, 1.24; 95% CI, 1.06-1.46) adults; suboptimal sleep among Asian Indian adults (OR, 1.20; 95% CI, 1.01-1.42); and nicotine exposure among Chinese (OR, 1.56; 95% CI, 1.15-2.11) and Filipino (OR, 1.50; 95% CI, 1.14-1.97) adults. CONCLUSIONS Unfavorable SDOH are associated with higher odds of cardiovascular risk factors in Asian American subgroups. Culturally specific interventions addressing SDOH may help improve cardiovascular health among Asian Americans.
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Affiliation(s)
- Alicia L Zhu
- Stanford University Center for Asian Healthcare Research and Education Stanford CA
- College of Arts and Sciences, School of Global Public Health New York University New York NY
| | - Austin D Le
- Stanford University Center for Asian Healthcare Research and Education Stanford CA
- Environmental Health Sciences Division University of California, Berkeley, School of Public Health Berkeley CA
| | - Yuemeng Li
- Stanford University Center for Asian Healthcare Research and Education Stanford CA
- Nell Hodgson Woodruff School of Nursing Emory University Atlanta GA
| | - Latha P Palaniappan
- Stanford University Center for Asian Healthcare Research and Education Stanford CA
- Division of Primary Care and Population Health Stanford University School of Medicine Stanford CA
| | - Malathi Srinivasan
- Stanford University Center for Asian Healthcare Research and Education Stanford CA
- Division of Primary Care and Population Health Stanford University School of Medicine Stanford CA
| | - Nilay S Shah
- Departments of Medicine (Cardiology) and Preventive Medicine Northwestern University Feinberg School of Medicine Chicago IL
| | - Sally S Wong
- American Heart Association, Office of Science, Medicine, and Health Dallas TX
| | - Javier Valero-Elizondo
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center Houston TX
| | - Tali Elfassy
- Stanford University Center for Asian Healthcare Research and Education Stanford CA
- Department of Medicine, Division of Nephrology and Hypertension University of Miami Miller School of Medicine Miami FL
| | - Eugene Yang
- Stanford University Center for Asian Healthcare Research and Education Stanford CA
- Division of Cardiology University of Washington School of Medicine Seattle WA
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Springer YP, Kammerer JS, Felix D, Newell K, Tompkins ML, Allison J, Castrodale LJ, Chandler B, Helfrich K, Rothoff M, McLaughlin JB, Silk BJ. Using Geographic Disaggregation to Compare Tuberculosis Epidemiology Among American Indian and Alaska Native Persons-USA, 2010-2020. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01919-z. [PMID: 38334874 DOI: 10.1007/s40615-024-01919-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 12/29/2023] [Accepted: 01/20/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND American Indian and Alaska Native (AIAN) populations are frequently associated with the highest rates of tuberculosis (TB) disease of any racial/ethnic group in the USA. We systematically investigated variation in patterns and potential drivers of TB epidemiology among geographically distinct AIAN subgroups. METHODS Using data reported to the National Tuberculosis Surveillance System during 2010-2020, we applied a geographic method of data disaggregation to compare annual TB incidence and the frequency of TB patient characteristics among AIAN persons in Alaska with AIAN persons in other states. We used US Census data to compare the prevalence of substandard housing conditions in AIAN communities in these two geographic areas. RESULTS The average annual age-adjusted TB incidence among AIAN persons in Alaska was 21 times higher than among AIAN persons in other states. Compared to AIAN TB patients in other states, AIAN TB patients in Alaska were associated with significantly higher frequencies of multiple epidemiologic TB risk factors (e.g., attribution of TB disease to recent transmission, previous diagnosis of TB disease) and significantly lower frequencies of multiple clinical risk factors for TB disease (e.g., diagnosis with diabetes mellitus, end-stage renal disease). Occupied housing units in AIAN communities in Alaska were associated with significantly higher frequencies of multiple measures of substandard housing conditions compared to AIAN communities in other states. CONCLUSIONS Observed differences in patient characteristics and substandard housing conditions are consistent with contrasting syndromes of TB epidemiology in geographically distinct AIAN subgroups and suggest ways that associated public health interventions could be tailored to improve efficacy.
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Affiliation(s)
- Yuri P Springer
- Centers for Disease Control and Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Division of Tuberculosis Elimination, Atlanta, GA, USA.
| | - J Steve Kammerer
- Centers for Disease Control and Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Division of Tuberculosis Elimination, Atlanta, GA, USA
| | - Derrick Felix
- Centers for Disease Control and Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Division of Tuberculosis Elimination, Atlanta, GA, USA
| | - Katherine Newell
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, National Center for State, Tribal, Local, and Territorial Public Health Infrastructure and Workforce, Division of Workforce Development, Atlanta, GA, USA
- Alaska Division of Public Health, Section of Epidemiology, Anchorage, Alaska, USA
| | - Megan L Tompkins
- Alaska Division of Public Health, Section of Epidemiology, Anchorage, Alaska, USA
| | - Jamie Allison
- Alaska Division of Public Health, Section of Epidemiology, Anchorage, Alaska, USA
| | - Louisa J Castrodale
- Alaska Division of Public Health, Section of Epidemiology, Anchorage, Alaska, USA
| | - Bruce Chandler
- Alaska Division of Public Health, Section of Epidemiology, Anchorage, Alaska, USA
| | - Kathryn Helfrich
- Alaska Division of Public Health, Section of Epidemiology, Anchorage, Alaska, USA
| | - Michelle Rothoff
- Alaska Division of Public Health, Section of Epidemiology, Anchorage, Alaska, USA
| | - Joseph B McLaughlin
- Alaska Division of Public Health, Section of Epidemiology, Anchorage, Alaska, USA
| | - Benjamin J Silk
- Centers for Disease Control and Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Division of Tuberculosis Elimination, Atlanta, GA, USA
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Springer YP, Filardo TD, Woodruff RS, Self JL. Racial and Ethnic Disaggregation of Tuberculosis Incidence and Risk Factors Among American Indian and Alaska Native Persons-United States, 2001-2020. Am J Public Health 2024; 114:226-236. [PMID: 38335486 PMCID: PMC10862211 DOI: 10.2105/ajph.2023.307498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Abstract
Objectives. To examine impacts of racial and ethnic disaggregation on the characterization of tuberculosis (TB) epidemiology among American Indian and Alaska Native (AI/AN) persons in the United States. Methods. Using data reported to the National Tuberculosis Surveillance System during 2001 to 2020, we compared annual age-adjusted TB incidence and the frequency of TB risk factors among 3 AI/AN analytic groups: non-Hispanic AI/AN alone persons, multiracial/Hispanic AI/AN persons, and all AI/AN persons (aggregate of the first 2 groups). Results. During 2009 to 2020, annual TB incidence (cases per 100 000 persons) among non-Hispanic AI/AN alone persons (range = 3.87-8.56) was on average 1.9 times higher than among all AI/AN persons (range = 1.89-4.70). Compared with non-Hispanic AI/AN alone patients with TB, multiracial/Hispanic AI/AN patients were significantly more likely to be HIV positive (prevalence ratio [PR] = 2.05) and to have been diagnosed while a resident of a correctional facility (PR = 1.71), and significantly less likely to have experienced homelessness (PR = 0.53) or died during TB treatment (PR = 0.47). Conclusions. Racial and ethnic disaggregation revealed significant differences in TB epidemiology among AI/AN analytic groups. Exclusion of multiracial/Hispanic AI/AN persons from AI/AN analytic groups can substantively affect estimates of racial and ethnic health disparities. (Am J Public Health. 2024;114(2):226-236. https://doi.org/10.2105/AJPH.2023.307498).
