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Tchoua PP, Clarke E, Wasser H, Agrawal S, Scothorn R, Thompson K, Schenkelberg M, Willis EA. The interaction between social determinants of health, health behaviors, and child's intellectual developmental diagnosis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.05.23.24307804. [PMID: 38826242 PMCID: PMC11142268 DOI: 10.1101/2024.05.23.24307804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2024]
Abstract
INTRODUCTION Social determinants of health (SDOH) may impact caregivers' ability to implement evidence-based health practices at home during early childhood, especially in families with children with intellectual and developmental disabilities (IDD). Therefore, we examined the influence of SDOH and children's diagnosis (typically developing [TD], Down syndrome [DS], autism) on caregiver's self-report of meeting evidence-based health practices. METHODS Caregivers (n=172) of children ages 2-6 years (TD: n=93, DS: n=40, autism: n=39) completed an online survey on SDOH and health practices related to child nutrition (CN), physical activity (PA), outdoor play (OP), and screen time (ST). A total SDOH score was computed by assigning 1 point for each favorable SDOH metric (range 0-13). Linear regressions were used to examine associations between SDOH and CN, PA, OP, ST health practices and the moderating effect of IDD diagnosis. RESULTS Most caregivers were non-Hispanic White (84.3%), female (76.7%), 18-35 years old (55.2%), and married (89.5%). The DS group had the lowest SDOH score (mean = 8.4±1.0) compared to autism (mean = 10.1±1.0) and TD (mean = 11.0±0.9). No family scored 100% in evidence-based practices for any health practice. SDOH score was significantly associated with evidence-based practices met score for CN (b = 1.94, 95% CI = 0.84, 3.04; p = 0.001) and PA (b = 4.86, 95% CI = 2.92, 6.79; p <0.0001). Moderation analysis showed no association in the DS and autism groups between SDOH score and CN percent total score, or between SDOH score and CN, PA, and OP for percent evidence-based practices met. SDOH score was also not associated with OP percent total score for the DS group. CONCLUSIONS This study highlights the differential influence of SDOH on caregivers' implementing health practices in families with children of different IDD diagnoses. Future research is needed to understand impacts of SDOH on non-typically developing children.
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Salisbury H. Helen Salisbury: Sick notes and a national illness service. BMJ 2024; 385:q918. [PMID: 38653533 DOI: 10.1136/bmj.q918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
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Ventres WB, Stone LA, Shah R, Carter T, Gusoff GM, Liaw W, Nguyen BM, Rachelson JV, Scott MA, Schiff-Elfalan TL, Yamada S, Like RC, Zoppi K, Catinella AP, Frankel RM, Prasad S. Storylines of family medicine II: foundational building blocks-context, community and health. Fam Med Community Health 2024; 12:e002789. [PMID: 38609084 PMCID: PMC11029393 DOI: 10.1136/fmch-2024-002789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024] Open
Abstract
Storylines of Family Medicine is a 12-part series of thematically linked mini-essays with accompanying illustrations that explore the many dimensions of family medicine, as interpreted by individual family physicians and medical educators in the USA and elsewhere around the world. In 'II: foundational building blocks-context, community and health', authors address the following themes: 'Context-grounding family medicine in time, place and being', 'Recentring community', 'Community-oriented primary care', 'Embeddedness in practice', 'The meaning of health', 'Disease, illness and sickness-core concepts', 'The biopsychosocial model', 'The biopsychosocial approach' and 'Family medicine as social medicine.' May readers grasp new implications for medical education and practice in these essays.
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Affiliation(s)
- William B Ventres
- Family and Preventive Medicine, University of Arkansas for Medical Sciences College of Medicine, Little Rock, Arkansas, USA
| | - Leslie A Stone
- Family and Preventive Medicine, University of Arkansas for Medical Sciences College of Medicine, Little Rock, Arkansas, USA
| | | | - Tamala Carter
- Penn Center for Community Health Workers, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Geoffrey M Gusoff
- National Clinician Scholars Program, UCLA David Geffen School of Medicine, Los Angeles, California, USA
| | - Winston Liaw
- Health Systems and Population Health Sciences, University of Houston Tilman J Fertitta Family College of Medicine, Houston, Texas, USA
| | - Bich-May Nguyen
- Health Systems and Population Health Sciences, University of Houston Tilman J Fertitta Family College of Medicine, Houston, Texas, USA
| | - Joanna V Rachelson
- Southern New Mexico Family Medicine Residency Program, Las Cruces, New Mexico, USA
| | - Mary Alice Scott
- New Mexico Primary Care Training Program, Silver City, New Mexico, USA
- Anthropology, New Mexico State University, Las Cruces, New Mexico, USA
| | - Teresa L Schiff-Elfalan
- Family Medicine and Community Health, University of Hawai'i at Manoa John A Burns School of Medicine, Honolulu, Hawaii, USA
| | - Seiji Yamada
- Family Medicine and Community Health, University of Hawai'i at Manoa John A Burns School of Medicine, Honolulu, Hawaii, USA
| | - Robert C Like
- Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Kathleen Zoppi
- Family Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - A Peter Catinella
- Family Medicine - Transmountain, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Richard M Frankel
- Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Shailendra Prasad
- Family Medicine and Community Health, University of Minnesota Medical School - Twin Cities Campus, Minneapolis, Minnesota, USA
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Ventres WB, Stone LA, Bryant WW, Pacheco MF, Figueroa E, Chu FN, Prasad S, Blane DN, Razon N, Mishori R, Ferrer RL, Kneese GS. Storylines of family medicine X: standing up for diversity, equity and inclusion. Fam Med Community Health 2024; 12:e002828. [PMID: 38609082 PMCID: PMC11029210 DOI: 10.1136/fmch-2024-002828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024] Open
Abstract
Storylines of Family Medicine is a 12-part series of thematically linked mini-essays with accompanying illustrations that explore the many dimensions of family medicine as interpreted by individual family physicians and medical educators in the USA and elsewhere around the world. In 'X: standing up for diversity, equity and inclusion', authors address the following themes: 'The power of diversity-why inclusivity is essential to equity in healthcare', 'Medical education for whom?', 'Growing a diverse and inclusive workforce', 'Therapeutic judo-an inclusive approach to patient care', 'Global family medicine-seeing the world "upside down"', 'The inverse care law', 'Social determinants of health as a lens for care', 'Why family physicians should care about human rights' and 'Toward health equity-the opportunome'. May the essays that follow inspire readers to promote change.
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Affiliation(s)
- William B Ventres
- Family and Preventive Medicine, University of Arkansas for Medical Sciences College of Medicine, Little Rock, Arkansas, USA
| | - Leslie A Stone
- Family and Preventive Medicine, University of Arkansas for Medical Sciences College of Medicine, Little Rock, Arkansas, USA
| | - Wayne W Bryant
- Family and Preventive Medicine, University of Arkansas for Medical Sciences College of Medicine, Little Rock, Arkansas, USA
| | - Mario F Pacheco
- Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Edgar Figueroa
- Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Francis N Chu
- San Jose Family Medicine Residency, Kaiser Permanente, San Jose, California, USA
| | - Shailendra Prasad
- Family Medicine and Community Health, University of Minnesota Medical School-Twin Cities Campus, Minneapolis, Minnesota, USA
| | - David N Blane
- School of Health and Wellbeing, University of Glasgow, Glasgow, Glasgow, UK
| | - Na'amah Razon
- Family and Community Medicine, University of California, Davis, Sacramento, California, USA
| | - Ranit Mishori
- Family Medicine, Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Robert L Ferrer
- Family and Community Medicine, UT Health San Antonio Long School of Medicine, San Antonio, Texas, USA
| | - Garrett S Kneese
- UC San Diego Family Medicine Residency Program, San Diego, California, USA
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Gorczyca AM, Washburn RA, Ptomey LT, Mayo MS, Krebill R, Sullivan DK, Gibson CA, Stolte S, Donnelly JE. Weight management in rural health clinics: Results from the randomized midwest diet and exercise trial. Obes Sci Pract 2024; 10:e753. [PMID: 38660371 PMCID: PMC11042259 DOI: 10.1002/osp4.753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 04/01/2024] [Accepted: 04/03/2024] [Indexed: 04/26/2024] Open
Abstract
Introduction Rural living adults have higher rates of obesity compared with their urban counterparts and less access to weight management programs. Previous research studies have demonstrated clinically relevant weight loss in rural living adults who complete weight management programs delivered by university affiliated interventionists. However, this approach limits the potential reach, adoption, implementation, and maintenance of weight management programs for rural residents. Weight management delivered through rural health clinics by non-physician clinic associated staff, for example, nurses, registered dieticians, allied health professionals, etc. has the potential to improve access to weight management for rural living adults. This trial compared the effectiveness of a 6-month multicomponent weight management intervention for rural living adults delivered using group phone calls (GP), individual phone calls (IP) or an enhanced usual care control (EUC) by rural clinic associated staff trained by our research team. Methods Rural living adults with overweight/obesity (n = 187, age ∼ 50 years 82% female, body mass index ∼35 kg/m2) were randomized (2:2:1) to 1 of 3 intervention arms: GP, which included weekly ∼ 45 min sessions with 7-14 participants (n = 71), IP, which included weekly ∼ 15 min individual sessions (n = 80), or EUC, which included one-45 min in-person session at baseline. Results Weight loss at 6 months was clinically relevant, that is, ≥5% in the GP (-11.4 kg, 11.7%) and the IP arms (-9.1 kg, 9.2%) but not in the EUC arm (-2.6%, -2.5% kg). Specifically, 6 month weight loss was significantly greater in the IP versus EUC arms (-6.5 kg. p ≤ 0.025) but did not differ between the GP and IP arms (-2.4 kg, p > 0.025). The per participant cost per kg. weight loss for implementing the intervention was $93 and $60 for the IP and GP arms, respectively. Conclusions Weight management delivered by interventionists associated with rural health clinics using both group and IP calls results in clinically relevant 6 months weight loss in rural dwelling adults with overweight/obesity with the group format offering the most cost-effective strategy. Clinical trial registration: ClinicalTrials.gov (NCT02932748).
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Affiliation(s)
- Anna M. Gorczyca
- Division of Physical Activity and Weight ManagementDepartment of Internal MedicineThe University of Kansas Medical CenterKansas CityKansasUSA
| | - Richard A. Washburn
- Division of Physical Activity and Weight ManagementDepartment of Internal MedicineThe University of Kansas Medical CenterKansas CityKansasUSA
| | - Lauren T. Ptomey
- Division of Physical Activity and Weight ManagementDepartment of Internal MedicineThe University of Kansas Medical CenterKansas CityKansasUSA
| | - Matthew S. Mayo
- Department of Biostatistics & Data ScienceThe University of Kansas Medical CenterKansas CityKansasUSA
| | - Ron Krebill
- Department of Biostatistics & Data ScienceThe University of Kansas Medical CenterKansas CityKansasUSA
| | - Debra K. Sullivan
- Department of Dietetics and NutritionThe University of Kansas Medical CenterKansas CityKansasUSA
| | - Cheryl A. Gibson
- Department of Internal MedicineThe University of Kansas Medical CenterKansas CityKansasUSA
| | - Sarah Stolte
- Department of Internal MedicineThe University of Kansas Medical CenterKansas CityKansasUSA
| | - Joseph E. Donnelly
- Division of Physical Activity and Weight ManagementDepartment of Internal MedicineThe University of Kansas Medical CenterKansas CityKansasUSA
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Zeitler EP, Joly J, Leggett CG, Wong SL, O’Malley AJ, Kraft SA, Mackwood MB, Jones ST, Skinner JS. The role of comorbidities, medications, and social determinants of health in understanding urban-rural outcome differences among patients with heart failure. J Rural Health 2024; 40:386-393. [PMID: 37867249 PMCID: PMC10954420 DOI: 10.1111/jrh.12803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 08/18/2023] [Accepted: 10/10/2023] [Indexed: 10/24/2023]
Abstract
PURPOSE There is now a 20% disparity in all-cause, excess deaths between urban and rural areas, much of which is driven by disparities in cardiovascular death. We sought to explain the sources of these disparities for Medicare beneficiaries with heart failure with reduced ejection fraction (HFrEF). METHODS Using a sample of Medicare Parts A, B, and D, we created a cohort of 389,528 fee-for-service beneficiaries with at least 1 heart failure hospitalization from 2008 to 2017. The primary outcome was 30-day mortality after discharge; 1-year mortality, readmissions, and return emergency room (ER) admissions were secondary outcomes. We used hierarchical, logistic regression modeling to determine the contribution of comorbidities, guideline-directed medical therapy (GDMT), and social determinants of health (SDOH) to outcomes. RESULTS Thirty-day mortality rates after hospital discharge were 6.3% in rural areas compared to 5.7% in urban regions (P < .001); after adjusting for patient health and GDMT receipt, the 30-day mortality odds ratio for rural residence was 1.201 (95% CI 1.164-1.239). Adding the SDOH measure reduced the odds ratio somewhat (1.140, 95% CI 1.103-1.178) but a gap remained. Readmission rates in rural areas were consistently lower for all model specifications, while ER admissions were consistently higher. CONCLUSIONS Among patients with HFrEF, living in a rural area is associated with an increased risk of death and return ER visits within 30 days of discharge from HF hospitalization. Differences in SDOH appear to partially explain mortality differences but the remaining gap may be the consequence of rural-urban differences in HF treatment.
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Affiliation(s)
- Emily P. Zeitler
- Dartmouth-Hitchcock Medical Center, Heart and Vascular Center, Lebanon, NH
- The Dartmouth Institute, Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Joanna Joly
- University of Alabama at Birmingham, Division of Cardiovascular Disease, Birmingham, AL
| | | | - Sandra L. Wong
- The Dartmouth Institute, Geisel School of Medicine at Dartmouth, Hanover, NH
- Dartmouth-Hitchcock Medical Center, Department of Surgery, Lebanon, NH
| | - A. James O’Malley
- The Dartmouth Institute, Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Sally A. Kraft
- Dartmouth-Hitchcock Medical Center, Center for Population Health, Lebanon, NH
| | - Matthew B. Mackwood
- The Dartmouth Institute, Geisel School of Medicine at Dartmouth, Hanover, NH
- Dartmouth-Hitchcock Medical Center, Department of General Internal Medicine, Lebanon, NH
| | - Sarah T. Jones
- Dartmouth-Hitchcock Medical Center, Heart and Vascular Center, Lebanon, NH
- The Dartmouth Institute, Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Jonathan S. Skinner
- The Dartmouth Institute, Geisel School of Medicine at Dartmouth, Hanover, NH
- Dartmouth College, Department of Economics, Hanover, NH
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Hansen MA, Hirth J, Zoorob R, Langabeer J. Demographics and clinical features associated with rates of electronic message utilization in the primary care setting. Int J Med Inform 2024; 183:105339. [PMID: 38219417 DOI: 10.1016/j.ijmedinf.2024.105339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 12/29/2023] [Accepted: 01/02/2024] [Indexed: 01/16/2024]
Abstract
INTRODUCTION Electronic messages are growing as an important form of patient-provider communication, particularly in the primary care setting. However, adoption of healthcare technology has been under-utilized by underserved patient populations. The purpose of this study was to describe how adoption and utilization of electronic messaging occurred within a large primary care urban-based patient population. METHODS In this retrospective study, the frequency of electronic messages initiated by adult outpatient primary care patients was observed. Patients were classified as either non-portal adopters, non-message utilizers, low message utilizers, and high message utilizers. Logistic regression modeling was used to compare factors associated with message utilization rates to determine disparities in access. RESULTS Among a sample of 27,453 ethnically diverse adult patients from the Houston, Texas Metropolitan area, 33,497 unique messages were sent (1.22 messages/patient). Message burden was predominantly derived by a small number of high utilizers (individuals who sent 3 or more messages), who comprised 15.7 % of the study population (n = 4302) but accounted for 77 % of the message volume (n = 25,776). These high utilizers were typically older, White, English speaking, from middle to upper income zip codes, had higher number of comorbidities, and a higher number of clinical visits. CONCLUSIONS Most inbox messages were generated by a small number of patients. While it was reassuring to see older and sicker individuals utilizing electronic messaging, patients from minority and/or lower income background utilized electronic messaging much less. This may propagate systematic bias and decrease the level of care for traditionally underserved patients.