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Affiliation(s)
- Yuri P Springer
- Yuri P. Springer, Thomas D. Filardo, Rachel S. Woodruff, and Julie L. Self are with the Centers for Disease Control and Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Division of Tuberculosis Elimination, Atlanta, GA. Thomas D. Filardo is also with the Epidemic Intelligence Service, Centers for Disease Control and Prevention, National Center for State, Tribal, Local, and Territorial Public Health Infrastructure and Workforce, Division of Workforce Development, Atlanta, GA
| | - Thomas D Filardo
- Yuri P. Springer, Thomas D. Filardo, Rachel S. Woodruff, and Julie L. Self are with the Centers for Disease Control and Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Division of Tuberculosis Elimination, Atlanta, GA. Thomas D. Filardo is also with the Epidemic Intelligence Service, Centers for Disease Control and Prevention, National Center for State, Tribal, Local, and Territorial Public Health Infrastructure and Workforce, Division of Workforce Development, Atlanta, GA
| | - Rachel S Woodruff
- Yuri P. Springer, Thomas D. Filardo, Rachel S. Woodruff, and Julie L. Self are with the Centers for Disease Control and Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Division of Tuberculosis Elimination, Atlanta, GA. Thomas D. Filardo is also with the Epidemic Intelligence Service, Centers for Disease Control and Prevention, National Center for State, Tribal, Local, and Territorial Public Health Infrastructure and Workforce, Division of Workforce Development, Atlanta, GA
| | - Julie L Self
- Yuri P. Springer, Thomas D. Filardo, Rachel S. Woodruff, and Julie L. Self are with the Centers for Disease Control and Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Division of Tuberculosis Elimination, Atlanta, GA. Thomas D. Filardo is also with the Epidemic Intelligence Service, Centers for Disease Control and Prevention, National Center for State, Tribal, Local, and Territorial Public Health Infrastructure and Workforce, Division of Workforce Development, Atlanta, GA
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Khan MM, Deb Nath N, Schmidt M, Njau G, Odoi A. Geographic disparities and temporal changes of COVID-19 hospitalization risks in North Dakota. Front Public Health 2023; 11:1062177. [PMID: 37006524 PMCID: PMC10061029 DOI: 10.3389/fpubh.2023.1062177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 02/24/2023] [Indexed: 03/18/2023] Open
Abstract
BackgroundAlthough the burden of the coronavirus disease 2019 (COVID-19) has been different across communities in the US, little is known about the disparities in COVID-19 burden in North Dakota (ND) and yet this information is important for guiding planning and provision of health services. Therefore, the objective of this study was to identify geographic disparities of COVID-19 hospitalization risks in ND.MethodsData on COVID-19 hospitalizations from March 2020 to September 2021 were obtained from the ND Department of Health. Monthly hospitalization risks were computed and temporal changes in hospitalization risks were assessed graphically. County-level age-adjusted and spatial empirical Bayes (SEB) smoothed hospitalization risks were computed. Geographic distributions of both unsmoothed and smoothed hospitalization risks were visualized using choropleth maps. Clusters of counties with high hospitalization risks were identified using Kulldorff's circular and Tango's flexible spatial scan statistics and displayed on maps.ResultsThere was a total of 4,938 COVID-19 hospitalizations during the study period. Overall, hospitalization risks were relatively stable from January to July and spiked in the fall. The highest COVID-19 hospitalization risk was observed in November 2020 (153 hospitalizations per 100,000 persons) while the lowest was in March 2020 (4 hospitalizations per 100,000 persons). Counties in the western and central parts of the state tended to have consistently high age-adjusted hospitalization risks, while low age-adjusted hospitalization risks were observed in the east. Significant high hospitalization risk clusters were identified in the north-west and south-central parts of the state.ConclusionsThe findings confirm that geographic disparities in COVID-19 hospitalization risks exist in ND. Specific attention is required to address counties with high hospitalization risks, especially those located in the north-west and south-central parts of ND. Future studies will investigate determinants of the identified disparities in hospitalization risks.