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Affiliation(s)
- Michael A Hansen
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, United States; University of Texas, School of Biomedical Informatics, Houston, TX, United States.
| | - Jacqueline Hirth
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, United States; University of Texas Medical Branch, Galveston, TX, United States
| | - Roger Zoorob
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, United States
| | - James Langabeer
- University of Texas, School of Biomedical Informatics, Houston, TX, United States
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Nagarajan S, Rosenbaum J, Joks R. The Relationship Between Allergic Rhinitis, Asthma, and Cardiovascular Disease in the National Health Interview Surveys (NHIS), 1999-2018. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024:S2213-2198(24)00154-5. [PMID: 38341139 DOI: 10.1016/j.jaip.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 01/14/2024] [Accepted: 02/01/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Atopic disease has been associated with immune dysregulation and chronic inflammation, but current practice guideline recommendations do not include the evaluation of inflammatory outcomes among patients with asthma and allergic rhinitis (AR). OBJECTIVE This study investigates the relationship between asthma, AR, and cardiovascular disease (CVD) using data from the U.S. National Health Interview Survey (NHIS) between 1999 and 2018. METHODS We used data from adults in the NHIS (n = 603,140, representing a population of 225,483,286). Exposures were physician-diagnosed asthma (lifetime/past-year) and AR (past-year). Outcomes were physician-diagnosed heart disease: coronary heart disease (CHD), angina, heart attack, and nonspecific "heart-condition" (all lifetime). We used survey-weighted descriptive analysis and logistic regression adjusting for demographic and socioeconomic factors. RESULTS A total of 11.44% reported at least 1 heart condition, with CHD the most prevalent (4.27%) across 20 years of pooled data. Asthma and AR were associated with higher CVD in all bivariate analyses. Specifically, lifetime asthma was associated with increased odds of CHD, (odds ratio [OR] 1.36; 95% confidence interval [95% CI] 1.29-1.42), with stronger effects observed for a past-year asthma attack (OR 1.66; 95% CI 1.55-1.80). The strongest effect of all was observed in those with a past-year asthma attack having increased odds of angina (OR 2.42; 95% CI 2.24-2.63). Allergic rhinitis was independently associated with increased odds of CHD (OR 1.25; 95% CI 1.18-1.28). CONCLUSIONS Asthma and AR are risk factors for all types of CVD in this nationally representative study covering a 2-decade period in the United States. Clinicians should consider screening patients with severe and/or uncontrolled asthma and AR early for CVD, particularly angina and CHD. Future studies are warranted to explore the immunological milieu in these patients and identify therapeutic targets.
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Affiliation(s)
- Sairaman Nagarajan
- Center for Allergy and Asthma Research, SUNY Downstate Health Sciences University, Brooklyn, NY; Department of Country Readiness Strengthening, World Health Emergencies Programme, World Health Organization, Geneva, Switzerland.
| | - Janet Rosenbaum
- Center for Allergy and Asthma Research, SUNY Downstate Health Sciences University, Brooklyn, NY; Department of Epidemiology and Biostatistics, School of Public Health, SUNY Downstate Health Sciences University, Brooklyn, NY
| | - Rauno Joks
- Center for Allergy and Asthma Research, SUNY Downstate Health Sciences University, Brooklyn, NY; Division of Allergy and Immunology, SUNY Downstate Health Sciences University, Brooklyn, NY
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Norland K, Schaid DJ, Naderian M, Na J, Kullo IJ. Joint Association of Polygenic Risk and Social Determinants of Health with Coronary Heart Disease in the United States. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.01.10.24301105. [PMID: 38260263 PMCID: PMC10802647 DOI: 10.1101/2024.01.10.24301105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Background The joint effects of polygenic risk and social determinants of health (SDOH) on coronary heart disease (CHD) in the United States are unknown. Methods In 67,256 All of Us (AoU) participants with available SDOH data, we ascertained self-reported race/ethnicity and calculated a polygenic risk score for CHD (PRS CHD ). We used 90 SDOH survey questions to develop an SDOH score for CHD (SDOH CHD ). We assessed the distribution of SDOH CHD across self-reported races and US states. We tested the joint association of SDOH CHD and PRS CHD with CHD in regression models that included clinical risk factors. Results SDOH CHD was highest in self-reported black and Hispanic people. Self-reporting as black was associated with higher odds of CHD but not after adjustment for SDOH CHD . Median SDOH CHD values varied by US state and were associated with heart disease mortality. A 1-SD increase in SDOH CHD was associated with CHD (OR=1.36; 95% CI, 1.29 to 1.46) and incident CHD (HR=1.73; 95% CI, 1.27 to 2.35) in models that included PRS CHD and clinical risk factors. Among people in the top 20% of PRS CHD , CHD prevalence was 4.8% and 7.8% in the bottom and top 20% of SDOH CHD , respectively. Conclusions Increased odds of CHD in self-reported black people are likely due to higher SDOH burden. SDOH and PRS were independently associated with CHD in the US. Our findings emphasize the need to consider both PRS and SDOH for equitable disease risk assessment.
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García-Mayor J, Moreno-Llamas A, De La Cruz Sánchez E. A decade beyond the economic recession: A study of health-related lifestyles in urban and rural Spain (2006-2017). Nurs Health Sci 2023; 25:700-711. [PMID: 37937892 DOI: 10.1111/nhs.13063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 10/09/2023] [Accepted: 10/19/2023] [Indexed: 11/09/2023]
Abstract
The 2008 economic recession may have affected health-related indicators differently depending on the living environment. We analyze health-related indicators in Spain using data from four Spanish health surveys (2006, 2011, 2014, and 2017, 95 924 individuals aged ≥16 years). In 2006-2011, physical activity decreased among men and women, while in 2006-2017, physical activity only decreased among urban women. Daily vegetable intake, except in rural women, increased in 2006-2011 but decreased in 2006-2017 in all groups. Smoking decreased among urban women in 2006-2011 and 2006-2014 but only decreased among men, and even increased among rural women, in 2006-2017. In 2006-2017, obesity increased among men and urban women, good self-rated health status increased in all groups and flu vaccination declined. Blood pressure and cholesterol control decreased in urban women in 2006-2011 but increased in 2006-2017 in all groups, as well as mammographic and cytological control. Our findings highlight the differential impact of the economic recession on health-related lifestyles according to sex and place of residence, underscoring the need for targeted health policies to address evolving health disparities over time.
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Affiliation(s)
- Jesús García-Mayor
- Public Health and Epidemiology Research Group, San Javier Campus, University of Murcia, San Javier, Spain
| | - Antonio Moreno-Llamas
- Public Health and Epidemiology Research Group, San Javier Campus, University of Murcia, San Javier, Spain
| | - Ernesto De La Cruz Sánchez
- Public Health and Epidemiology Research Group, San Javier Campus, University of Murcia, San Javier, Spain
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Heindl B, Howard G, Clarkson S, Kamin Mukaz D, Lackland D, Muntner P, Jackson EA. Urban-rural differences in hypertension prevalence, blood pressure control, and systolic blood pressure levels. J Hum Hypertens 2023; 37:1112-1118. [PMID: 37407675 DOI: 10.1038/s41371-023-00842-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 09/05/2022] [Accepted: 05/30/2023] [Indexed: 07/07/2023]
Abstract
Higher rates of cardiovascular events have been observed among rural residents compared with urban. Hypertension and lack of blood pressure (BP) control are risk factors for cardiovascular events. We compared the prevalence of hypertension and controlled BP, and the distribution of systolic blood pressure (SBP), by urban-rural residence. Participants from the REasons for Geographic And Racial Differences in Stroke (REGARDS) Study, a prospective cohort of Black and White adults aged ≥45 years, were categorized as either urban, large rural, or small-isolated rural, by using the Rural-Urban Commuting Area (RUCA) categorization B system. Oucomes were hypertension prevalence (BP ≥ 140/90 mmHg or antihypertensive use), BP control (BP < 140/90 among participants on antihypertensive medication), and the distribution of SBP. Counfounders were age, race, sex, antihypertensive medication use, and US Census Bureau division. The analysis included 26,133 participants (80.3% urban, 11.6% large-rural, 8.2% small-isolated rural). The unadjusted prevalence of hypertension was not different between groups. However, after adjustment, the odds of hypertension was higher among participants in the large rural group (odds ratio [OR] 1.17; 95% confidence interval [CI], 1.08-1.27) and small-isolated rural group (OR 1.19; 95% CI, 1.08-1.30), compared with the urban group. There was no evidence of an adjusted difference in BP control for those taking antihypertensive medications. Adjusted differences in SBP were greater for both rural groups, compared with urban, at the higher percentiles of SBP. Rural residence was associated with a higher adjusted odds of hypertension and higher SBP.
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Affiliation(s)
- Brittain Heindl
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - George Howard
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Stephen Clarkson
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Debora Kamin Mukaz
- Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Daniel Lackland
- Department of Neurology, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Paul Muntner
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Elizabeth A Jackson
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA.
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Piscitello GM, Stein D, Arnold RM, Schenker Y. Rural Hospital Disparities in Goals of Care Documentation. J Pain Symptom Manage 2023; 66:578-586. [PMID: 37544552 PMCID: PMC10592198 DOI: 10.1016/j.jpainsymman.2023.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 07/21/2023] [Accepted: 07/29/2023] [Indexed: 08/08/2023]
Abstract
CONTEXT Goals of care conversations for seriously ill hospitalized patients are associated with high-quality patient-centered care. OBJECTIVES We aimed to assess the prevalence of documented goals of care conversations for rural hospitalized patients compared to nonrural hospitalized patients. METHODS We retrospectively assessed goals of care documentation using a template note for adult patients with predicted 90-day mortality greater than 30% admitted to eight rural and nine nonrural community hospitals between July 2021 and April 2023. We compared predictors and prevalence of goals of care documentation among rural and nonrural hospitals. RESULTS Of the 31,098 patients admitted during the study period, 21% were admitted to a rural hospital. Rural patients were more likely than nonrural patients to be >65 years old (89% vs. 86%, P = <.0001), more likely to live in a neighborhood classified in the highest quintile of socioeconomic disadvantage (40% vs. 16%, P = <.0001), and less likely to receive a palliative care consult (8% vs. 18%, P = <.0001). Goals of care documentation occurred less often for patients admitted to rural vs. nonrural community hospitals (2% vs. 7%, P < .0001). In the base multivariable logistic regression model adjusting for patient characteristics, the odds of goals care documentation were lower in rural vs. nonrural community hospitals (aOR 0.4, P = .0232). In a second multivariable logistic regression model including both patient characteristics and severity of illness, the odds of goals of care documentation in rural community hospitals were no longer statistically different than nonrural community hospitals (aOR 0.5, P = .1080). Patients who received a palliative care consult had a lower prevalence of goals of care documentation in rural vs. nonrural hospitals (16% vs. 37%, P = <.0001). CONCLUSION In this study of 17 rural and nonrural community hospitals, we found low overall prevalence of goals of care documentation with particularly infrequent documentation occurring within rural hospitals. Future study is needed to assess barriers to goals of care documentation contributing to low prevalence of goals of care conversations in rural hospital settings.
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Affiliation(s)
- Gina M Piscitello
- Division of General Internal Medicine (G.P., R.A., Y.S.), Section of Palliative Care and Medical Ethics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Palliative Research Center (G.P., R.A., Y.S.), University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
| | - Dillon Stein
- Butler Memorial Hospital (D.S.), Butler, Pennsylvania, USA
| | - Robert M Arnold
- Division of General Internal Medicine (G.P., R.A., Y.S.), Section of Palliative Care and Medical Ethics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Palliative Research Center (G.P., R.A., Y.S.), University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Yael Schenker
- Division of General Internal Medicine (G.P., R.A., Y.S.), Section of Palliative Care and Medical Ethics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Palliative Research Center (G.P., R.A., Y.S.), University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Black JA, Lees C, Chapman N, Kelleher L, Campbell JA, Otahal P, Cheng K, Marwick TH, Sharman JE. Telehealth Rapid Access Chest Pain Clinic: Initial Experience During COVID-19 Pandemic. Telemed J E Health 2023; 29:1476-1483. [PMID: 36862536 DOI: 10.1089/tmj.2022.0493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
Abstract
Objectives: Rapid Access Chest Pain Clinics (RACPCs) provide safe and efficient follow-up for outpatients presenting with new-onset chest pain. RACPC delivery by telehealth has not been reported. We sought to evaluate a telehealth RACPC established during the coronavirus disease 2019 (COVID-19) pandemic. There was a need to reduce the frequency of additional testing arranged by the RACPC during this time, and the safety of this approach was also explored. Methods: This was a prospective evaluation of a cohort of RACPC patients reviewed by telehealth during the COVID-19 pandemic compared with a historical control group of face-to-face consultations. The main outcomes included emergency department re-presentation at 30 days and 12 months, major adverse cardiovascular events at 12 months, and patient satisfaction scores. Results: One hundred forty patients seen in the telehealth clinic were compared with 1,479 in-person RACPC controls. Baseline demographics were similar; however, telehealth patients were less likely to have a normal prereferral electrocardiogram than RACPC controls (81.4% vs. 88.1%, p = 0.03). Additional testing was ordered less often for telehealth patients (35.0% vs. 80.7%, p < 0.001). Rates of adverse cardiovascular events were low in both groups. One hundred twenty (85.7%) patients reported being satisfied or highly satisfied with the telehealth clinic service. Conclusions: In the setting of COVID-19, a telehealth RACPC model with reduced use of additional testing facilitated social distancing and achieved clinical outcomes equivalent to a face-to-face RACPC control. Telehealth may have an ongoing role beyond the pandemic, supporting specialist chest pain assessment for rural and remote communities. Pending further study, it may be safe to reduce the frequency of additional testing following RACPC review.
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Affiliation(s)
- James A Black
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
- Cardiology Department, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Conor Lees
- Cardiology Department, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Niamh Chapman
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Liam Kelleher
- Cardiology Department, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Julie A Campbell
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Petr Otahal
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Kevin Cheng
- Cardiology Department, Monash Medical Centre Clayton, Clayton, Victoria, Australia
| | - Thomas H Marwick
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - James E Sharman
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
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Littlejohn EL, Booker NE, Chambers S, Akinsanya JA, Sankar CA, Benson RT. Advancing Health Equity in Neurologic Disorders and Stroke: Stakeholder Insights Into Health Disparities, Research Gaps, and Potential Interventions. Neurology 2023; 101:S92-S103. [PMID: 37580149 PMCID: PMC10605949 DOI: 10.1212/wnl.0000000000207570] [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: 09/09/2022] [Accepted: 05/09/2023] [Indexed: 08/16/2023] Open
Abstract
OBJECTIVES The purpose of this study was to analyze the National Institute of Neurological Disorders and Stroke (NINDS) Request for Information (RFI) input from the public-including health care providers, researchers, patients, patient advocates, caregivers, advocacy organizations, professional societies, and private and academic stakeholders with an interest in health disparities (HDs) in neurologic disease. RFI questions were structured to solicit input on what stakeholders believe are neurologic disease HD research priorities, drivers of health inequity, and potential interventions. Furthermore, these stakeholder insights were examined within the context of contemporary scientific literature and research frameworks on health equity and health disparities. BACKGROUND The NINDS published a RFI from March 31 to July 15, 2020. The RFI analysis presented here is part of a larger strategic planning process aimed to guide future NINDS efforts in neurologic disorder health equity (HE) research and training. The public commented on facilitators of HDs, populations that experience HDs (HDPs), potential interventions, and research opportunities related to HDs in neurologic disease and/or care in the United States across the lifespan. Responses were analyzed using qualitative methodology. Frequently suggested interventions were thematically clustered using the interpretive phenomenological analysis methodology and are presented in this article to provide a stakeholder-identified roadmap for advancing HE. RESULTS Respondents identified socioecological factors as driving HDs in 89% of determinants reported. Stakeholder-reported HD determinants and subsequent interventions could be classified into the following conceptual categories: HDP neurospecialty care access, innovative HDP engagement and research inclusion strategies, and development of a well-trained clinician-scientist HD workforce. Clustering of the feedback from patient and patient-adjacent respondents (i.e., caretakers and patient advocates) highlighted the prevalence of patient-provider interpersonal factors and limited resources driving access-to-care barriers among their sentiments. DISCUSSION Respondent sentiments suggest prioritization of social determinants of health (SDOH) research, shifting away from the common target of biological and behavioral themes addressed in the existing body of HE research provided by the stakeholder. Overall, respondents suggest focusing research prioritization on access to care, engagement across the HE research and care landscape, and HE workforce development.
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Affiliation(s)
- Erica L Littlejohn
- From the Office of Global Health and Health Disparities (E.L.L., N.E.B., S.C., C.A.S., R.T.B.), Division of Clinical Research, Division of Extramural Research, and Neuroimmunology Clinic (J.A.A.), Division of Intramural Research, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD.
| | - Naomi E Booker
- From the Office of Global Health and Health Disparities (E.L.L., N.E.B., S.C., C.A.S., R.T.B.), Division of Clinical Research, Division of Extramural Research, and Neuroimmunology Clinic (J.A.A.), Division of Intramural Research, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
| | - Stacey Chambers
- From the Office of Global Health and Health Disparities (E.L.L., N.E.B., S.C., C.A.S., R.T.B.), Division of Clinical Research, Division of Extramural Research, and Neuroimmunology Clinic (J.A.A.), Division of Intramural Research, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
| | - Jemima A Akinsanya
- From the Office of Global Health and Health Disparities (E.L.L., N.E.B., S.C., C.A.S., R.T.B.), Division of Clinical Research, Division of Extramural Research, and Neuroimmunology Clinic (J.A.A.), Division of Intramural Research, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
| | - Cheryse A Sankar
- From the Office of Global Health and Health Disparities (E.L.L., N.E.B., S.C., C.A.S., R.T.B.), Division of Clinical Research, Division of Extramural Research, and Neuroimmunology Clinic (J.A.A.), Division of Intramural Research, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
| | - Richard T Benson
- From the Office of Global Health and Health Disparities (E.L.L., N.E.B., S.C., C.A.S., R.T.B.), Division of Clinical Research, Division of Extramural Research, and Neuroimmunology Clinic (J.A.A.), Division of Intramural Research, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
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15
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Nicolau JC, Owen R, Furtado RHM, Goodman SG, Granger CB, Cohen MG, Westermann D, Yasuda S, Simon T, Hedman K, Hunt PR, Brieger DB, Pocock SJ. Long-term outcomes among stable post-acute myocardial infarction patients living in rural versus urban areas: insights from the prospective, observational TIGRIS registry. Open Heart 2023; 10:e002326. [PMID: 37604649 PMCID: PMC10445369 DOI: 10.1136/openhrt-2023-002326] [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: 03/28/2023] [Accepted: 07/11/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Insights on the differences in clinical outcomes, quality of life (QoL) and health resource utilisation (HRU) with different levels of care available to post-acute myocardial infarction (AMI) populations in rural and urban settings are limited. METHODS The long-Term rIsk, clinical manaGement, and healthcare Resource utilisation of stable coronary artery dISease (TIGRIS), a prospective, observational registry, enrolled 8452 patients aged ≥50 years 1-3 years post-AMI from June 2013 to November 2014 from 24 countries in Asia Pacific/Australia, Europe, North America and South America. Differences in QoL (measured using the EuroQol Research Foundation instrument) and HRU between patients in rural and urban settings were evaluated in this post hoc analysis. The incidence of clinical endpoints (cardiovascular (CV) death, AMI, unstable angina with urgent revascularisation and stroke; bleeding; and all-cause mortality) was analysed. Data were collected at baseline and every 6 months for 24 months. RESULTS There were fewer hospitalisations and visits to general practitioners (GPs) and cardiologists in the rural versus urban populations (adjusted event rate ratio (ERR)=0.90 (95% CI, 0.82 to 1.00, p=0.04); ERR=0.84 (95% CI, 0.78 to 0.92, p<0.001); ERR=0.86 (95% CI, 0.81 to 0.92, p<0.001), respectively). No statistically significant differences were observed between rural and urban populations in all-cause death, AMI, unstable angina with urgent revascularisation, CV death, stroke, major bleeding events and health-related QoL. The adjusted incidence rate ratio was 0.92 (95% CI, 0.74 to 1.15) for the composite of CV death, AMI and stroke. CONCLUSIONS Living in rural areas was associated with fewer GP/cardiologist visits and hospitalisations; no significant differences in clinical outcomes and QoL were observed. TRIAL REGISTRATION NUMBER NCT01866904.
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Affiliation(s)
- Jose Carlos Nicolau
- Instituto do Coracao (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Ruth Owen
- London School of Hygiene and Tropical Medicine, London, UK
| | - Remo H M Furtado
- Instituto do Coracao (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Shaun G Goodman
- Terrence Donnelly Heart Centre, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Christopher B Granger
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - Mauricio G Cohen
- Cleveland Clinic Florida, Heart & Vascular Center, Cleveland, Ohio, USA
| | - Dirk Westermann
- Department of General and Interventional Cardiology, University Heart Center Hamburg Eppendorf, Hamburg, Germany
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Tabassome Simon
- Department of Clinical Pharmacology and Research Platform of East of Paris, Assistance Publique-Hôpitaux de Paris, Paris, France
- Sorbonne Université, Paris, France
| | - Katarina Hedman
- BioPharmaceuticals R&D, CVRM Biometrics, AstraZeneca, Gothenburg, Sweden
| | | | - David B Brieger
- Cardiology Department, Concord Hospital, Sydney, New South Wales, Australia
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Moss JL, Hearn M, Cuffee YL, Wardecker BM, Kitt-Lewis E, Pinto CN. The role of social cohesion in explaining rural/urban differences in healthcare access and health status among older adults in the mid-Atlantic United States. Prev Med 2023; 173:107588. [PMID: 37385410 DOI: 10.1016/j.ypmed.2023.107588] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 06/19/2023] [Accepted: 06/23/2023] [Indexed: 07/01/2023]
Abstract
Social cohesion can influence health. It is higher among rural versus urban residents, but the burden of chronic disease is higher in rural communities. We examined the role of social cohesion in explaining rural/urban differences in healthcare access and health status. Rural (n = 1080) and urban (n = 1846) adults (ages 50+) from seven mid-Atlantic U.S. states completed an online, cross-sectional survey on social cohesion and health. We conducted bivariate and multivariable analyses to evaluate the relationships of rurality and social cohesion with healthcare access and health status. Rural participants had higher social cohesion scores than did urban participants (rural: mean = 61.7, standard error[SE] = 0.40; urban: mean = 60.6, SE = 0.35; adjusted beta = 1.45, SE = 0.54, p < .01). Higher social cohesion was associated with greater healthcare access: last-year check-up: adjusted odds ratio[aOR] = 1.25, 95% confidence interval[CI] = 1.17-1.33; having a personal provider: aOR = 1.11, 95% CI = 1.03-1.18; and being up-to-date with CRC screening: aOR = 1.17, 95% CI = 1.10-1.25. In addition, higher social cohesion was associated with improved health status: higher mental health scores (adjusted beta = 1.03, SE = 0.15, p < .001) and lower body mass index (BMI; beta = -0.26, SE = 0.10, p = .01). Compared to urban participants, rural participants were less likely to have a personal provider, had lower physical and mental health scores, and had higher BMI. Paradoxically, rural residents had higher social cohesion but generally poorer health outcomes than did urban residents, even though higher social cohesion is associated with better health. These findings have implications for research and policy to promote social cohesion and health, particularly for health promotion interventions to reduce disparities experienced by rural residents.
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Affiliation(s)
- Jennifer L Moss
- Penn State College of Medicine, The Pennsylvania State University, Hershey, PA, United States of America.
| | - Madison Hearn
- Penn State College of Medicine, The Pennsylvania State University, Hershey, PA, United States of America
| | - Yendelela L Cuffee
- College of Health Sciences, University of Delaware, Newark, DE, United States of America
| | - Britney M Wardecker
- Penn State Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, PA, United States of America
| | - Erin Kitt-Lewis
- Penn State Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, PA, United States of America
| | - Casey N Pinto
- Penn State College of Medicine, The Pennsylvania State University, Hershey, PA, United States of America
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17
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Evans L, Wu Y, Xi W, Ghosh AK, Kim MH, Alexopoulos GS, Pathak J, Banerjee S. Risk stratification models for predicting preventable hospitalization in commercially insured late middle-aged adults with depression. BMC Health Serv Res 2023; 23:621. [PMID: 37312121 DOI: 10.1186/s12913-023-09478-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 04/29/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND A significant number of late middle-aged adults with depression have a high illness burden resulting from chronic conditions which put them at high risk of hospitalization. Many late middle-aged adults are covered by commercial health insurance, but such insurance claims have not been used to identify the risk of hospitalization in individuals with depression. In the present study, we developed and validated a non-proprietary model to identify late middle-aged adults with depression at risk for hospitalization, using machine learning methods. METHODS This retrospective cohort study involved 71,682 commercially insured older adults aged 55-64 years diagnosed with depression. National health insurance claims were used to capture demographics, health care utilization, and health status during the base year. Health status was captured using 70 chronic health conditions, and 46 mental health conditions. The outcomes were 1- and 2-year preventable hospitalization. For each of our two outcomes, we evaluated seven modelling approaches: four prediction models utilized logistic regression with different combinations of predictors to evaluate the relative contribution of each group of variables, and three prediction models utilized machine learning approaches - logistic regression with LASSO penalty, random forests (RF), and gradient boosting machine (GBM). RESULTS Our predictive model for 1-year hospitalization achieved an AUC of 0.803, with a sensitivity of 72% and a specificity of 76% under the optimum threshold of 0.463, and our predictive model for 2-year hospitalization achieved an AUC of 0.793, with a sensitivity of 76% and a specificity of 71% under the optimum threshold of 0.452. For predicting both 1-year and 2-year risk of preventable hospitalization, our best performing models utilized the machine learning approach of logistic regression with LASSO penalty which outperformed more black-box machine learning models like RF and GBM. CONCLUSIONS Our study demonstrates the feasibility of identifying depressed middle-aged adults at higher risk of future hospitalization due to burden of chronic illnesses using basic demographic information and diagnosis codes recorded in health insurance claims. Identifying this population may assist health care planners in developing effective screening strategies and management approaches and in efficient allocation of public healthcare resources as this population transitions to publicly funded healthcare programs, e.g., Medicare in the US.
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Affiliation(s)
- Lauren Evans
- Division of Biostatistics, Department of Population Health Sciences, Weill Cornell Medicine, 402 East 67th Street, New York, NY, 10065, USA
| | - Yiyuan Wu
- Division of Biostatistics, Department of Population Health Sciences, Weill Cornell Medicine, 402 East 67th Street, New York, NY, 10065, USA
| | - Wenna Xi
- Division of Biostatistics, Department of Population Health Sciences, Weill Cornell Medicine, 402 East 67th Street, New York, NY, 10065, USA
| | - Arnab K Ghosh
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, 350 Ladson House 70th St, New York, NY, 10065, USA
| | - Min-Hyung Kim
- Division of Health Informatics, Department of Population Health Sciences, Weill Cornell Medicine, 425 East 61st Street, New York, NY, 10065, USA
| | - George S Alexopoulos
- Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medicine Psychiatry, 21 Bloomingdale Rd, White Plains, NY, USA
| | - Jyotishman Pathak
- Division of Health Informatics, Department of Population Health Sciences, Weill Cornell Medicine, 425 East 61st Street, New York, NY, 10065, USA
| | - Samprit Banerjee
- Division of Biostatistics, Department of Population Health Sciences, Weill Cornell Medicine, 402 East 67th Street, New York, NY, 10065, USA.
- Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medicine Psychiatry, 21 Bloomingdale Rd, White Plains, NY, USA.
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Leveau CM, Hussein M, Tapia-Granados JA, Velázquez GA. Economic fluctuations and educational inequalities in premature ischemic heart disease mortality in Argentina. CAD SAUDE PUBLICA 2023; 39:e00181222. [PMID: 37255190 PMCID: PMC10549982 DOI: 10.1590/0102-311xen181222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 02/15/2023] [Accepted: 03/02/2023] [Indexed: 06/01/2023] Open
Abstract
Although mortality from ischemic heart disease has declined over the past decades in Argentina, ischemic heart disease remains one of the most frequent causes of death. This study aimed to describe the role of individual and contextual factors on premature ischemic heart disease mortality and to analyze how educational differentials in premature ischemic heart disease mortality changed during economic fluctuations in two provinces of Argentina from 1990 to 2018. To test the relationship between individual (age, sex, and educational level) and contextual (urbanization, poverty, and macroeconomic variations) factors, a multilevel Poisson model was estimated. When controlling for the level of poverty at the departmental level, we observed inequalities in premature ischemic heart disease mortality according to the educational level of individuals, affecting population of low educational level. Moreover, economic expansion was related to an increase in ischemic heart disease mortality, however, expansion years were not associated with increasing educational inequalities in ischemic heart disease mortality. At the departmental level, we found no contextual association beween area-related socioeconomic level and the risk of ischemic heart disease mortality. Despite the continuing decline in ischemic heart disease mortality in Argentina, this study highlighted that social inequalities in mortality risk increased over time. Therefore, prevention policies should be more focused on populations of lower socioeconomic status in Argentina.
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Affiliation(s)
- Carlos Marcelo Leveau
- Instituto de Producción, Economía y Trabajo, Universidad Nacional de Lanús, Lanús, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
| | - Mustafa Hussein
- Graduate School of Public Health, The City University of New York, New York, U.S.A
| | | | - Guillermo A Velázquez
- Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
- Instituto de Geografía, Historia y Ciencias Sociales, Consejo Nacional de Investigaciones Científicas y Técnicas/Universidad Nacional del Centro de la Provincia de Buenos Aires, Buenos Aires, Argentina
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Damsees R, Jaghbir M, Salam M, Al-Omari A, Al-Rawashdeh N. Unravelling the predictors of late cancer presentation and diagnosis in Jordan: a cross-sectional study of patients with lung and colorectal cancers. BMJ Open 2023; 13:e069529. [PMID: 37130680 PMCID: PMC10163555 DOI: 10.1136/bmjopen-2022-069529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
OBJECTIVES Late presentation or diagnosis of cancer results in a poor clinical prognosis, negatively affects treatment and subsequently lowers one's chances of survival. This study aimed to identify the factors associated with late lung and colorectal cancer presentation and diagnosis in Jordan. DESIGN This correlational cross-sectional study was based on face-to-face interviews and medical chart reviews from a cancer registry database. A structured questionnaire based on a review of the literature was used. SETTING AND PARTICIPANTS The study participants were a representative sample of adult patients with colorectal or lung cancer who visited the outpatient clinics at King Hussein Cancer Center in Amman, Jordan, between January 2019 and December 2020, to get their first medical consultation. RESULTS 382 study participants were surveyed, with a response rate of 82.3%. Of these, 162 (42.2%) reported a late presentation and 92 (24.1%) reported a late diagnosis of cancer. The results of backward multivariate logistic regression analyses showed that female gender and not seeking a medical advice when feeling ill combined was associated with an almost three times increased likelihood of reporting a late presentation with cancer (adjusted OR 2.97, 95% CI 1.19 to 7.43). Not having health insurance and not seeking medical advice combined was also associated with late presentation (2.5, 95% CI 1.02 to 6.12). For lung cancer, Jordanians living in rural areas were 9.29 (95% CI 2.46 to 35.1) times more likely to report late diagnosis. Jordanians who did not screen for cancer in the past were 7.02 (95% CI 1.69 to 29.18) times more likely to report late diagnosis. For colorectal cancer, those having no previous knowledge about cancers or screening programmes had increased odds of reporting late diagnosis (2.30, 95% CI 1.06 to 4.97). CONCLUSIONS This study highlights important factors associated with the late presentation and diagnosis of colorectal and lung cancers in Jordan. Investing in national screening and early detection programmes as well as public outreach and awareness campaigns will have a significant impact on early detection to improve treatment outcomes.