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Affiliation(s)
- Md Marufuzzaman Khan
- Department of Public Health, College of Education, Health, and Human Sciences, University of Tennessee, Knoxville, TN, United States
| | - Nirmalendu Deb Nath
- Department of Biomedical and Diagnostic Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN, United States
| | - Matthew Schmidt
- North Dakota Department of Health and Human Services, Special Projects and Health Analytics, Bismarck, ND, United States
| | - Grace Njau
- North Dakota Department of Health and Human Services, Special Projects and Health Analytics, Bismarck, ND, United States
| | - Agricola Odoi
- Department of Biomedical and Diagnostic Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN, United States
- *Correspondence: Agricola Odoi
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Lord J, Roberson S, Odoi A. A retrospective investigation of spatial clusters and determinants of diabetes prevalence: scan statistics and geographically weighted regression modeling approaches. PeerJ 2023; 11:e15107. [PMID: 37155464 PMCID: PMC10122841 DOI: 10.7717/peerj.15107] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/01/2023] [Indexed: 05/10/2023] Open
Abstract
Background Diabetes and its complications represent a significant public health burden in the United States. Some communities have disproportionately high risks of the disease. Identification of these disparities is critical for guiding policy and control efforts to reduce/eliminate the inequities and improve population health. Thus, the objectives of this study were to investigate geographic high-prevalence clusters, temporal changes, and predictors of diabetes prevalence in Florida. Methods Behavioral Risk Factor Surveillance System data for 2013 and 2016 were provided by the Florida Department of Health. Tests for equality of proportions were used to identify counties with significant changes in the prevalence of diabetes between 2013 and 2016. The Simes method was used to adjust for multiple comparisons. Significant spatial clusters of counties with high diabetes prevalence were identified using Tango's flexible spatial scan statistic. A global multivariable regression model was fit to identify predictors of diabetes prevalence. A geographically weighted regression model was fit to assess for spatial non-stationarity of the regression coefficients and fit a local model. Results There was a small but significant increase in the prevalence of diabetes in Florida (10.1% in 2013 to 10.4% in 2016), and statistically significant increases in prevalence occurred in 61% (41/67) of counties in the state. Significant, high-prevalence clusters of diabetes were identified. Counties with a high burden of the condition tended to have high proportions of the population that were non-Hispanic Black, had limited access to healthy foods, were unemployed, physically inactive, and had arthritis. Significant non-stationarity of regression coefficients was observed for the following variables: proportion of the population physically inactive, proportion with limited access to healthy foods, proportion unemployed, and proportion with arthritis. However, density of fitness and recreational facilities had a confounding effect on the association between diabetes prevalence and levels of unemployment, physical inactivity, and arthritis. Inclusion of this variable decreased the strength of these relationships in the global model, and reduced the number of counties with statistically significant associations in the local model. Conclusions The persistent geographic disparities of diabetes prevalence and temporal increases identified in this study are concerning. There is evidence that the impacts of the determinants on diabetes risk vary by geographical location. This implies that a one-size-fits-all approach to disease control/prevention would be inadequate to curb the problem. Therefore, health programs will need to use evidence-based approaches to guide health programs and resource allocation to reduce disparities and improve population health.
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Affiliation(s)
- Jennifer Lord
- Biomedical and Diagnostic Sciences, University of Tennessee, Knoxville, United States of America
| | | | - Agricola Odoi
- Biomedical and Diagnostic Sciences, University of Tennessee, Knoxville, United States of America
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Association of Acculturation with Cardiovascular Risk Factors in Asian-American Subgroups. Am J Prev Cardiol 2022; 13:100437. [PMID: 36545389 PMCID: PMC9761380 DOI: 10.1016/j.ajpc.2022.100437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 11/23/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022] Open
Abstract
Objective This cross-sectional study aims to better understand the heterogeneous associations of acculturation level on CV risk factors among disaggregated Asian subgroups. We hypothesize that the association between acculturation level and CV risk factors will differ significantly by Asian subgroup. Methods We used the National Health Interview Survey (NHIS), a nationally representative US survey, years 2014-18. Acculturation was defined using: (a) years in the US, (b) US citizenship status, and (c) level of English proficiency. We created an acculturation index, categorized into low vs. high (scores of 0-3 and 4, respectively). Self-reported CV risk factors included diabetes, high cholesterol, hypertension, obesity, tobacco use, and sufficient physical activity. Rao-Scott Chi Square was used to compare age-standardized, weighted prevalence of CV risk factors between Asian subgroups. We used logistic regression analysis to assess associations between acculturation and CV risk factors, stratified by Asian subgroup. Results The study sample consisted of 6,051 adults ≥ 18 years of age (53.9% female; mean age 46.6 [SE 0.33]). The distribution by race/ethnicity was Asian Indian 26.9%, Chinese 22.8%, Filipino 18.1%, and other Asian 32.3%. The association between acculturation and CV risk factors differed by Asian subgroups. From multivariable adjusted models, high vs. low acculturation was associated with: high cholesterol amongst Asian Indian (OR=1.57, 95% CI: 1.11, 2.37) and other Asian (OR=1.48, 95% CI: 1.10, 2.01) adults, obesity amongst Filipino adults (OR= 1.62, 95% CI: 1.07, 2.45), and sufficient physical activity amongst Chinese (OR= 1.54, 95% CI: 1.09, 2.19) and Filipino adults (OR=1.58, 95% CI: 1.10, 2.27). Conclusion This study demonstrates that acculturation is heterogeneously associated with higher prevalence of CV risk factors among Asian subgroups. More studies are needed to better understand these differences that can help to inform targeted, culturally specific interventions.
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Lopez-Neyman SM, Davis K, Zohoori N, Broughton KS, Moore CE, Miketinas D. Racial disparities and prevalence of cardiovascular disease risk factors, cardiometabolic risk factors, and cardiovascular health metrics among US adults: NHANES 2011-2018. Sci Rep 2022; 12:19475. [PMID: 36376533 PMCID: PMC9663590 DOI: 10.1038/s41598-022-21878-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 10/05/2022] [Indexed: 11/16/2022] Open
Abstract
This study estimated the prevalence of cardiovascular disease (CVD) risk factors, cardiometabolic (CM) risk factors, and cardiovascular health metrics (CVHMs) among US adults and across race/ethnicity groups. The study comprised 8370 US adults aged ≥ 20 years from the National Health and Nutrition Examination Survey (NHANES) 2011-2018, free of coronary heart disease/heart failure, angina/angina pectoris, heart attack, and stroke, who provided complete data for the outcome variables of interest. Age-adjusted prevalence of CVD and CM risk factors, and CVHMs were computed for all adults and across race/ethnicity groups. All analyses accounted for the complex, multi-stage survey sampling design of the NHANES. Hypertension (45.0%), obesity (40.0%), fasting plasma glucose ≥ 100 mg/dL or hypoglycemic medication (51.0%), ideal physical activity (59.2%) and ideal smoking status (56.9%) were most prevalent for the whole sample. Mexican Americans and non-Hispanic Blacks had elevated risk for some, but not all, CVD and CM risk factors compared to non-Hispanic Whites and non-Hispanic Asians. Reducing further health disparities and persisting differences among racial and ethnic groups is vital to achieving the American Heart Association vision of all people having ideal cardiovascular health, living healthier and longer.