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Affiliation(s)
- Rana Damsees
- Office of Scientific Affairs and Research, King Hussein Cancer Center, Amman, Jordan
- Department of Science, Technology and Research, UAE Ministry of Education, Abu Dhabi, UAE
| | - Madi Jaghbir
- Department of Family and Community Medicine, The University of Jordan, Amman, Jordan
| | - Mahmoud Salam
- Hariri School of Nursing, American University of Beirut, Beirut, Lebanon
| | - Amal Al-Omari
- Office of Scientific Affairs and Research, King Hussein Cancer Center, Amman, Jordan
| | - Nedal Al-Rawashdeh
- Office of Scientific Affairs and Research, King Hussein Cancer Center, Amman, Jordan
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Shaver N, Bennett A, Beck A, Skidmore B, Traversy G, Brouwers M, Little J, Moher D, Moore A, Persaud N. Health equity considerations in guideline development: a rapid scoping review. CMAJ Open 2023; 11:E357-E371. [PMID: 37171906 PMCID: PMC10139082 DOI: 10.9778/cmajo.20220130] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/14/2023] Open
Abstract
BACKGROUND Systematic guidance for considering health equity in guidelines is lacking. This scoping review aims to synthesize current best practices for integrating health equity into guideline development and the benefits or drawbacks of these practices. METHODS We searched Ovid MEDLINE ALL and Embase Classic+Embase on the Ovid platform, CINAHL on EBSCO, and Web of Science (Core Collection) from 2010 to 2022. We searched grey literature from 2015 to 2022, using the Canadian Agency for Drugs and Technologies in Health Grey Matters checklist and searches of potentially relevant websites. Articles were screened independently by 1 reviewer. Proposed best practices, advantages and disadvantages, and tools were extracted independently by 1 reviewer and qualitatively synthesized based on the relevant steps of a comprehensive checklist covering the stages of guideline development. RESULTS We included 26 articles that proposed best practices for incorporating health equity within the guideline development process. These practices were organized under different stages of the development process, including guideline planning, evidence review, guideline development and dissemination. Included studies provided best practices from guideline producers, articles discussing health equity in current guidelines, articles addressing strategies to increase equity in the guideline implementation process, and literature reviews of promising health equity practices. INTERPRETATION Our scoping review identified best practices to incorporate health equity considerations at each phase of guideline development. Identified practices may be used to inform equity-promoting strategies with the guideline development process; however, guideline producers should carefully consider the advantages and disadvantages of best practices when integrating health equity.
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Affiliation(s)
- Nicole Shaver
- School of Epidemiology and Public Health, Faculty of Medicine (Shaver, Bennett, Beck, Brouwers, Little, Moher), University of Ottawa; Skidmore Research & Information Consulting (Skidmore); Centre for Chronic Disease Prevention and Health Equity (Traversy), Public Health Agency of Canada; Clinical Epidemiology Program (Moher), Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Persaud), St. Michael's Hospital, Toronto, Ont
| | - Alexandria Bennett
- School of Epidemiology and Public Health, Faculty of Medicine (Shaver, Bennett, Beck, Brouwers, Little, Moher), University of Ottawa; Skidmore Research & Information Consulting (Skidmore); Centre for Chronic Disease Prevention and Health Equity (Traversy), Public Health Agency of Canada; Clinical Epidemiology Program (Moher), Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Persaud), St. Michael's Hospital, Toronto, Ont.
| | - Andrew Beck
- School of Epidemiology and Public Health, Faculty of Medicine (Shaver, Bennett, Beck, Brouwers, Little, Moher), University of Ottawa; Skidmore Research & Information Consulting (Skidmore); Centre for Chronic Disease Prevention and Health Equity (Traversy), Public Health Agency of Canada; Clinical Epidemiology Program (Moher), Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Persaud), St. Michael's Hospital, Toronto, Ont
| | - Becky Skidmore
- School of Epidemiology and Public Health, Faculty of Medicine (Shaver, Bennett, Beck, Brouwers, Little, Moher), University of Ottawa; Skidmore Research & Information Consulting (Skidmore); Centre for Chronic Disease Prevention and Health Equity (Traversy), Public Health Agency of Canada; Clinical Epidemiology Program (Moher), Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Persaud), St. Michael's Hospital, Toronto, Ont
| | - Gregory Traversy
- School of Epidemiology and Public Health, Faculty of Medicine (Shaver, Bennett, Beck, Brouwers, Little, Moher), University of Ottawa; Skidmore Research & Information Consulting (Skidmore); Centre for Chronic Disease Prevention and Health Equity (Traversy), Public Health Agency of Canada; Clinical Epidemiology Program (Moher), Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Persaud), St. Michael's Hospital, Toronto, Ont
| | - Melissa Brouwers
- School of Epidemiology and Public Health, Faculty of Medicine (Shaver, Bennett, Beck, Brouwers, Little, Moher), University of Ottawa; Skidmore Research & Information Consulting (Skidmore); Centre for Chronic Disease Prevention and Health Equity (Traversy), Public Health Agency of Canada; Clinical Epidemiology Program (Moher), Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Persaud), St. Michael's Hospital, Toronto, Ont
| | - Julian Little
- School of Epidemiology and Public Health, Faculty of Medicine (Shaver, Bennett, Beck, Brouwers, Little, Moher), University of Ottawa; Skidmore Research & Information Consulting (Skidmore); Centre for Chronic Disease Prevention and Health Equity (Traversy), Public Health Agency of Canada; Clinical Epidemiology Program (Moher), Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Persaud), St. Michael's Hospital, Toronto, Ont
| | - David Moher
- School of Epidemiology and Public Health, Faculty of Medicine (Shaver, Bennett, Beck, Brouwers, Little, Moher), University of Ottawa; Skidmore Research & Information Consulting (Skidmore); Centre for Chronic Disease Prevention and Health Equity (Traversy), Public Health Agency of Canada; Clinical Epidemiology Program (Moher), Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Persaud), St. Michael's Hospital, Toronto, Ont
| | - Ainsley Moore
- School of Epidemiology and Public Health, Faculty of Medicine (Shaver, Bennett, Beck, Brouwers, Little, Moher), University of Ottawa; Skidmore Research & Information Consulting (Skidmore); Centre for Chronic Disease Prevention and Health Equity (Traversy), Public Health Agency of Canada; Clinical Epidemiology Program (Moher), Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Persaud), St. Michael's Hospital, Toronto, Ont
| | - Navindra Persaud
- School of Epidemiology and Public Health, Faculty of Medicine (Shaver, Bennett, Beck, Brouwers, Little, Moher), University of Ottawa; Skidmore Research & Information Consulting (Skidmore); Centre for Chronic Disease Prevention and Health Equity (Traversy), Public Health Agency of Canada; Clinical Epidemiology Program (Moher), Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Persaud), St. Michael's Hospital, Toronto, Ont
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Morgan S, Mottaleb MA, Kraemer MP, Moser DK, Worley J, Morris AJ, Petriello MC. Effect of lifestyle-based lipid lowering interventions on the relationship between circulating levels of per-and polyfluoroalkyl substances and serum cholesterol. ENVIRONMENTAL TOXICOLOGY AND PHARMACOLOGY 2023; 98:104062. [PMID: 36621559 PMCID: PMC9992109 DOI: 10.1016/j.etap.2023.104062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 01/01/2023] [Accepted: 01/04/2023] [Indexed: 06/17/2023]
Abstract
Exposure to certain per-and polyfluoroalkyl substances (PFAS) has been shown to be positively associated with total and/or low-density lipoprotein cholesterol. Examining this association in lipid lowering interventions may provide additional evidence linking PFAS to cardiovascular risk. We examined the relationship of 6 PFAS with cholesterol in a 6-month lifestyle-based intervention. We quantitated PFAS in 350 individuals at baseline and post intervention and examined associations of PFAS with cholesterol before and after intervention. Food frequency questionnaires and GIS analyses were used to investigate PFAS hotspots and possible exposure routes. Cholesterol significantly decreased following intervention and in parallel, PFOS, PFOA, PFHxS, and PFHpA significantly decreased. PFOS was positively correlated with total cholesterol only post-intervention. We observed that PFOS was distributed among both non-albumin and albumin lipoprotein fractions pre-intervention, but entirely in albumin fraction post-intervention. Our results indicate that lipid-lowering via lifestyle modification may impact on circulating levels or distribution of PFAS.
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Affiliation(s)
- Stephanie Morgan
- Institute of Environmental Health Sciences, Wayne State University, Detroit, MI 48202, USA
| | - M Abdul Mottaleb
- Division of Cardiovascular Medicine, College of Medicine, University of Kentucky, Lexington, KY 40536, USA; Lexington Veterans Affairs Medical Center, Lexington, KY, USA
| | - Maria P Kraemer
- Lexington Veterans Affairs Medical Center, Lexington, KY, USA
| | - Debra K Moser
- College of Nursing, University of Kentucky, Lexington, KY 40536, USA
| | - Jessica Worley
- Institute of Environmental Health Sciences, Wayne State University, Detroit, MI 48202, USA
| | - Andrew J Morris
- Division of Cardiovascular Medicine, College of Medicine, University of Kentucky, Lexington, KY 40536, USA; Lexington Veterans Affairs Medical Center, Lexington, KY, USA
| | - Michael C Petriello
- Institute of Environmental Health Sciences, Wayne State University, Detroit, MI 48202, USA; Lexington Veterans Affairs Medical Center, Lexington, KY, USA; Department of Pharmacology, School of Medicine, Wayne State University, Detroit, MI 48202, USA.
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22
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Lee JH, Wheeler DC, Zimmerman EB, Hines AL, Chapman DA. Urban-Rural Disparities in Deaths of Despair: A County-Level Analysis 2004-2016 in the U.S. Am J Prev Med 2023; 64:149-156. [PMID: 38584644 PMCID: PMC10997338 DOI: 10.1016/j.amepre.2022.08.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Introduction The purpose of this study is to examine nationwide disparities in drug, alcohol, and suicide mortality; evaluate the association between county-level characteristics and these mortality rates; and illustrate spatial patterns of mortality risk to identify areas with elevated risk. Methods The authors applied a Bayesian spatial regression technique to investigate the association between U.S. county-level characteristics and drug, alcohol, and suicide mortality rates for 2004-2016, accounting for spatial correlation that occurs among counties. Results Mortality risks from drug, alcohol, and suicide were positively associated with the degree of rurality, the proportion of vacant housing units, the population with a disability, the unemployed population, the population with low access to grocery stores, and the population with no health insurance. Conversely, risks were negatively associated with Hispanic population, non-Hispanic Black population, and population with a bachelor's degree or higher. Conclusions Spatial disparities in drug, alcohol, and suicide mortality exist at the county level across the U.S. social determinants of health; educational attainment, degree of rurality, ethnicity, disability, unemployment, and health insurance status are important factors associated with these mortality rates. A comprehensive strategy that includes downstream interventions providing equitable access to healthcare services and upstream efforts in addressing socioeconomic conditions is warranted to effectively reduce these mortality burdens.
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Affiliation(s)
- Jong Hyung Lee
- Center on Society and Health, Virginia Commonwealth University, Richmond, Virginia
| | - David C. Wheeler
- Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia
| | - Emily B. Zimmerman
- Center on Society and Health, Virginia Commonwealth University, Richmond, Virginia
- Division of Epidemiology, Department of Family Medicine and Population Health, Virginia Commonwealth University School of Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Anika L. Hines
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, Virginia
| | - Derek A. Chapman
- Center on Society and Health, Virginia Commonwealth University, Richmond, Virginia
- Division of Epidemiology, Department of Family Medicine and Population Health, Virginia Commonwealth University School of Medicine, Virginia Commonwealth University, Richmond, Virginia
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Reliability and Validity of the State-Trait Hopelessness Scale in a Primarily Rural Population of Adults With Ischemic Heart Disease in the US Great Plains. J Cardiovasc Nurs 2023; 38:84-91. [PMID: 35030110 DOI: 10.1097/jcn.0000000000000886] [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] [Indexed: 12/15/2022]
Abstract
PURPOSE Hopelessness and rurality are each independently associated with increased mortality in adults with ischemic heart disease (IHD), yet there is no known research examining hopelessness in rural patients with IHD. The authors of this study evaluated the reliability and validity of the State-Trait Hopelessness Scale (STHS) in a primarily rural population of adults with IHD living in West North Central United States (US Great Plains). METHODS Reliability, concurrent validity, and convergent validity were evaluated for 115 adults hospitalized for IHD. Rural-Urban Commuting Area codes were used to stratify participants by rurality level, with 66% categorized as rural. Principal component analysis was used to examine potential factor structure of the STHS. FINDINGS Cronbach α for the State and Trait Hopelessness subscales were 0.884 and 0.903, respectively. Concurrent validity was supported for the State and Trait subscales using the Patient Health Questionnaire-8 (State: r = 0.50, P < .001; Trait: r = 0.35, P < .001). Convergent validity was supported for the State subscale using the Duke Activity Status Index ( r = -0.23, P = .013). Principal component analysis showed 2 factors (hopelessness present and hopelessness absent) for the State and Trait subscales, accounting for 63% and 58% of variance, respectively. CONCLUSIONS Findings support the reliability and validity of the STHS for evaluation of hopelessness in rural adults with IHD in clinical and research settings. Results replicated the same factor structure found in testing of the STHS in a primarily urban sample. Because of the prevalence of hopelessness in rural adults with IHD and association with increased mortality, hopelessness should be assessed during hospitalization and in the recovery period.
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Khalid N, Ahmad SA. Disparities in Urgent Cardiovascular Care in the United States. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 46:10-11. [PMID: 36307362 DOI: 10.1016/j.carrev.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 10/03/2022] [Indexed: 01/12/2023]
Affiliation(s)
- Nauman Khalid
- Section of Interventional Cardiology, St. Francis Medical Center, Monroe, LA, United States of America.
| | - Sarah Aftab Ahmad
- Section of Cardiothoracic Surgery, St. Francis Medical Center, Monroe, LA, United States of America
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Scott L, Dunn L, Oliver J. Increasing lipid screenings in children 9-11 years old at a federally qualified health center - A quality improvement project. J Pediatr Nurs 2022; 67:1-6. [PMID: 35870386 DOI: 10.1016/j.pedn.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 06/28/2022] [Accepted: 07/08/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Coronary artery disease (CAD) remains the leading cause of death in the U.S. Atherosclerotic changes leading to CAD begin in early childhood. Universal lipid screenings remain low nationwide despite the 2011 National Heart, Lung, and Blood Institute's (NHLBI) Expert Panel Guidelines. LOCAL PROBLEM The aim of this quality improvement project was to examine the benefit of an educational intervention on the implementation of universal lipid screening guidelines within a federally qualified health center tasked with providing care to a high-risk population. INTERVENTION An educational intervention was offered detailing the 2011 NHLBI guidelines. A total of seven medical providers participated in the intervention. METHOD Following the intervention, a pre- and post- knowledge survey was given to assess improvement in knowledge. A retrospective chart review was performed to evaluate application to practice. RESULTS The number of lipid screenings improved from 7.8% (n = 384) pre-intervention to 39.2% (n = 74) post intervention. There was a statistically significant increase in screenings post-intervention t (456) = 7.842, p = .000, two-tailed). CONCLUSION More studies are needed to adequately identify the impact of universal screening guidelines on the health of both children and adults alike. PRACTICE IMPLICATIONS Universal lipid screenings remain promising in early identification of CAD in the pediatric population. Interventions related to expanding the knowledge of healthcare providers, patients, and families are key to decreasing CAD morbidity and mortality.
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Affiliation(s)
- Letisha Scott
- Capstone College of Nursing, The University of Alabama, 650 University Blvd, Tuscaloosa, AL 35487, USA.
| | - Linda Dunn
- Capstone College of Nursing, The University of Alabama, 650 University Blvd, Tuscaloosa, AL 35487, USA.
| | - JoAnn Oliver
- Capstone College of Nursing, The University of Alabama, 650 University Blvd, Tuscaloosa, AL 35487, USA.
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Teppo K, Jaakkola J, Langén VL, Biancari F, Halminen O, Linna M, Haukka J, Putaala J, Mustonen P, Kinnunen J, Luojus A, Hartikainen J, Airaksinen KEJ, Lehto M. Rural-urban differences in the initiation of oral anticoagulant therapy in patients with incident atrial fibrillation: A Finnish nationwide cohort study. PLoS One 2022; 17:e0276612. [PMID: 36315505 PMCID: PMC9621410 DOI: 10.1371/journal.pone.0276612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 10/10/2022] [Indexed: 01/24/2023] Open
Abstract
AIMS Little is known about rural-urban differences in the treatment and outcomes in patients with atrial fibrillation (AF). We aimed to assess whether the initiation of oral anticoagulant (OAC) therapy in patients with AF differs between those with rural and urban residence. METHODS The registry-based FinACAF cohort covers all patients with AF from all levels of care in Finland. Patients were divided into rural and urban categories and into urbanization degree tertiles based on their municipality of residence at the time of AF diagnosis. The outcome was the first redeemed OAC prescription. RESULTS We identified 222 419 patients (50.1% female; mean age 72.8 (SD 13.2) years) with incident AF during 2007-2018. Urban residence was associated with a lower rate of OAC therapy initiation (adjusted subdistribution hazard ratio (SHR) (95% CI) 0.96 (0.95-0.97)). Correspondingly, an inverse graded dose-response relationship was observed between higher urbanization degree tertile and OAC initiation rate (highest tertile compared to lowest: adjusted SHR (95% CI) 0.94 (0.93-0.95)). The adoption of direct oral anticoagulants for stroke prevention was faster among patients with urban residence. CONCLUSION This nationwide cohort study documented that urban residence is associated with a slightly lower rate of OAC therapy initiation in patients with incident AF, but faster adoption of direct oral anticoagulant use.
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Affiliation(s)
| | - Jussi Jaakkola
- University of Turku, Turku, Finland
- Heart Unit, Satakunta Central Hospital, Pori, Finland
| | - Ville L. Langén
- Division of Medicine, Turku University Hospital, Turku, Finland
| | - Fausto Biancari
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
- Clinica Montevergine, GVM Care & Research, Mercogliano, Italy
| | - Olli Halminen
- Department of Industrial Engineering and Management, Aalto University, Espoo Finland
| | - Miika Linna
- Aalto University, Espoo, Finland
- University of Eastern Finland, Kuopio, Finland
| | - Jari Haukka
- Faculty of Medicine, Clinicum, University of Helsinki, Helsinki, Finland
| | - Jukka Putaala
- Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | | | - Janne Kinnunen
- Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Alex Luojus
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
- Faculty of Medicine, Clinicum, University of Helsinki, Helsinki, Finland
| | - Juha Hartikainen
- University of Eastern Finland, Kuopio, Finland
- Heart Center, Kuopio University Hospital, Kuopio, Finland
| | | | - Mika Lehto
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
- Faculty of Medicine, Clinicum, University of Helsinki, Helsinki, Finland
- Department of Internal Medicine, Lohja Hospital, Lohja, Finland
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de Walque D, Kandpal E. Reviewing the evidence on health financing for effective coverage: do financial incentives work? BMJ Glob Health 2022; 7:bmjgh-2022-009932. [PMID: 36130774 PMCID: PMC9490608 DOI: 10.1136/bmjgh-2022-009932] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 09/06/2022] [Indexed: 11/30/2022] Open
Abstract
The widening gap between improving healthcare coverage rates and stagnating health outcomes across low-income and middle-income countries highlights the need for investments in quality of care, in addition to access. New research, presented in a World Bank report, examines one type of relevant policy reform: performance-based financing (PBF), which is a package reform that always includes performance pay to front-line health workers and often also provides facility autonomy, transparency and community engagement. A large body of rigorous studies and new analysis show that in under-resourced, centralised health systems, PBF can result in gains to service utilisation, but only has limited impacts on quality. Even the relative benefits of PBF on service utilisation are less clear when compared with (1) direct facility financing which provides front-line facilities with operating budgets and provider autonomy, but not performance pay and (2) demand-side financial support for health services (ie, conditional cash transfers and vouchers). Thus, the central component of PBF—the performance pay—appears to add little value over flexible payment systems and provider autonomy. The analysis shows that this lack of impact is unsurprising because most of the constraints to improving quality do not lie with the health worker in these settings. While PBF was conceived as a complex package ‘blueprint’, we review the evidence to conclude that only some elements seem to make sense. To improve quality of care, health financing should pivot from performance pay while retaining the elements of direct facility financing, autonomy, transparency and community engagement.
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Affiliation(s)
- Damien de Walque
- Development Research Group, World Bank, Washington, District of Columbia, USA
| | - Eeshani Kandpal
- Development Research Group, World Bank, Washington, District of Columbia, USA
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Denslow S, Wingert JR, Hanchate AD, Rote A, Westreich D, Sexton L, Cheng K, Curtis J, Jones WS, Lanou AJ, Halladay JR. Rural-urban outcome differences associated with COVID-19 hospitalizations in North Carolina. PLoS One 2022; 17:e0271755. [PMID: 35976813 PMCID: PMC9384999 DOI: 10.1371/journal.pone.0271755] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 07/07/2022] [Indexed: 01/08/2023] Open
Abstract
People living in rural regions in the United States face more health challenges than their non-rural counterparts which could put them at additional risks during the COVID-19 pandemic. Few studies have examined if rurality is associated with additional mortality risk among those hospitalized for COVID-19. We studied a retrospective cohort of 3,991 people hospitalized with SARS-CoV-2 infections discharged between March 1 and September 30, 2020 in one of 17 hospitals in North Carolina that collaborate as a clinical data research network. Patient demographics, comorbidities, symptoms and laboratory data were examined. Logistic regression was used to evaluate associations of rurality with a composite outcome of death/hospice discharge. Comorbidities were more common in the rural patient population as were the number of comorbidities per patient. Overall, 505 patients died prior to discharge and 63 patients were discharged to hospice. Among rural patients, 16.5% died or were discharged to hospice vs. 13.3% in the urban cohort resulting in greater odds of death/hospice discharge (OR 1.3, 95% CI 1.1, 1.6). This estimate decreased minimally when adjusted for age, sex, race/ethnicity, payer, disease comorbidities, presenting oxygen levels and cytokine levels (adjusted model OR 1.2, 95% CI 1.0, 1.5). This analysis demonstrated a higher COVID-19 mortality risk among rural residents of NC. Implementing policy changes may mitigate such disparities going forward.
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Affiliation(s)
- Sheri Denslow
- Epidemiologist/Statistician, Department of Research, UNC Health Sciences at MAHEC, Asheville, North Carolina, United States of America
| | - Jason R. Wingert
- Department of Health and Wellness, University of North Carolina Asheville, Asheville, NC, United States of America
- * E-mail:
| | - Amresh D. Hanchate
- Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States of America
| | - Aubri Rote
- Department of Health and Wellness, University of North Carolina Asheville, Asheville, NC, United States of America
| | - Daniel Westreich
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Laura Sexton
- Sage Nutrition Associates, University of North Carolina Asheville, Asheville, North Carolina, United States of America
| | - Kedai Cheng
- Department of Mathematics, University of North Carolina Asheville, Asheville, North Carolina, United States of America
| | - Janis Curtis
- Clinical Data Research Networks, Duke University, Durham, North Carolina, United States of America
| | - William Schuyler Jones
- Associate Professor of Medicine, Associate Professor of Population Health Sciences, Member of the Duke Clinical Research Institute, Duke University, Durham, North Carolina, United States of America
| | - Amy Joy Lanou
- Department of Health and Wellness, Executive Director, NC Center for Health and Wellness, University of North Carolina Asheville, Asheville, North Carolina, United States of America
| | - Jacqueline R. Halladay
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
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Abbott L, Graven L, Schluck G, Lemacks J. A Structural Equation Modeling Analysis to Explore Diabetes Self-Care Factors in a Rural Sample. Healthcare (Basel) 2022; 10:1536. [PMID: 36011193 PMCID: PMC9407851 DOI: 10.3390/healthcare10081536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/07/2022] [Accepted: 08/09/2022] [Indexed: 11/16/2022] Open
Abstract
Diabetes is a public health problem that requires management to avoid health sequelae. Little is known about the determinants that influence diabetes self-care activities among rural populations. The purpose of this analysis was to explore the relationships among diabetes self-care activities, diabetes knowledge, perceived diabetes self-management, diabetes fatalism, and social support among an underserved rural group in the southern United States. A diabetes health promotion program was tested during a cluster randomized trial that tested a disease risk reduction program among adults living with prediabetes and diabetes. A structural equation model was fit to test psychosocial factors that influence diabetes self-care activities using the Information-Motivation-Behavioral Skills Model of Diabetes Self-Care (IMB-DSC) to guide the study. Perceived diabetes self-management significantly predicted self-care behaviors, and there was also a correlation between perceived diabetes self-management and diabetes fatalism. Perceived diabetes self-management influenced diabetes self-care activities in this rural sample and had an association with diabetes fatalism. The findings of this study can facilitate clinical care and community programs targeting diabetes and advance health equity among underserved rural groups.
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Affiliation(s)
- Laurie Abbott
- College of Nursing, Florida State University, Tallahassee, FL 32306, USA
| | - Lucinda Graven
- College of Nursing, Florida State University, Tallahassee, FL 32306, USA
| | - Glenna Schluck
- College of Nursing, Florida State University, Tallahassee, FL 32306, USA
| | - Jennifer Lemacks
- College of Nursing and Health Professions, University of Southern Mississippi, Hattiesburg, MS 39406, USA
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Adrianzen-Herrera D, Sparks AD, Shastri A, Zakai NA, Littenberg B. Geographic disparities in cardiovascular mortality among patients with myelodysplastic syndromes: A population-based analysis. Cancer Epidemiol 2022; 80:102238. [PMID: 35970010 DOI: 10.1016/j.canep.2022.102238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/30/2022] [Accepted: 08/07/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Clonal hematopoiesis, a precursor to myelodysplastic syndromes (MDS), constitutes a novel cardiovascular disease (CVD) risk factor, causing growing interest in cardiovascular outcomes in MDS. Rurality is associated with increased CVD but studies on cardiovascular geographic disparities in MDS are lacking. METHODS Using the U.S. Surveillance, Epidemiology, and End Results (SEER) registry, we identified 52,750 MDS patients between 2001 and 2016. Rurality was defined using Rural-Urban Continuum Codes. Cox regression estimated the association of rurality and cardiovascular death. RESULTS MDS incidence was equal in urban and rural populations (6.7 per 100,000). Crude probability of cardiovascular death was higher among rural MDS patients. Adjusting for age, sex, race/ethnicity, marital status, insurance, and MDS risk (defined from histology), rural patients had 12% increased risk of CVD death compared to urban patients (HR=1.12, 95%CI 1.03-1.21). HR for CVD death was 1.22 (95%CI 1.01-1.5) in patients from the most rural areas (less than 2500 urban population). Among MDS patients younger than 65 years, rurality was associated with 25% increased risk of CVD death (HR=1.25, 95%CI 1.01-1.59). DISCUSSION This population-based analysis suggests that rural residence is linked to higher burden of cardiovascular death in patients with MDS. The disparity is not explained by demographic factors or MDS risk. Interventions targeting CVD may improve outcomes in rural MDS patients.
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Affiliation(s)
- Diego Adrianzen-Herrera
- Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT, USA.
| | - Andrew D Sparks
- Biomedical Statistics Research Core, University of Vermont, Burlington, VT, USA
| | - Aditi Shastri
- Department of Oncology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Neil A Zakai
- Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT, USA
| | - Benjamin Littenberg
- Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT, USA
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Robbins NM, Charleston L, Saadi A, Thayer Z, Codrington WU, Landry A, Bernat JL, Hamilton R. Black Patients Matter in Neurology: Race, Racism, and Race-Based Neurodisparities. Neurology 2022; 99:106-114. [PMID: 35851551 DOI: 10.1212/wnl.0000000000200830] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 04/22/2022] [Indexed: 11/15/2022] Open
Abstract
Black people living in the United States suffer disproportionate morbidity and mortality across a wide range of neurologic conditions. Despite common conceptions to the contrary, "race" is a socially defined construct with little genetic validity. Therefore, racial health inequities in neurology ("neurodisparities") are not a consequence of biologic differences between races. Instead, racism and associated social determinants of health are the root of neurodisparities. To date, many neurologists have neglected racism as a root cause of neurologic disease, further perpetuating the problem. Structural racism, largely ignored in current neurologic practice and policy, drives neurodisparities through mediators such as excessive poverty, inferior health insurance, and poorer access to neurologic and preventative care. Interpersonal racism (implicit or explicit) and associated discriminatory practices in neurologic research, workforce advancement, and medical education also exacerbate neurodisparities. Neurologists cannot fulfill their professional and ethical responsibility to care for Black patients without understanding how racism, not biologic race, drives neurodisparities. In our review of race, racism, and race-based disparities in neurology, we highlight the current literature on neurodisparities across a wide range of neurologic conditions and focus on racism as the root cause. We discuss why all neurologists are ethically and professionally obligated to actively promote measures to counteract racism. We conclude with a call for actions that should be implemented by individual neurologists and professional neurologic organizations to mitigate racism and work towards health equity in neurology.