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Affiliation(s)
- Stephanie M. Lopez-Neyman
- grid.264797.90000 0001 0016 8186Department of Nutrition Sciences, Texas Woman’s University, Denton, TX USA
| | - Kathleen Davis
- grid.264797.90000 0001 0016 8186Department of Nutrition Sciences, Texas Woman’s University, Denton, TX USA
| | - Namvar Zohoori
- grid.241054.60000 0004 4687 1637Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR USA
| | - K. Shane Broughton
- grid.264797.90000 0001 0016 8186Department of Nutrition Sciences, Texas Woman’s University, Denton, TX USA
| | - Carolyn E. Moore
- grid.264797.90000 0001 0016 8186Department of Nutrition Sciences, Texas Woman’s University, Houston, TX USA
| | - Derek Miketinas
- grid.264797.90000 0001 0016 8186Department of Nutrition Sciences, Texas Woman’s University, Houston, TX USA
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Springer YP, Kammerer JS, Silk BJ, Langer AJ. Tuberculosis in Indigenous Persons - United States, 2009-2019. J Racial Ethn Health Disparities 2022; 9:1750-1764. [PMID: 34448124 PMCID: PMC8881557 DOI: 10.1007/s40615-021-01112-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/08/2021] [Accepted: 07/09/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Populations of indigenous persons are frequently associated with pronounced disparities in rates of tuberculosis (TB) disease compared to co-occurring nonindigenous populations. METHODS Using data from the National Tuberculosis Surveillance System on TB cases in U.S.-born patients reported in the United States during 2009-2019, we calculated incidence rate ratios and risk ratios for TB risk factors to compare cases in American Indian or Alaska Native (AIAN) and Native Hawaiian or other Pacific Islander (NHPI) TB patients to cases in White TB patients. RESULTS Annual TB incidence rates among AIAN and NHPI TB patients were on average ≥10 times higher than among White TB patients. Compared to White TB patients, AIAN and NHPI TB patients were 1.91 (95% confidence interval (CI): 1.35-2.71) and 3.39 (CI: 1.44-5.74) times more likely to have renal disease or failure, 1.33 (CI: 1.16-1.53) and 1.63 (CI: 1.20-2.20) times more likely to have diabetes mellitus, and 0.66 (CI: 0.44-0.99) and 0.19 (CI: 0-0.59) times less likely to be HIV positive, respectively. AIAN TB patients were 1.84 (CI: 1.69-2.00) and 1.48 (CI: 1.27-1.71) times more likely to report using excess alcohol and experiencing homelessness, respectively. CONCLUSION TB among U.S. indigenous persons is associated with persistent and concerning health disparities.
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Affiliation(s)
- Yuri P Springer
- Division of Tuberculosis Elimination, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - J Steve Kammerer
- Division of Tuberculosis Elimination, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Benjamin J Silk
- Division of Tuberculosis Elimination, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Adam J Langer
- Division of Tuberculosis Elimination, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
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Yahya T, Acquah I, Taha MB, Valero-Elizondo J, Al-Mallah MH, Chamsi-Pasha MA, Zoghbi WA, Soliman A, Faza N, Cainzos-Achirica M, Nasir K. Cardiovascular risk profile of Middle Eastern immigrants living in the United States-the National Health Interview Survey. Am J Prev Cardiol 2022; 9:100312. [PMID: 35024678 PMCID: PMC8732795 DOI: 10.1016/j.ajpc.2021.100312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 12/17/2021] [Accepted: 12/22/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Middle Eastern (ME) immigrants are one of the fastest-growing groups in the US. Although ME countries have a high burden of atherosclerotic cardiovascular disease (ASCVD), the cardiovascular health status among ME immigrants in the US has not been studied in detail. This study aims to characterize the cardiovascular health status (CVD risk factors and ASCVD burden) among ME immigrants in the US. METHODS We used 2012-2018 data from the National Health Interview Survey, a US nationally representative survey. ME origin, CVD risk factors, and ASCVD status were self-reported. We compared these to US-born non-Hispanic white (NHW) individuals in the US. RESULTS Among 139,778 adults included, 886 (representing 1.3 million individuals, mean age 46.8) were of ME origin, and 138,892 were US-born NHWs (representing 150 million US adults, mean age 49.3). ME participants were more likely to have higher education, lower income and be uninsured. The age-adjusted prevalence of hypertension (22.4% vs 27.4%) and obesity (21.4% vs 31.4%) were significantly lower in ME vs NHW participants, respectively. There were no significant differences between the groups in the age-adjusted prevalence of ASCVD, diabetes, hyperlipidemia, and smoking. Only insufficient physical activity was higher among ME individuals. ME immigrants living in the US for 10 years or more reported higher age-adjusted prevalence of hypertension, hyperlipidemia, and ASCVD. CONCLUSIONS ME immigrants in the US have lower odds of hypertension and obesity, and of having a suboptimal CRF profile compared to US-born NHWs. Further studies are needed to determine whether these findings are related to lower risk, selection of a healthier ME subgroup in NHIS, or possible under-detection of cardiovascular risk factors in ME immigrants living in the US.