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Affiliation(s)
- Nathaniel M Robbins
- From the Department of Neurology (N.M.R., J.L.B.), Dartmouth Geisel School of Medicine, Hanover, NH; Department of Neurology and Ophthalmology Michigan State University College of Human Medicine (L.C.), East Lansing, MI; Department of Neurology (A.S.), Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Anthropology (Z.T.), Dartmouth College, Hanover, NH; Brooklyn Law School (W.U.C.), Brooklyn, NY; Department of Emergency Medicine (A.L.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Perelman School of Medicine (R.H.), University of Pennsylvania, Philadelphia, PA.
| | - Larry Charleston
- From the Department of Neurology (N.M.R., J.L.B.), Dartmouth Geisel School of Medicine, Hanover, NH; Department of Neurology and Ophthalmology Michigan State University College of Human Medicine (L.C.), East Lansing, MI; Department of Neurology (A.S.), Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Anthropology (Z.T.), Dartmouth College, Hanover, NH; Brooklyn Law School (W.U.C.), Brooklyn, NY; Department of Emergency Medicine (A.L.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Perelman School of Medicine (R.H.), University of Pennsylvania, Philadelphia, PA
| | - Altaf Saadi
- From the Department of Neurology (N.M.R., J.L.B.), Dartmouth Geisel School of Medicine, Hanover, NH; Department of Neurology and Ophthalmology Michigan State University College of Human Medicine (L.C.), East Lansing, MI; Department of Neurology (A.S.), Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Anthropology (Z.T.), Dartmouth College, Hanover, NH; Brooklyn Law School (W.U.C.), Brooklyn, NY; Department of Emergency Medicine (A.L.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Perelman School of Medicine (R.H.), University of Pennsylvania, Philadelphia, PA
| | - Zaneta Thayer
- From the Department of Neurology (N.M.R., J.L.B.), Dartmouth Geisel School of Medicine, Hanover, NH; Department of Neurology and Ophthalmology Michigan State University College of Human Medicine (L.C.), East Lansing, MI; Department of Neurology (A.S.), Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Anthropology (Z.T.), Dartmouth College, Hanover, NH; Brooklyn Law School (W.U.C.), Brooklyn, NY; Department of Emergency Medicine (A.L.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Perelman School of Medicine (R.H.), University of Pennsylvania, Philadelphia, PA
| | - Wilfred U Codrington
- From the Department of Neurology (N.M.R., J.L.B.), Dartmouth Geisel School of Medicine, Hanover, NH; Department of Neurology and Ophthalmology Michigan State University College of Human Medicine (L.C.), East Lansing, MI; Department of Neurology (A.S.), Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Anthropology (Z.T.), Dartmouth College, Hanover, NH; Brooklyn Law School (W.U.C.), Brooklyn, NY; Department of Emergency Medicine (A.L.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Perelman School of Medicine (R.H.), University of Pennsylvania, Philadelphia, PA
| | - Alden Landry
- From the Department of Neurology (N.M.R., J.L.B.), Dartmouth Geisel School of Medicine, Hanover, NH; Department of Neurology and Ophthalmology Michigan State University College of Human Medicine (L.C.), East Lansing, MI; Department of Neurology (A.S.), Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Anthropology (Z.T.), Dartmouth College, Hanover, NH; Brooklyn Law School (W.U.C.), Brooklyn, NY; Department of Emergency Medicine (A.L.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Perelman School of Medicine (R.H.), University of Pennsylvania, Philadelphia, PA
| | - James L Bernat
- From the Department of Neurology (N.M.R., J.L.B.), Dartmouth Geisel School of Medicine, Hanover, NH; Department of Neurology and Ophthalmology Michigan State University College of Human Medicine (L.C.), East Lansing, MI; Department of Neurology (A.S.), Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Anthropology (Z.T.), Dartmouth College, Hanover, NH; Brooklyn Law School (W.U.C.), Brooklyn, NY; Department of Emergency Medicine (A.L.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Perelman School of Medicine (R.H.), University of Pennsylvania, Philadelphia, PA
| | - Roy Hamilton
- From the Department of Neurology (N.M.R., J.L.B.), Dartmouth Geisel School of Medicine, Hanover, NH; Department of Neurology and Ophthalmology Michigan State University College of Human Medicine (L.C.), East Lansing, MI; Department of Neurology (A.S.), Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Anthropology (Z.T.), Dartmouth College, Hanover, NH; Brooklyn Law School (W.U.C.), Brooklyn, NY; Department of Emergency Medicine (A.L.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Perelman School of Medicine (R.H.), University of Pennsylvania, Philadelphia, PA
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Turner S, Posthumus AG, Steegers EAP, AlMakoshi A, Sallout B, Rifas-Shiman SL, Oken E, Kumwenda B, Alostad F, Wright-Corker C, Watson L, Mak D, Cheung HC, Judge A, Aucott L, Jaddoe VWV, Annesi Maesano I, Soomro MH, Hindmarsh P, Jacobsen G, Vik T, Riaño-Galan I, Rodríguez-Dehli AC, Lertxundi A, Rodriguez LSM, Vrijheid M, Julvez J, Esplugues A, Iñiguez C. Household income, fetal size and birth weight: an analysis of eight populations. J Epidemiol Community Health 2022; 76:629-636. [PMID: 35414519 DOI: 10.1136/jech-2021-218112] [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: 09/21/2021] [Accepted: 03/12/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND The age at onset of the association between poverty and poor health is not understood. Our hypothesis was that individuals from highest household income (HI), compared to those with lowest HI, will have increased fetal size in the second and third trimester and birth. METHODS Second and third trimester fetal ultrasound measurements and birth measurements were obtained from eight cohorts. Results were analysed in cross-sectional two-stage individual patient data (IPD) analyses and also a longitudinal one-stage IPD analysis. RESULTS The eight cohorts included 21 714 individuals. In the two-stage (cross-sectional) IPD analysis, individuals from the highest HI category compared with those from the lowest HI category had larger head size at birth (mean difference 0.22 z score (0.07, 0.36)), in the third trimester (0.25 (0.16, 0.33)) and second trimester (0.11 (0.02, 0.19)). Weight was higher at birth in the highest HI category. In the one-stage (longitudinal) IPD analysis which included data from six cohorts (n=11 062), head size was larger (mean difference 0.13 (0.03, 0.23)) for individuals in the highest HI compared with lowest category, and this difference became greater between the second trimester and birth. Similarly, in the one-stage IPD, weight was heavier in second highest HI category compared with the lowest (mean difference 0.10 (0 .00, 0.20)) and the difference widened as pregnancy progressed. Length was not linked to HI category in the longitudinal model. CONCLUSIONS The association between HI, an index of poverty, and fetal size is already present in the second trimester.
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Affiliation(s)
- Steve Turner
- Child Health, University of Aberdeen, Aberdeen, UK
| | - Anke G Posthumus
- The Generation R Study Group, Erasmus MC, Rotterdam, The Netherlands.,Department of Obstetrics and Gynaecology, Erasmus MC, Rotterdam, The Netherlands
| | - Eric A P Steegers
- The Generation R Study Group, Erasmus MC, Rotterdam, The Netherlands.,Department of Obstetrics and Gynaecology, Erasmus MC, Rotterdam, The Netherlands
| | - Amel AlMakoshi
- Child Health, University of Aberdeen, Aberdeen, UK.,Maternal-Fetal medicine, Women's Specialized Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Bahauddin Sallout
- Medical Service Directorate, Ministry of Defence, Riyadh, Saudi Arabia
| | - Sheryl L Rifas-Shiman
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Emily Oken
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Ben Kumwenda
- Child Health, University of Aberdeen, Aberdeen, UK
| | | | | | - Laura Watson
- Child Health, University of Aberdeen, Aberdeen, UK
| | - Diane Mak
- Child Health, University of Aberdeen, Aberdeen, UK
| | | | - Alice Judge
- Child Health, University of Aberdeen, Aberdeen, UK
| | - Lorna Aucott
- Centre for Healthcare Randomised Trial, University of Aberdeen, Aberdeen, UK
| | - Vincent W V Jaddoe
- The Generation R Study Group, Erasmus MC, Rotterdam, The Netherlands.,Department of Paediatrics, Erasmus MC, Rotterdam, The Netherlands
| | - Isabella Annesi Maesano
- Debrest Institute of Epidemiology and Public Health, Montpellier University and INSERM, Montpellier, France
| | - Munawar Hussain Soomro
- Debrest Institute of Epidemiology and Public Health, Montpellier University and INSERM, Montpellier, France
| | | | - Geir Jacobsen
- Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Torstein Vik
- Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Isolina Riaño-Galan
- AGC de Pediatría, Hospital Universitario Central de Asturias, Asturias, Oviedo, Spain.,IUOPA-Departamento de Medicina-ISPA, Universidad de Oviedo, Oviedo, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Ana Cristina Rodríguez-Dehli
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Pediatrics Service, Hospital Universitario San Agustín, Avilés, Spain.,Servicio de Salud del Principado de Asturias (SESPA), IUOPA-Departamento de Medicina-ISPA, Universidad de Oviedo, Oviedo, Spain
| | - Aitana Lertxundi
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Biodonostia Health Research Institute, San Sebastian, Spain.,Department of Preventive Medicine and Public Health, Faculty of Medicine, University of the Basque Country, (UPV/EHU), Spain
| | - Loreto Santa Marina Rodriguez
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Biodonostia Health Research Institute, San Sebastian, Spain.,Health Department of Basque Government, Subdirectorate of Public Health of Gipuzkoa, San Sebastian, Spain
| | - Martine Vrijheid
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,ISGlobal- Instituto de Salud Global de Barcelona-Campus MAR, PRBB, Barcelona, Catalonia, Spain.,Universitat Pompeau Fabra (UPF), Barcelona, Spain
| | - Jordi Julvez
- Institut d'Investigació Sanitària Pere Virgili (IISPV), Hospital Universitari Sant Joan de Reus, Reus, Spain.,Instituto de Salud Global, Barcelona, Spain.,Hospital Universitari Sant Joan de Reus, Reus, Spain
| | - Ana Esplugues
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Joint Research Unit of Epidemiology and Environmental Health, FISABIO, Valencia, Spain
| | - Carmen Iñiguez
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Department of Statistics and Operational Research, Universitat de València, València, Spain
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Hadley MB, Nalini M, Adhikari S, Szymonifka J, Etemadi A, Kamangar F, Khoshnia M, McChane T, Pourshams A, Poustchi H, Sepanlou SG, Abnet C, Freedman ND, Boffetta P, Malekzadeh R, Vedanthan R. Spatial environmental factors predict cardiovascular and all-cause mortality: Results of the SPACE study. PLoS One 2022; 17:e0269650. [PMID: 35749347 PMCID: PMC9231727 DOI: 10.1371/journal.pone.0269650] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 05/25/2022] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Environmental exposures account for a growing proportion of global mortality. Large cohort studies are needed to characterize the independent impact of environmental exposures on mortality in low-income settings. METHODS We collected data on individual and environmental risk factors for a multiethnic cohort of 50,045 individuals in a low-income region in Iran. Environmental risk factors included: ambient fine particular matter air pollution; household fuel use and ventilation; proximity to traffic; distance to percutaneous coronary intervention (PCI) center; socioeconomic environment; population density; local land use; and nighttime light exposure. We developed a spatial survival model to estimate the independent associations between these environmental exposures and all-cause and cardiovascular mortality. FINDINGS Several environmental factors demonstrated associations with mortality after adjusting for individual risk factors. Ambient fine particulate matter air pollution predicted all-cause mortality (per μg/m3, HR 1.20, 95% CI 1.07, 1.36) and cardiovascular mortality (HR 1.17, 95% CI 0.98, 1.39). Biomass fuel use without chimney predicted all-cause mortality (reference = gas, HR 1.23, 95% CI 0.99, 1.53) and cardiovascular mortality (HR 1.36, 95% CI 0.99, 1.87). Kerosene fuel use without chimney predicted all-cause mortality (reference = gas, HR 1.09, 95% CI 0.97, 1.23) and cardiovascular mortality (HR 1.19, 95% CI 1.01, 1.41). Distance to PCI center predicted all-cause mortality (per 10km, HR 1.01, 95% CI 1.004, 1.022) and cardiovascular mortality (HR 1.02, 95% CI 1.004, 1.031). Additionally, proximity to traffic predicted all-cause mortality (HR 1.13, 95% CI 1.01, 1.27). In a separate validation cohort, the multivariable model effectively predicted both all-cause mortality (AUC 0.76) and cardiovascular mortality (AUC 0.81). Population attributable fractions demonstrated a high mortality burden attributable to environmental exposures. INTERPRETATION Several environmental factors predicted cardiovascular and all-cause mortality, independent of each other and of individual risk factors. Mortality attributable to environmental factors represents a critical opportunity for targeted policies and programs.
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Affiliation(s)
- Michael B. Hadley
- Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
- * E-mail:
| | - Mahdi Nalini
- Digestive Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cardiovascular Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Samrachana Adhikari
- New York University Grossman School of Medicine, New York, New York, United States of America
| | - Jackie Szymonifka
- New York University Grossman School of Medicine, New York, New York, United States of America
| | - Arash Etemadi
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, United States of America
| | - Farin Kamangar
- Department of Biology, School of Computer, Mathematical, and Natural Sciences, Morgan State University, Baltimore, Maryland, United States of America
| | - Masoud Khoshnia
- Golestan University of Medical Sciences, Gorgan, Golestan, Iran
| | - Tyler McChane
- Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Akram Pourshams
- Digestive Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Poustchi
- Digestive Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sadaf G. Sepanlou
- Digestive Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Christian Abnet
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, United States of America
| | - Neal D. Freedman
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, United States of America
| | - Paolo Boffetta
- Stony Brook Cancer Center, Stony Brook University, Stony Brook, New York, United States of America
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Reza Malekzadeh
- Digestive Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Rajesh Vedanthan
- New York University Grossman School of Medicine, New York, New York, United States of America
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35
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Cato S, Ramer S, Hajjar I, Kulshreshtha A. Alzheimer's Disease Mortality as a Function of Urbanization Level: 1999-2019. J Alzheimers Dis 2022; 87:1461-1466. [PMID: 35466938 DOI: 10.3233/jad-215586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study investigated Alzheimer's disease (AD) mortality trends by urbanization level and geographical location in the U.S. The CDC's WONDER database was used to investigate AD mortality from 1999-2019 stratified by urbanization level, census division, race, and sex. Data showed that while AD mortality increased across the U.S., rural areas, particularly in the South, had higher mortality compared to urban counterparts. AD mortality was higher among the female and White population. Data suggested that the urban-rural discrepancy is widening over time. Identifying health disparities underlying the urban-rural discrepancy in AD mortality is critical for allocating social and public health resources.
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Affiliation(s)
- Sarah Cato
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| | - Stephanie Ramer
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Ihab Hajjar
- Department of Neurology, School of Medicine, Emory University, Atlanta, GA, USA
| | - Ambar Kulshreshtha
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA, USA.,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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36
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Abdalla SM, Hernandez M, Fazaludeen Koya S, Rosenberg SB, Robbins G, Magana L, Nsoesie EO, Sabin L, Galea S. What matters for health? Public views from eight countries. BMJ Glob Health 2022; 7:bmjgh-2022-008858. [PMID: 35705225 PMCID: PMC9204457 DOI: 10.1136/bmjgh-2022-008858] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 05/24/2022] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Despite growing scholarship on the social determinants of health (SDoH), wider action remains in its early stages. Broad public understanding of SDoH can help catalyse such action. This paper aimed to document public perception of what matters for health from countries with broad geographic, cultural, linguistic, population composition, language and income level variation. METHODS We conducted an online survey in Brazil, China, Germany, Egypt, India, Indonesia, Nigeria and the USA to assess rankings of what respondents thought matters for health and what they perceived decision makers think matters for health. We analysed the percentages of each determinant rated as the most important for good health using two metrics: the top selection and a composite of the top three selections. We used two-tailed χ2 test for significance testing between groups. RESULTS Of 8753 respondents, 56.2% (95% CI 55.1% to 57.2%) ranked healthcare as the most important determinant of good health using the composite metric. This ranking was consistent across countries except in China where it appeared second. While genetics was cited as the most important determinant by 22.3% (95% CI 21.5% to 23.2%) of the overall sample with comparable rates in most countries, the percentage increased to 33.3% (95% CI 30.5% to 36.3%) in Germany and 35.9% (95% CI 33.0% to 38.8%) in the USA. Politics was the determinant with the greatest absolute difference (18.5%, 95% CI 17.3% to 19.6%) between what respondents considered matters for health versus what they perceived decision makers think matters for health. CONCLUSION The majority of people consider healthcare the most important determinant of health, well above other social determinants. This highlights the need for more investment in communication efforts around the importance of SDoH.
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Affiliation(s)
- Salma M Abdalla
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Mark Hernandez
- Boston University School of Public Health, Boston, Massachusetts, USA.,Massachusetts Institute of Technology Lincoln Laboratory, Lexington, Kentucky, USA
| | - Shaffi Fazaludeen Koya
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Samuel B Rosenberg
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Grace Robbins
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Laura Magana
- Association of Schools and Programs of Public Health, Washington, DC, USA
| | | | - Lora Sabin
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Sandro Galea
- Boston University School of Public Health, Boston, Massachusetts, USA
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37
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Urban Scaling of Health Outcomes: a Scoping Review. J Urban Health 2022; 99:409-426. [PMID: 35513600 PMCID: PMC9070109 DOI: 10.1007/s11524-021-00577-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/09/2021] [Indexed: 11/04/2022]
Abstract
Urban scaling is a framework that describes how city-level characteristics scale with variations in city size. This scoping review mapped the existing evidence on the urban scaling of health outcomes to identify gaps and inform future research. Using a structured search strategy, we identified and reviewed a total of 102 studies, a majority set in high-income countries using diverse city definitions. We found several historical studies that examined the dynamic relationships between city size and mortality occurring during the nineteenth and early twentieth centuries. In more recent years, we documented heterogeneity in the relation between city size and health. Measles and influenza are influenced by city size in conjunction with other factors like geographic proximity, while STIs, HIV, and dengue tend to occur more frequently in larger cities. NCDs showed a heterogeneous pattern that depends on the specific outcome and context. Homicides and other crimes are more common in larger cities, suicides are more common in smaller cities, and traffic-related injuries show a less clear pattern that differs by context and type of injury. Future research should aim to understand the consequences of urban growth on health outcomes in low- and middle-income countries, capitalize on longitudinal designs, systematically adjust for covariates, and examine the implications of using different city definitions.
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Krokstad S, Weiss DA, Krokstad MA, Rangul V, Kvaløy K, Ingul JM, Bjerkeset O, Twenge J, Sund ER. Divergent decennial trends in mental health according to age reveal poorer mental health for young people: repeated cross-sectional population-based surveys from the HUNT Study, Norway. BMJ Open 2022; 12:e057654. [PMID: 35584877 PMCID: PMC9119156 DOI: 10.1136/bmjopen-2021-057654] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES Public health trends are formed by political, economic, historical and cultural factors in society. The aim of this paper was to describe overall changes in mental health among adolescents and adults in a Norwegian population over the three last decades and discuss some potential explanations for these changes. DESIGN Repeated population-based health surveys to monitor decennial changes. SETTING Data from three cross-sectional surveys in 1995-1997, 2006-2008 and 2017-2019 in the population-based HUNT Study in Norway were used. PARTICIPANTS The general population in a Norwegian county covering participants aged 13-79 years, ranging from 48 000 to 62 000 000 in each survey. MAIN OUTCOME MEASURES Prevalence estimates of subjective anxiety and depression symptoms stratified by age and gender were assessed using the Hopkins Symptom Checklist-5 for adolescents and the Hospital Anxiety and Depression Scale for adults. RESULTS Adolescents' and young adults' mental distress increased sharply, especially between 2006-2008 and 2017-2019. However, depressive symptoms instead declined among adults aged 60 and over and anxiety symptoms remained largely unchanged in these groups. CONCLUSIONS Our trend data from the HUNT Study in Norway indicate poorer mental health among adolescents and young adults that we suggest are related to relevant changes in young people's living conditions and behaviour, including the increased influence of screen-based media.
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Affiliation(s)
- Steinar Krokstad
- HUNT Research Centre, Department of Public Health and Nursing, Norwegian University of Science and Technology, Levanger, Norway
- Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | | | - Morten Austheim Krokstad
- Faculty of Health Sciences and Nursing, Nord Universitet - Levanger Campus, Levanger, Norway
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Vegar Rangul
- HUNT Research Centre, Department of Public Health and Nursing, Norwegian University of Science and Technology, Levanger, Norway
- Faculty of Health Sciences and Nursing, Nord Universitet - Levanger Campus, Levanger, Norway
| | - Kirsti Kvaløy
- HUNT Research Centre, Department of Public Health and Nursing, Norwegian University of Science and Technology, Levanger, Norway
- Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Jo Magne Ingul
- Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Ottar Bjerkeset
- Faculty of Health Sciences and Nursing, Nord Universitet - Levanger Campus, Levanger, Norway
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Jean Twenge
- Department of Psychology, College of Sciences, San Diego State University, San Diego, California, USA
| | - Erik R Sund
- HUNT Research Centre, Department of Public Health and Nursing, Norwegian University of Science and Technology, Levanger, Norway
- Faculty of Health Sciences and Nursing, Nord Universitet - Levanger Campus, Levanger, Norway
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Hammond G, Waken RJ, Johnson DY, Towfighi A, Joynt Maddox KE. Racial Inequities Across Rural Strata in Acute Stroke Care and In-Hospital Mortality: National Trends Over 6 Years. Stroke 2022; 53:1711-1719. [PMID: 35172607 PMCID: PMC9324215 DOI: 10.1161/strokeaha.121.035006] [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: 03/10/2021] [Accepted: 11/19/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND There are glaring racial and rural-urban inequities in stroke outcomes. The objective of this study was to determine whether there were recent changes to trends in racial inequities in stroke treatment and in-hospital mortality, and whether racial inequities differed across rural strata. METHODS Retrospective analysis of Black and White patients >18 years old admitted to US acute care hospitals with a primary discharge diagnosis of stroke (unweighted N=652 836) from the National Inpatient Sample from 2012 to 2017. Rural residence was classified by county as urban, town, or rural. The primary outcomes were intravenous thrombolysis and endovascular therapy use among patients with acute ischemic stroke, and in-hospital mortality for all stroke patients. Logistic regression models were run for each outcome adjusting for age, comorbidities, primary payer, and ZIP code median income. RESULTS The sample was 53% female, 81% White, and 19% Black. Black patients from rural areas had the lowest odds of receiving intravenous thrombolysis (adjusted odds ratio [aOR], 0.43 [95% CI, 0.37-0.50]) and endovascular therapy (aOR, 0.60 [0.46-0.78]), compared with White urban patients. Black rural patients were the least likely to be discharged home after a stroke compared with White/urban patients (aOR, 0.79 [0.75-0.83]), this was true for Black patients across the urban-rural spectrum when compared with Whites. Black patients from urban areas had lower mortality than White patients from urban areas (aOR, 0.87 [0.84-0.91]), while White patients from rural areas (aOR, 1.14 [1.10-1.19]) had the highest mortality of all groups. CONCLUSIONS Black patients living in rural areas represent a particularly high-risk group for poor access to advanced stroke care and impaired poststroke functional status. Rural White patients have the highest in-hospital mortality. Clinical and policy interventions are needed to improve access and reduce inequities in stroke care and outcomes.
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Affiliation(s)
- Gmerice Hammond
- Department of Medicine, Cardiovascular Division, Washington University School of Medicine, St. Louis, MO
| | - RJ Waken
- Department of Medicine, Cardiovascular Division, Washington University School of Medicine, St. Louis, MO
| | - Daniel Y. Johnson
- Department of Medicine, Cardiovascular Division, Washington University School of Medicine, St. Louis, MO
| | - Amytis Towfighi
- Department of Neurology, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Karen E. Joynt Maddox
- Department of Medicine, Cardiovascular Division, Washington University School of Medicine, St. Louis, MO
- Center for Health Economics and Policy, Institute for Public Health at Washington University, St. Louis, MO
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Muqri H, Shrivastava A, Muhtadi R, Chuck RS, Mian UK. The Cost-Effectiveness of a Telemedicine Screening Program for Diabetic Retinopathy in New York City. Clin Ophthalmol 2022; 16:1505-1512. [PMID: 35607437 PMCID: PMC9123910 DOI: 10.2147/opth.s357766] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 04/11/2022] [Indexed: 11/23/2022] Open
Abstract
Background A telemedicine screening initiative was implemented by the Montefiore Health System to improve access to eyecare for a multi-ethnic, at-risk population of diabetic patients in a largely underserved urban community in the Bronx, New York. This retrospective, cross-sectional analysis evaluates the societal benefit and financial sustainability of this program by analyzing both cost and revenue generation based on current standard Medicare reimbursement rates. Methods Non-mydriatic fundus cameras were placed in collaboration with a vendor in eight outpatient primary care sites throughout the Montefiore Health Care System, and data was collected between June 2014 and July 2016. Fundus photos were electronically transmitted to a central reading center to be systematically reviewed and coded by faculty ophthalmologists, and patients were subsequently scheduled for ophthalmic evaluation based upon a predetermined treatment algorithm. A retrospective chart review of 2251 patients was performed utilizing our electronic medical record system (Epic Systems, Verona WI). Revenue was projected utilizing standard Medicare rates for our region while societal benefit was calculated using quality adjusted life years (QALY). Results Of the 2251 patient charts reviewed, 791 patients (35.1%) were seen by Montefiore ophthalmologists within a year of the original screening date. Estimated revenue generated by these visits was $276,800, with the majority from the treatment of retinal disease ($208,535), and the remainder from other ophthalmic conditions detected in the fundus photos ($68,265). There was a societal benefit of 14.66 quality adjusted life years (QALYs) with an estimated value of $35,471/QALY. Conclusion This telemedicine initiative was successful in identifying many patients with diabetic retinopathy and other ophthalmic conditions who may otherwise not have been formally evaluated. Our analysis demonstrates the program to generate a downstream revenue of nearly $280K with a cost benefit below <50% of the threshold of $100,000/QALY, and therefore cost-effective in marginalized communities.
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Affiliation(s)
- Hasan Muqri
- Department of Ophthalmology, The University of Texas Health Sciences Center at Houston, Houston, TX, USA
| | - Anurag Shrivastava
- Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Bronx, NY, USA
| | - Rakin Muhtadi
- Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Bronx, NY, USA
| | - Roy S Chuck
- Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Bronx, NY, USA
| | - Umar K Mian
- Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Bronx, NY, USA
- Correspondence: Umar K Mian, Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, 3332 Rochambeau Avenue, Bronx, NY, 10467, USA, Tel +1 718-920-2020, Fax +1 718-920-4791, Email
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Kelty C, Dickinson M, Fogarty K. The effects of demographic, psychosocial, and socioeconomic characteristics on access to heart transplantation and left ventricular assist device. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2022; 17:100172. [PMID: 38559883 PMCID: PMC10978320 DOI: 10.1016/j.ahjo.2022.100172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 06/29/2022] [Indexed: 04/04/2024]
Abstract
Background This study aims to better understand how demographic, psychosocial, and socioeconomic factors influence the selection of patients for advanced therapies for heart failure (heart transplant and left ventricular assist device (LVAD)). Methods Patients evaluated for heart transplant or LVAD at a large, Midwestern hospital system were assessed retrospectively. Three outcomes were analyzed: 1) Patients who were evaluated and approved to receive a transplant or LVAD were compared to patients who were not approved for transplant or LVAD; 2) Patients who were listed for transplant were compared to patients not listed; and 3) Patients who received a transplant or LVAD were compared to patients who did not receive a transplant or LVAD. ANOVA was used for continuous variables and Chi-squared test for categorical variables. Significant variables were further analyzed by logistic regression. Results Four hundred fifty-nine patients were included. Marital status (p = 0.004), race (p = 0.008), social support (p < 0.001), mental health (p = 0.006), and substance use (p < 0.001) were associated with whether patients were approved for transplant or LVAD. Patients with public insurance were half as likely (OR 0.495) to be listed for transplant once approved. Conclusions Financial, psychosocial, and demographic characteristics all play a role in selection for advanced therapies for heart failure. These insights can help guide future work on interventions to address the social disparities in access to heart transplant and LVAD.
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Affiliation(s)
- C.E. Kelty
- Interdisciplinary Health Sciences PhD Program, Western Michigan University, Kalamazoo, MI, United States of America
- The DeVos Cardiovascular Research Program, Spectrum Health, Grand Rapids, MI, United States of America
| | - M.G. Dickinson
- Frederik Meijer Heart & Vascular Institute, Spectrum Health, Grand Rapids, MI, United States of America
| | - K.J. Fogarty
- Interdisciplinary Health Sciences PhD Program, Western Michigan University, Kalamazoo, MI, United States of America
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Eum KD, Honda TJ, Wang B, Kazemiparkouhi F, Manjourides J, Pun VC, Pavlu V, Suh H. Long-term nitrogen dioxide exposure and cause-specific mortality in the U.S. Medicare population. ENVIRONMENTAL RESEARCH 2022; 207:112154. [PMID: 34634310 PMCID: PMC8810665 DOI: 10.1016/j.envres.2021.112154] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 09/26/2021] [Accepted: 09/28/2021] [Indexed: 05/03/2023]
Abstract
BACKGROUND Since 1971, the annual National Ambient Air Quality Standard (NAAQS) for nitrogen dioxide (NO2) has remained at 53 ppb, the impact of long-term NO2 exposure on mortality is poorly understood. OBJECTIVES We examined associations between long-term NO2 exposure (12-month moving average of NO2) below the annual NAAQS and cause-specific mortality among the older adults in the U.S. METHODS Cox proportional-hazard models were used to estimate Hazard Ratio (HR) for cause-specific mortality associated with long-term NO2 exposures among about 50 million Medicare beneficiaries living within the conterminous U.S. from 2001 to 2008. RESULTS A 10 ppb increase in NO2 was associated with increased mortality from all-cause (HR: 1.06; 95% CI: 1.05-1.06), cardiovascular (HR: 1.10; 95% CI: 1.10-1.11), respiratory disease (HR: 1.09; 95% CI: 1.08-1.11), and cancer (HR: 1.01; 95% CI: 1.00-1.02) adjusting for age, sex, race, ZIP code as strata ZIP code- and state-level socio-economic status (SES) as covariates, and PM2.5 exposure using a 2-stage approach. NO2 was also associated with elevated mortality from ischemic heart disease, cerebrovascular disease, congestive heart failure, chronic obstructive pulmonary disease, pneumonia, and lung cancer. We found no evidence of a threshold, with positive and significant HRs across the range of NO2 exposures for all causes of death examined. Exposure-response curves were linear for all-cause, supra-linear for cardiovascular-, and sub-linear for respiratory-related mortality. HRs were highest consistently among Black beneficiaries. CONCLUSIONS Long-term NO2 exposure is associated with elevated risks of death by multiple causes, without evidence of a threshold response. Our findings raise concerns about the sufficiency of the annual NAAQS for NO2.
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Affiliation(s)
- Ki-Do Eum
- Department of Civil and Environmental Engineering, Tufts University, Medford, MA, USA.
| | | | - Bingyu Wang
- Khoury College of Computer Sciences, Northeastern University, Boston, MA, USA
| | | | - Justin Manjourides
- Bouvè College of Health Sciences, Northeastern University, Boston, MA, USA
| | - Vivian C Pun
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Virgil Pavlu
- Khoury College of Computer Sciences, Northeastern University, Boston, MA, USA
| | - Helen Suh
- Department of Civil and Environmental Engineering, Tufts University, Medford, MA, USA
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Power GM, Vaughan AM, Qiao L, Sanchez Clemente N, Pescarini JM, Paixão ES, Lobkowicz L, Raja AI, Portela Souza A, Barreto ML, Brickley EB. Socioeconomic risk markers of arthropod-borne virus (arbovirus) infections: a systematic literature review and meta-analysis. BMJ Glob Health 2022; 7:bmjgh-2021-007735. [PMID: 35428678 PMCID: PMC9014035 DOI: 10.1136/bmjgh-2021-007735] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 03/02/2022] [Indexed: 02/04/2023] Open
Abstract
Introduction Arthropod-borne viruses (arboviruses) are of notable public health importance worldwide, owing to their potential to cause explosive outbreaks and induce debilitating and potentially life-threatening disease manifestations. This systematic review and meta-analysis aims to assess the relationship between markers of socioeconomic position (SEP) and infection due to arboviruses with mosquito vectors. Methods We conducted a systematic search on PubMed, Embase, and LILACS databases to identify studies published between 1980 and 2020 that measured the association of SEP markers with arbovirus infection. We included observational studies without geographic location or age restrictions. We excluded studies from grey literature, reviews and ecological studies. Study findings were extracted and summarised, and pooled estimates were obtained using random-effects meta-analyses. Results We identified 36 observational studies using data pertaining to 106 524 study participants in 23 geographic locations that empirically examined the relationship between socioeconomic factors and infections caused by seven arboviruses (dengue, chikungunya, Japanese encephalitis, Rift Valley fever, Sindbis, West Nile and Zika viruses). While results were varied, descriptive synthesis pointed to a higher risk of arbovirus infection associated with markers of lower SEP, including lower education, income poverty, low healthcare coverage, poor housing materials, interrupted water supply, marital status (married, divorced or widowed), non-white ethnicities and migration status. Pooled crude estimates indicated an increased risk of arboviral infection associated with lower education (risk ratio, RR 1.5 95% CI 1.3 to 1.9); I2=83.1%), interruption of water supply (RR 1.2; 95% CI 1.1 to 1.3; I2=0.0%) and having been married (RR 1.5 95% CI 1.1 to 2.1; I2=85.2%). Conclusion Evidence from this systematic review suggests that lower SEP increases the risk of acquiring arboviral infection; however, there was large heterogeneity across studies. Further studies are required to delineate the relationship between specific individual, household and community-level SEP indicators and arbovirus infection risks to help inform targeted public health interventions. PROSPERO registration number CRD42019158572.