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Affiliation(s)
- Tamer Yahya
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, 6550 Fannin St Suite 1801, Houston TX 77030, USA
| | - Isaac Acquah
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, 6550 Fannin St Suite 1801, Houston TX 77030, USA
- Center for Outcomes Research, Houston Methodist, Houston TX, USA
| | - Mohamad B Taha
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, 6550 Fannin St Suite 1801, Houston TX 77030, USA
| | | | - Mouaz H. Al-Mallah
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, 6550 Fannin St Suite 1801, Houston TX 77030, USA
| | - Mohammed A. Chamsi-Pasha
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, 6550 Fannin St Suite 1801, Houston TX 77030, USA
| | - William A. Zoghbi
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, 6550 Fannin St Suite 1801, Houston TX 77030, USA
| | - Ahmed Soliman
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, 6550 Fannin St Suite 1801, Houston TX 77030, USA
| | - Nadeen Faza
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, 6550 Fannin St Suite 1801, Houston TX 77030, USA
| | - Miguel Cainzos-Achirica
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, 6550 Fannin St Suite 1801, Houston TX 77030, USA
- Center for Outcomes Research, Houston Methodist, Houston TX, USA
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, 6550 Fannin St Suite 1801, Houston TX 77030, USA
- Center for Outcomes Research, Houston Methodist, Houston TX, USA
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Nasir K, Acquah I, Dey AK, Agrawal T, Hassan SZ, Glassner K, Abraham B, Quigley EM, Blankstein R, Virani SS, Blaha MJ, Valero-Elizondo J, Cainzos-Achirica M, Mehta NN. Inflammatory bowel disease and atherosclerotic cardiovascular disease in U.S. adults—A population-level analysis in the national health interview survey. Am J Prev Cardiol 2022; 9:100316. [PMID: 35112094 PMCID: PMC8790599 DOI: 10.1016/j.ajpc.2022.100316] [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: 09/23/2021] [Revised: 12/31/2021] [Accepted: 01/15/2022] [Indexed: 11/04/2022] Open
Abstract
Objectives To evaluate the association between inflammatory bowel disease (IBD) and atherosclerotic cardiovascular disease (ASCVD) and whether this association is modified by age or sex. Methods We conducted a cross-sectional analysis using data from the 2015–2016 National Health Interview Survey (NHIS). The exposure of interest was self-reported IBD. The outcome of interest was prevalent ASCVD, which included a history of angina, myocardial infarction or stroke. We used survey-specific descriptive statistics to obtain weighted national estimates for IBD and ASCVD prevalence. Logistic regression models were used to assess the association between IBD and ASCVD, progressively adjusting for demographics and traditional risk factors. Effect modification by age and sex was evaluated. Results Among participants with IBD, the age-adjusted prevalence of ASCVD was 12.0% compared to 6.9% among those without IBD (p < 0.001). In multivariable regression analyses IBD was associated with increased odds of having ASCVD, even after adjustment for demographics and traditional risk factors (odds ratio 1.58, 95% CI 1.17–2.13). We found statistically significant interaction by age (p < 0.001) whereby those in the younger age strata had the strongest association (fully adjusted odds ratio among 18- to 44-year-olds 3.35, 95% CI 1.75, 6.40) while the association was null in those ≥65 years. Effect modification by sex was not observed. Conclusion Our analysis confirms an independent association between IBD and ASCVD in the U.S., particularly among young adults. Further studies are needed to fully establish a causal relationship between IBD and ASCVD, characterize the mechanisms underlying these associations, and identify tailored opportunities for ASCVD prevention in young and middle-aged adults with IBD.
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Ogunwole SM, Turkson-Ocran RAN, Boakye E, Creanga AA, Wang X, Bennett WL, Sharma G, Cooper LA, Commodore-Mensah Y. Disparities in cardiometabolic risk profiles and gestational diabetes mellitus by nativity and acculturation: findings from 2016-2017 National Health Interview Survey. BMJ Open Diabetes Res Care 2022; 10:10/1/e002329. [PMID: 35168940 PMCID: PMC8852664 DOI: 10.1136/bmjdrc-2021-002329] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 01/19/2022] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Gestational diabetes mellitus (GDM) is a common complication of pregnancy with implications for cardiovascular health. Among reproductive-aged women, less is known about nativity-related disparities in cardiometabolic risk profiles and GDM history. We examined how cardiometabolic risk profiles and GDM history differed by nativity and explored associations between acculturation, cardiometabolic risk profiles and GDM history. RESEARCH DESIGN AND METHODS We analyzed cross-sectional data from the 2016-2017 National Health Interview Survey among reproductive-aged women (18-49 years) who both reported ever being pregnant and answered the question on GDM history. Using multivariable logistic regression, we examined the percentage with GDM history and compared cardiometabolic profiles by nativity status and acculturation (duration of US residence). RESULTS Of 9525 women, 22.5% were foreign-born. Also, 11.7% of foreign-born women had a GDM history vs 9.6% of US-born women. Foreign-born women with ≥10 years US residence had the highest age-standardized percentage with GDM history (11.0%) compared with US-born women (9.2%) and foreign-born women with <10 years US residence (6.7%). US-born women had a higher prevalence of hypertension, current smoking, and alcohol use than foreign-born women. Among foreign-born women, those with ≥10 years US residence had a higher prevalence of hypertension, current smoking, and alcohol use than those with <10 years US residence. In the fully adjusted model, foreign-born women with ≥10 years US residence had higher odds of GDM history than US-born women (OR 1.43; 95% CI 1.17 to 1.76) while foreign-born women with <10 years US residence and US-born women has similar odds of GDM history. CONCLUSIONS Greater duration of US residence may be associated with nativity-related disparities in GDM. Acculturation, including changing health-related behaviors may explain the disparities among foreign-born women and should be further investigated to appropriately target interventions to prevent GDM and future cardiometabolic diseases.
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Affiliation(s)
- S Michelle Ogunwole
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Ellen Boakye
- Ciccarone Center for Prevention of Cardiovascular Diseases, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Andreea A Creanga
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Xiaobin Wang
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Wendy L Bennett
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Garima Sharma
- Ciccarone Center for Prevention of Cardiovascular Diseases, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Lisa A Cooper
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Yvonne Commodore-Mensah
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Community-Public Health, Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
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12
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Shapiro JA, Soman AV, Berkowitz Z, Fedewa SA, Sabatino SA, de Moor JS, Clarke TC, Doria-Rose VP, Breslau ES, Jemal A, Nadel MR. Screening for Colorectal Cancer in the United States: Correlates and Time Trends by Type of Test. Cancer Epidemiol Biomarkers Prev 2021; 30:1554-1565. [PMID: 34088751 DOI: 10.1158/1055-9965.epi-20-1809] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/19/2021] [Accepted: 05/21/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND It is strongly recommended that adults aged 50-75 years be screened for colorectal cancer. Recommended screening options include colonoscopy, sigmoidoscopy, CT colonography, guaiac fecal occult blood testing (FOBT), fecal immunochemical testing (FIT), or the more recently introduced FIT-DNA (FIT in combination with a stool DNA test). Colorectal cancer screening programs can benefit from knowledge of patterns of use by test type and within population subgroups. METHODS Using 2018 National Health Interview Survey (NHIS) data, we examined colorectal cancer screening test use for adults aged 50-75 years (N = 10,595). We also examined time trends in colorectal cancer screening test use from 2010-2018. RESULTS In 2018, an estimated 66.9% of U.S. adults aged 50-75 years had a colorectal cancer screening test within recommended time intervals. However, the prevalence was less than 50% among those aged 50-54 years, those without a usual source of health care, those with no doctor visits in the past year, and those who were uninsured. The test types most commonly used within recommended time intervals were colonoscopy within 10 years (61.1%), FOBT or FIT in the past year (8.8%), and FIT-DNA within 3 years (2.7%). After age-standardization to the 2010 census population, the percentage up-to-date with CRC screening increased from 61.2% in 2015 to 65.3% in 2018, driven by increased use of stool testing, including FIT-DNA. CONCLUSIONS These results show some progress, driven by a modest increase in stool testing. However, colorectal cancer testing remains low in many population subgroups. IMPACT These results can inform efforts to achieve population colorectal cancer screening goals.
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Affiliation(s)
- Jean A Shapiro
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Ashwini V Soman
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Zahava Berkowitz
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Stacey A Fedewa
- Office of the Chief Medical and Scientific Officer, American Cancer Society, Atlanta, Georgia
| | - Susan A Sabatino
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Janet S de Moor
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Tainya C Clarke
- Division of Health Interview Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland
| | - V Paul Doria-Rose
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Erica S Breslau
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Ahmedin Jemal
- Office of the Chief Medical and Scientific Officer, American Cancer Society, Atlanta, Georgia
| | - Marion R Nadel
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Lord J, Roberson S, Odoi A. Geographic disparities, determinants, and temporal changes in the prevalence of pre-diabetes in Florida. PeerJ 2021; 9:e10443. [PMID: 33520433 PMCID: PMC7811289 DOI: 10.7717/peerj.10443] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 11/07/2020] [Indexed: 12/17/2022] Open
Abstract
Background Left unchecked, pre-diabetes progresses to diabetes and its complications that are important health burdens in the United States. There is evidence of geographic disparities in the condition with some areas having a significantly high risks of the condition and its risk factors. Identifying these disparities, their determinants, and changes in burden are useful for guiding control programs and stopping the progression of pre-diabetes to diabetes. Therefore, the objectives of this study were to investigate geographic disparities of pre-diabetes prevalence in Florida, identify predictors of the observed spatial patterns, as well as changes in disease burden between 2013 and 2016. Methods The 2013 and 2016 Behavioral Risk Factor Surveillance System data were obtained from the Florida Department of Health. Counties with significant changes in the prevalence of the condition between 2013 and 2016 were identified using tests for equality of proportions adjusted for multiple comparisons using the Simes method. Flexible scan statistics were used to identify significant high prevalence geographic clusters. Multivariable regression models were used to identify determinants of county-level pre-diabetes prevalence. Results The state-wide age-adjusted prevalence of pre-diabetes increased significantly (p ≤ 0.05) from 8.0% in 2013 to 10.5% in 2016 with 72% (48/67) of the counties reporting statistically significant increases. Significant local geographic hotspots were identified. High prevalence of pre-diabetes tended to occur in counties with high proportions of non-Hispanic black population, low median household income, and low proportion of the population without health insurance coverage. Conclusions Geographic disparities of pre-diabetes continues to exist in Florida with most counties reporting significant increases in prevalence between 2013 and 2016. These findings are critical for guiding health planning, resource allocation and intervention programs.
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Affiliation(s)
- Jennifer Lord
- Biomedical and Diagnostic Sciences, College of Veterinary Medicine, The University of Tennessee, Knoxville, TN, United States of America
| | | | - Agricola Odoi
- Biomedical and Diagnostic Sciences, College of Veterinary Medicine, The University of Tennessee, Knoxville, TN, United States of America
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Vasan RS, Zuo Y, Kalesan B. Divergent Temporal Trends in Morbidity and Mortality Related to Heart Failure and Atrial Fibrillation: Age, Sex, Race, and Geographic Differences in the United States, 1991-2015. J Am Heart Assoc 2020; 8:e010756. [PMID: 30955391 PMCID: PMC6507208 DOI: 10.1161/jaha.118.010756] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background Heart failure ( HF ) and atrial fibrillation ( AF ) are rising in prevalence and pose a substantial public health burden. Methods and Results We evaluated temporal trends specific to age, sex, race, and geographic region in rates of HF - and AF -related morbidity, mortality, and years of potential life lost at age 75 years between 1991 and 2015 in the United States. For trends in hospitalization with a primary diagnosis of HF versus AF , we used data for patients aged ≥30 years from 1993 to 2014 from the Nationwide Inpatient Sample. For trends in death due to HF versus AF , we used data from 1991 to 2015 from the National Center for Health Statistics. Over the past 25 years, the age-adjusted rates of hospitalization declined for HF (-1.72% per year) but increased for AF (+1.61% per year). HF mortality rates remained unchanged, whereas those for AF increased (+11.2% per year). Years of potential life lost increased for both HF (+0.4% per year) and AF (+9.8% per year). Trends in HF and AF morbidity rates varied moderately by age group, whereas mortality rates varied by age and race. HF and AF hospitalization and mortality rates rose for individuals aged <50 years. HF hospitalization rates declined in all 4 US census regions, whereas AF rates increased. Conclusions We observed divergent trends of decreasing hospitalization and mortality rates for HF versus increasing rates for AF . Variations in disease burden by race and geography warrant specific targeting of "at risk" groups in selected US regions. Additional studies are warranted to evaluate the rising burden of both conditions in younger adults.