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Affiliation(s)
- Grace M Power
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Aisling M Vaughan
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Luxi Qiao
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
- Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Nuria Sanchez Clemente
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Julia M Pescarini
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Enny S Paixão
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Ludmila Lobkowicz
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Amber I Raja
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - André Portela Souza
- São Paulo School of Economics and Center for Applied Microeconomic Studies, Getulio Vargas Foundation, São Paulo, Brazil
| | - Mauricio Lima Barreto
- Centro de Integração de Dados e Conhecimentos para Saúde, Oswaldo Cruz Foundation, Salvador, Brazil
| | - Elizabeth B Brickley
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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Noochpoung R, Hung P, Hair NL, Putthasri W, Chen B. Can a High-Powered Financial Incentive Program Reduce Resignation Rates among Healthcare Providers in Rural Areas? Evidence from Thailand's 2008 Hardship Allowance Program. Health Policy Plan 2022; 37:624-633. [PMID: 35233635 DOI: 10.1093/heapol/czac018] [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: 08/28/2021] [Revised: 02/22/2022] [Accepted: 03/01/2022] [Indexed: 11/14/2022] Open
Abstract
Geographic disparities in the availability of healthcare providers remain a global health challenge. Financial incentives have been widely implemented to attract rural healthcare workers with limited scientific evidence in developing economies. In this study, we investigate the relationship between financial incentives and rural resignations in a middle-income country using Thailand's Hardship Allowance program that first doubled or tripled but later decreased direct payments to rural providers. This retrospective observational study used data on dentists' work status from the Human Resource Management Department at the Ministry of Public Health in Thailand. Segmented regression and difference-in-differences approaches were used to analyze the effect of changes to the Hardship Allowance on rural dentists' resignation and relocation patterns. We found that the dramatic increase in the Hardship Allowance in 2008 was associated with a decrease in resignation rates among dentists in rural areas. However, after Thailand recategorized certain rural districts into urban areas in 2016, dentists were more likely to relocate from the newly urbanized areas to established urban centers, likely due in part to reductions in the Hardship Allowance that accompanied recategorization. However, we did not find that resignations increased in these affected areas. Finally, in a subgroup analysis, we found that older dentists were less likely than younger dentists to relocate from areas affected by the 2016 rural-to-urban recategorization. Overall, our study found that a dramatic increase in financial incentives reduced resignation rates in rural Thailand, but a reversal of the incentives as a result of rural-to-urban reclassification resulted in relocations from the affected areas to established urban centers. When considering their strategic goals of equitable healthcare workforce distribution, policy makers should be aware that both direct and indirect changes to payment incentives may affect dentists' resignation and practice location decisions, and that these decisions may be influenced by provider demographics.
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Affiliation(s)
| | - Peiyin Hung
- Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, USA
| | - Nicole L Hair
- Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, USA
| | | | - Brian Chen
- Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, USA
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Gender differences in prevalence of myocardial infarction in rural West Texans. ZEITSCHRIFT FUR GESUNDHEITSWISSENSCHAFTEN = JOURNAL OF PUBLIC HEALTH 2022; 30:385-397. [PMID: 35402143 DOI: 10.1007/s10389-020-01262-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Heart disease is the leading cause of death in the United States. Incidence rates of myocardial infarction (MI) in rural West Texas signify a lack of effective, risk-specific prevention programs. The purpose of this study was to identify gender-specific risk factors for MI in rural West Texans. Subjects and methods Hospital patient data for those with and without a history of MI were obtained from the Project FRONTIER database for rural West Texas counties. We used statistical software, such as SPSS, R, and WinBUGS to detect and understand the nature of MI risk factors. Statistical methods including t-tests, Chi-squared, logistic regression, and a Bayesian approach were utilized to analyze data. Results MI significant risk factors obtained for females were systolic blood pressure (p = 0.002), diastolic blood pressure (p = 0.004), pulse (p = 0.015), and smoking (p = 0.002). For males, these were glucose (p = 0.022), age (p = 0.050), body fat (p = 0.034), and smoking (p = 0.017). The mean risk parameter followed a normal distribution, while the precision parameter depicted skew for both sexes. Conclusions Gender-specific differences in MI risk factors exist, and incorporating such variables can guide relevant policymaking to reduce MI incidence in rural West Texans.
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Şahin B, İlgün G. Risk factors of deaths related to cardiovascular diseases in World Health Organization (WHO) member countries. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:73-80. [PMID: 32909378 DOI: 10.1111/hsc.13156] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 07/26/2020] [Accepted: 08/12/2020] [Indexed: 06/11/2023]
Abstract
This study aims to identify the risk factors affecting deaths related to cardiovascular diseases. The research population comprised of 194 World Health Organization (WHO) member countries, but the data analysis was conducted with the data from 152 countries as 42 of them do not have any data on study variables. Multivariable regression analysis was utilised for this study to analyse the effect of factors regarding metabolism, lifestyle, economic, socio-demographic and health system on the cardiovascular diseases related to deaths. As a result of regression analysis, the number of deaths related to cardiovascular diseases increases with the increase in blood pressure (p < .001), blood glucose (p = .032), obesity rate (p < .001), salt consumption (p < .001), GINI index (p = .002) and dependent age ratio (p < .001); the frequency of cardiovascular disease-related deaths is higher in the countries within low (p < .001) and high (p < .001) middle-income levels; yet, the number of deaths based on cardiovascular diseases diminishes with the increase in the number of doctors (p = .005) and health expenditures per capita (p = .044). The research findings are considered to guide the countries in the determination of their steps towards the prevention of deaths related to cardiovascular diseases.
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Affiliation(s)
- Bayram Şahin
- Department of Health Care Management, Faculty of Economics and Administrative Sciences, Hacettepe University, Ankara, Turkey
| | - Gülnur İlgün
- Aksaray University, Faculty of Health Sciences, Department of Health Care Management, Aksaray, Turkey
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Abbott LS, Killian MO, Graven LJ, Williams KJ. Latent profile analysis of stress and resilience among rural women: A cross-sectional study. Public Health Nurs 2021; 39:536-544. [PMID: 34750856 DOI: 10.1111/phn.13005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 10/08/2021] [Accepted: 10/19/2021] [Indexed: 01/14/2023]
Abstract
Stress is a cardiovascular disease risk factor, and resilience may serve as a buffer for stress. Little is known about stress and resilience among rural women. OBJECTIVE The purposes of this study were to identify profiles of rural women based upon indicators of psychosocial and environmental stress and to examine the relationships between the identified profiles and resilience. DESIGN AND SAMPLE A cross-sectional, descriptive design was used to explore stress, social support, and resilience among a representative sample of women (n = 354). MEASURES Data were collected to measure perceived stress, social support, chronic stress, and resilience. RESULTS A latent profile analysis identified three profiles (59.9% Low Stress, 25.4% Moderate Stress, and 14.7% High Stress). Women in the High Stress profile were less likely to afford necessities and have attended college and more likely to be employed. Women in the Low Stress profile had the highest scores for all five resilience subscales. CONCLUSION The current study demonstrates the social and environmental impact of stress and how this stress can manifest differently for different women. Underserved women may benefit from strategies that reduce stress and improve social support and resilience. Future research is needed for advancing health equity in rural populations.
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Affiliation(s)
- Laurie S Abbott
- Florida State University College of Nursing, Tallahassee, Florida, USA
| | - Michael O Killian
- Florida State University College of Social Work, Tallahassee, Florida, USA
| | - Lucinda J Graven
- Florida State University College of Nursing, Tallahassee, Florida, USA
| | - Krystal J Williams
- Florida Agricultural & Mechanical University College of Pharmacy and Pharmaceutical Sciences, Tallahassee, Florida, USA
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Wang Q, Li W, Wang Y, Li H, Zhai D, Wu W. Prediction of coronary heart disease in rural Chinese adults: a cross sectional study. PeerJ 2021; 9:e12259. [PMID: 34721974 PMCID: PMC8515995 DOI: 10.7717/peerj.12259] [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: 05/11/2021] [Accepted: 09/15/2021] [Indexed: 11/25/2022] Open
Abstract
Background Coronary heart disease (CHD) is a common cardiovascular disease with high morbidity and mortality in China. The CHD risk prediction model has a great value in early prevention and diagnosis. Methods In this study, CHD risk prediction models among rural residents in Xinxiang County were constructed using Random Forest (RF), Support Vector Machine (SVM), and the least absolute shrinkage and selection operator (LASSO) regression algorithms with identified 16 influencing factors. Results Results demonstrated that the CHD model using the RF classifier performed best both on the training set and test set, with the highest area under the curve (AUC = 1 and 0.9711), accuracy (one and 0.9389), sensitivity (one and 0.8725), specificity (one and 0.9771), precision (one and 0.9563), F1-score (one and 0.9125), and Matthews correlation coefficient (MCC = one and 0.8678), followed by the SVM (AUC = 0.9860 and 0.9589) and the LASSO classifier (AUC = 0.9733 and 0.9587). Besides, the RF model also had an increase in the net reclassification index (NRI) and integrated discrimination improvement (IDI) values, and achieved a greater net benefit in the decision curve analysis (DCA) compared with the SVM and LASSO models. Conclusion The CHD risk prediction model constructed by the RF algorithm in this study is conducive to the early diagnosis of CHD in rural residents of Xinxiang County, Henan Province.
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Affiliation(s)
- Qian Wang
- School of Public Health, Xinxiang Medical University, Xinxiang, Henan, China
| | - Wenxing Li
- Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong, China
| | - Yongbin Wang
- School of Public Health, Xinxiang Medical University, Xinxiang, Henan, China
| | - Huijun Li
- School of Public Health, Xinxiang Medical University, Xinxiang, Henan, China
| | - Desheng Zhai
- School of Public Health, Xinxiang Medical University, Xinxiang, Henan, China
| | - Weidong Wu
- School of Public Health, Xinxiang Medical University, Xinxiang, Henan, China
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Kobo O, Khattak S, Lopez-Mattei J, Van Spall HGC, Graham M, Cheng RK, Osman M, Sun L, Ullah W, Fischman DL, Roguin A, Mohamed MO, Mamas MA. Trends in cardiovascular mortality of cancer patients in the US over two decades 1999-2019. Int J Clin Pract 2021; 75:e14841. [PMID: 34514707 DOI: 10.1111/ijcp.14841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 09/10/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Cancer is the second most common cause of death globally after cardiovascular disease, and cancer patients are at an increased risk of CV death. This recognition has led to publication of cardio-oncological guidelines and to the widespread adoption of dedicated cardio-oncology services in many institutes. However, it is unclear whether there has been a change in the incidence of CV death in cancer patients. METHODS AND RESULTS Using Centers for Disease Control and Prevention Wide-Ranging, Online Data for Epidemiologic Research (CDC WONDER) Multiple Cause of Death dataset, we determined national trends in age-standardised mortality rates attributed to cardiovascular diseases in patients with and without cancer, from 1999 to 2019, stratified by cancer type, age, gender, race, and place of residence (state and urbanisation status). Among more than 17.8 million cardiovascular deaths in the United States, 13.6% were patients with a concomitant cancer diagnosis. During the study period, among patients with cancer, the age-adjusted mortality rate dropped by 52% (vs 38% in patients with no cancer). In cancer patients, age-adjusted mortality rate dropped more significantly among patients with gastrointestinal, breast, and prostate malignancy than among patients with haematological malignancy (59%-63% vs. 41%). Similar reduction was observed in both genders (53%-54%), but more prominent reduction was observed in older patients and in those living in metro areas. CONCLUSIONS Our findings emphasise the role of multidisciplinary management of cancer patients. Widespread adoption of cardio oncology services have the potential to impact the inherent risk of increased CV mortality in both cancer patients and survivors.
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Affiliation(s)
- Ofer Kobo
- Department of Cardiology, Hillel Yaffe Medical Center, Hadera, Israel
- Keele Cardiovascular Research Group, Keele University, Keele, UK
| | - Sophia Khattak
- Keele Cardiovascular Research Group, Keele University, Keele, UK
| | - Juan Lopez-Mattei
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Harriette G C Van Spall
- Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton, Ontario, Canada
| | - Michelle Graham
- Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Richard K Cheng
- Division of Cardiology, University of Washington Heart Institute, Seattle, Washington, USA
| | - Mohammed Osman
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Louise Sun
- Division of Cardiac Anesthesiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Waqas Ullah
- Department of Cardiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - David L Fischman
- Department of Cardiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Ariel Roguin
- Department of Cardiology, Hillel Yaffe Medical Center, Hadera, Israel
| | | | - Mamas A Mamas
- Keele Cardiovascular Research Group, Keele University, Keele, UK
- Department of Cardiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- Institute of Population Health, University of Manchester, Manchester, UK
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Xu W, Topping M, Fletcher J. State of birth and cardiovascular disease mortality: Multilevel analyses of the National Longitudinal Mortality Study. SSM Popul Health 2021; 15:100875. [PMID: 34345647 PMCID: PMC8319560 DOI: 10.1016/j.ssmph.2021.100875] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 07/12/2021] [Accepted: 07/13/2021] [Indexed: 12/04/2022] Open
Abstract
Cardiovascular disease (CVD) is the leading contributor to mortality in the United States. Previous studies have linked early life individual and family factors, along with various contemporaneous place-based exposures to differential individual CVD mortality risk. However, the impacts of early life place exposures and how they compare to the effects of an individual's current place of residence on CVD mortality risk is not well understood. Using the National Longitudinal Mortality Study, this research examined the effects of both state of birth and state of residence on individual's risk of CVD mortality. We estimated individual mortality risk by estimating multi-level logistic regression models. We found that during a follow-up period of 11 years, 18,292 (4.2%) out of 433,345 participants died from CVD. The impact of state of birth on subsequent CVD mortality risk are greater than state of residence, even after adjusting for socio-demographic factors. Individuals who were born in certain states such as Tennessee, Kentucky, and Pennsylvania on average had higher CVD mortality risk. Conversely, those born in California, North Dakota, and Montana were found to have lower risk, no matter where they presently live. This study implies that early life state-level environments may be more prominent to individual's CVD mortality risk, compared to the state in which one lives. Future research should address specific mechanisms through which state of birth may affect people's risk of CVD mortality. State of birth is a stronger predictor of CVD mortality than state of residence. Models including state of birth random effects better predict individual CVD mortality risk. Those born in Tennessee and Kentucky had the highest average CVD mortality risk while those born in California and North Dakota had the lowest risk. Tennessee, Kentucky, Virginia, West Virginia, and Pennsylvania are a cluster of high state of birth effects.
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Affiliation(s)
- Wei Xu
- Center for Demography of Health and Aging, University of Wisconsin Madison, 1180 Observatory Drive, WI, 53706, USA
| | - Michael Topping
- Department of Sociology, University of Wisconsin Madison, 1180 Observatory Drive, WI, 53706, USA
| | - Jason Fletcher
- Center for Demography of Health and Aging, University of Wisconsin Madison, 1180 Observatory Drive, WI, 53706, USA.,Department of Sociology, University of Wisconsin Madison, 1180 Observatory Drive, WI, 53706, USA
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