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Affiliation(s)
- Ramachandran S Vasan
- 1 Section of Preventive Medicine and Epidemiology Department of Medicine Boston University Schools of Medicine Boston MA.,2 Cardiovascular Medicine Department of Medicine Boston University Schools of Medicine Boston MA.,3 Department of Epidemiology Boston University School of Public Health Boston MA
| | - Yi Zuo
- 1 Section of Preventive Medicine and Epidemiology Department of Medicine Boston University Schools of Medicine Boston MA
| | - Bindu Kalesan
- 1 Section of Preventive Medicine and Epidemiology Department of Medicine Boston University Schools of Medicine Boston MA.,3 Department of Epidemiology Boston University School of Public Health Boston MA
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Armstrong LR, Kammerer JS, Haddad MB. Diabetes mellitus among adults with tuberculosis in the USA, 2010-2017. BMJ Open Diabetes Res Care 2020; 8:8/1/e001275. [PMID: 32641300 PMCID: PMC7342266 DOI: 10.1136/bmjdrc-2020-001275] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 05/16/2020] [Accepted: 06/02/2020] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION To describe diabetes trends among adults with incident tuberculosis (TB) disease and examine diabetes-associated TB characteristics and patient outcomes in the USA. RESEARCH DESIGN AND METHODS We examined all 71 855 persons aged ≥20 years with incident TB disease reported to the National Tuberculosis Surveillance System during 2010-2017. We performed multivariable logistic regression, comparing characteristics and outcomes among patients with TB reported to have diabetes and those whose diabetes status was unknown. RESULTS An overall 18% (n=13 281) of the 71 855 adults with incident TB disease were reported as also having diabetes; the annual proportion increased from 15% in 2010 to 22% in 2017. Among patients aged ≥45 years with both TB and diabetes, the adjusted OR for cavitary or sputum smear-positive TB was 1.7 and 1.5, respectively (95% CIs 1.5 to 1.8 and 1.4 to 1.6). Patients with TB and diabetes had 30% greater odds of dying and took longer to achieve negative Mycobacterium tuberculosis cultures and complete treatment. CONCLUSIONS The prevalence of reported diabetes among adults with TB disease has increased. Having diabetes as a comorbidity negatively affects patient outcomes. In accordance with national recommendations, all patients aged ≥45 years and all younger patients who have risk factors for diabetes should be screened for diabetes at the start of TB treatment.
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Affiliation(s)
- Lori R Armstrong
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - J Steve Kammerer
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Maryam B Haddad
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Odoi EW, Nagle N, Zaretzki R, Jordan M, DuClos C, Kintziger KW. Sociodemographic Determinants of Acute Myocardial Infarction Hospitalization Risks in Florida. J Am Heart Assoc 2020; 9:e012712. [PMID: 32427043 PMCID: PMC7428988 DOI: 10.1161/jaha.119.012712] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background Identifying social determinants of myocardial infarction (MI) hospitalizations is crucial for reducing/eliminating health disparities. Therefore, our objectives were to identify sociodemographic determinants of MI hospitalization risks and to assess if the impacts of these determinants vary by geographic location in Florida. Methods and Results This is a retrospective ecologic study at the county level. We obtained data for principal and secondary MI hospitalizations for Florida residents for the 2005-2014 period and calculated age- and sex-adjusted MI hospitalization risks. We used a multivariable negative binomial model to identify sociodemographic determinants of MI hospitalization risks and a geographically weighted negative binomial model to assess if the strength of associations vary by location. There were 645 935 MI hospitalizations (median age, 72 years; 58.1%, men; 73.9%, white). Age- and sex-adjusted risks ranged from 18.49 to 69.48 cases/10 000 persons, and they were significantly higher in counties with low education levels (risk ratio [RR]=1.033, P<0.0001) and high divorce rate (RR, 0.995; P=0.018). However, they were significantly lower in counties with high proportions of rural (RR, 0.996; P<0.0001), black (RR, 1.026; P=0.032), and uninsured populations (RR, 0.983; P=0.040). Associations of MI hospitalization risks with education level and uninsured rate varied geographically (P for non-stationarity test=0.001 and 0.043, respectively), with strongest associations in southern Florida (RR for <high school education, 1.036-1.041; RR for uninsured rate, 0.971-0.976). Conclusions Black race, divorce, rural residence, low education level, and lack of health insurance were significant determinants of MI hospitalization risks, but associations with the latter 2 were stronger in southern Florida. Thus, interventions for addressing MI hospitalization risks need to prioritize these populations and allocate resources based on empirical evidence from global and local models for maximum efficiency and effectiveness.
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Affiliation(s)
- Evah Wangui Odoi
- Comparative and Experimental Medicine College of Veterinary Medicine The University of Tennessee Knoxville TN
| | - Nicholas Nagle
- Department of Geography The University of Tennessee Knoxville TN
| | - Russell Zaretzki
- Department of Business Analytics and Statistics The University of Tennessee Knoxville TN
| | - Melissa Jordan
- Public Health Research Division of Community Health Promotion Florida Department of Health Tallahassee FL
| | - Chris DuClos
- Environmental Public Health Tracking Division of Community Health Promotion Florida Department of Health Tallahassee FL
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Turkson‐Ocran RN, Nmezi NA, Botchway MO, Szanton SL, Golden SH, Cooper LA, Commodore‐Mensah Y. Comparison of Cardiovascular Disease Risk Factors Among African Immigrants and African Americans: An Analysis of the 2010 to 2016 National Health Interview Surveys. J Am Heart Assoc 2020; 9:e013220. [PMID: 32070204 PMCID: PMC7335539 DOI: 10.1161/jaha.119.013220] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 01/06/2020] [Indexed: 12/19/2022]
Abstract
Background Racial/ethnic minorities, especially non-Hispanic blacks, in the United States are at higher risk of developing cardiovascular disease. However, less is known about the prevalence of cardiovascular disease risk factors among ethnic sub-populations of blacks such as African immigrants residing in the United States. This study's objective was to compare the prevalence of cardiovascular disease risk factors among African immigrants and African Americans in the United States. Methods and Results We performed a cross-sectional analysis of the 2010 to 2016 National Health Interview Surveys and included adults who were black and African-born (African immigrants) and black and US-born (African Americans). We compared the age-standardized prevalence of hypertension, diabetes mellitus, overweight/obesity, hypercholesterolemia, physical inactivity, and current smoking by sex between African immigrants and African Americans using the 2010 census data as the standard. We included 29 094 participants (1345 African immigrants and 27 749 African Americans). In comparison with African Americans, African immigrants were more likely to be younger, educated, and employed but were less likely to be insured (P<0.05). African immigrants, regardless of sex, had lower age-standardized hypertension (22% versus 32%), diabetes mellitus (7% versus 10%), overweight/obesity (61% versus 70%), high cholesterol (4% versus 5%), and current smoking (4% versus 19%) prevalence than African Americans. Conclusions The age-standardized prevalence of cardiovascular disease risk factors was generally lower in African immigrants than African Americans, although both populations are highly heterogeneous. Data on blacks in the United States. should be disaggregated by ethnicity and country of origin to inform public health strategies to reduce health disparities.
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Affiliation(s)
| | | | | | - Sarah L. Szanton
- Johns Hopkins University School of Nursing and Bloomberg School of Public HealthBaltimoreMD
| | - Sherita Hill Golden
- Johns Hopkins University School of Medicine and Bloomberg School of Public HealthBaltimoreMD
| | - Lisa A. Cooper
- Johns Hopkins University School of MedicineSchool of Nursing, and Bloomberg School of Public HealthBaltimoreMD
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Odoi EW, Nagle N, DuClos C, Kintziger KW. Disparities in Temporal and Geographic Patterns of Myocardial Infarction Hospitalization Risks in Florida. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E4734. [PMID: 31783516 PMCID: PMC6926732 DOI: 10.3390/ijerph16234734] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 11/23/2019] [Accepted: 11/24/2019] [Indexed: 12/12/2022]
Abstract
Knowledge of geographical disparities in myocardial infarction (MI) is critical for guiding health planning and resource allocation. The objectives of this study were to identify geographic disparities in MI hospitalization risks in Florida and assess temporal changes in these disparities between 2005 and 2014. This study used retrospective data on MI hospitalizations that occurred among Florida residents between 2005 and 2014. We identified spatial clusters of hospitalization risks using Kulldorff's circular and Tango's flexible spatial scan statistics. Counties with persistently high or low MI hospitalization risks were identified. There was a 20% decline in hospitalization risks during the study period. However, we found persistent clustering of high risks in the Big Bend region, South Central and southeast Florida, and persistent clustering of low risks primarily in the South. Risks decreased by 7%-21% in high-risk clusters and by 9%-28% in low-risk clusters. The risk decreased in the high-risk cluster in the southeast but increased in the Big Bend area during the last four years of the study. Overall, risks in low-risk clusters were ahead those for high-risk clusters by at least 10 years. Despite MI risk declining over the study period, disparities in MI risks persist. Eliminating/reducing those disparities will require prioritizing high-risk clusters for interventions.
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Affiliation(s)
- Evah W. Odoi
- Comparative and Experimental Medicine, College of Veterinary Medicine, The University of Tennessee, Knoxville, TN 37996, USA;
| | - Nicholas Nagle
- Department of Geography, The University of Tennessee, Knoxville, TN 37996, USA;
| | - Chris DuClos
- Environmental Public Health Tracking, Division of Community Health Promotion, Florida Department of Health, Tallahassee, FL 32399, USA;
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Sedentary lifestyle in middle-aged women is associated with severe menopausal symptoms and obesity. Menopause 2018; 23:488-93. [PMID: 26818013 DOI: 10.1097/gme.0000000000000575] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The aim of the study was to evaluate the association between sedentary lifestyle and the severity of menopausal symptoms and obesity in middle-aged women. METHODS The Menopause Rating Scale, the Goldberg Anxiety and Depression Scale, and the Athens Insomnia Scale were administered to 6,079 Latin American women aged 40 to 59 years. Sedentary lifestyle was defined as fewer than three weekly, 30-minute periods of physical activity. RESULTS Sedentary women had more severe menopausal symptoms (total Menopause Rating Scale score: 9.57 ± 6.71 vs 8.01 ± 6.27 points, P < 0.0001) and more depressive symptoms (Goldberg), anxiety (Goldberg), and insomnia (Athens Scale) compared with non-sedentary women. They also had greater mean waist circumference (86.2 ± 12.3 vs 84.3 ± 1.8 cm, P < 0.0001) and a higher prevalence of obesity (20.9% vs 14.3%, P < 0.0001). Logistic regression analysis showed that both obesity (odds ratio [OR] 1.52; 95% CI, 1.32-1.76) and severe menopausal symptoms (OR 1.28; 95% CI, 1.06-1.53), including insomnia and depressive mood, were positively associated with a sedentary lifestyle. Having a stable partner (OR 0.85; 95% CI, 0.76-0.96), using hormone therapy (OR 0.75; 95% CI, 0.64-0.87) and having a higher educational level (OR 0.66; 95% CI, 0.60-0.74) were negatively related to sedentary lifestyle. CONCLUSIONS There was a high prevalence of sedentary lifestyle in this middle-aged Latin American female sample which was associated with more severe menopausal symptoms and obesity.
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