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Buchanan DA, Brown AE, Osigwe EC, Pfalzer AC, Mann LG, Yan Y, Kang H, Claassen DO. Racial Differences in the Presentation and Progression of Huntington's Disease. Mov Disord 2023; 38:1945-1949. [PMID: 37559498 DOI: 10.1002/mds.29536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 06/08/2023] [Accepted: 06/21/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Huntington's disease (HD) is an autosomal dominant neurodegenerative disease that predominantly impacts a Caucasian population, but few efforts have explored racial differences in presentation and progression. OBJECTIVE The aim was to assess the presentation and progression of HD across race groups using the Enroll-HD longitudinal observational study. METHODS We applied propensity score matching for cytosine-adenine-guanine age product score, and age, to identify White, Hispanic, Asian, and Black participants from the Enroll-HD database. We compared clinical presentations at baseline, and progression over time, using White participants as a control cohort. RESULTS Black participants were more severe at baseline across all clinical measures. No significant differences in progression were observed between race groups. CONCLUSIONS We consider the factors driving clinical differences at baseline for Black participants. Our data emphasize the necessary improvement in underrepresented minority recruitment for studies of rare diseases. © 2023 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Danielle A Buchanan
- Division of Cognitive and Behavioral Neurology, Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Amy E Brown
- Division of Cognitive and Behavioral Neurology, Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Elicia C Osigwe
- Department of Neuroscience, Vanderbilt University, Nashville, Tennessee, USA
| | - Anna C Pfalzer
- Division of Cognitive and Behavioral Neurology, Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Leah G Mann
- Department of Neuroscience, Vanderbilt University, Nashville, Tennessee, USA
| | - Yan Yan
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee, USA
| | - Hakmook Kang
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee, USA
| | - Daniel O Claassen
- Division of Cognitive and Behavioral Neurology, Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Woolf SH, Chapman DA, Lee JH, Johnston KC, Benson RT, Trevathan E, Smith WR, Gaskin DJ. The Lives Lost to Inequities: Avertable Deaths From Neurologic Diseases in the Past Decade. Neurology 2023; 101:S9-S16. [PMID: 37580146 PMCID: PMC10605951 DOI: 10.1212/wnl.0000000000207561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 05/09/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Mortality rates for neurologic diseases are increasing in the United States, with large disparities across geographical areas and populations. Racial and ethnic populations, notably the non-Hispanic (NH) Black population, experience higher mortality rates for many causes of death, but the magnitude of the disparities for neurologic diseases is unclear. The objectives of this study were to calculate mortality rates for neurologic diseases by race and ethnicity and-to place this disparity in perspective-to estimate how many US deaths would have been averted in the past decade if the NH Black population experienced the same mortality rates as other groups. METHODS Mortality rates for deaths attributed to neurologic diseases, as defined by the International Classification of Diseases, were calculated for 2010 to 2019 using death and population data obtained from the Centers for Disease Control and Prevention and the US Census Bureau. Avertable deaths were calculated by indirect standardization: For each calendar year of the decade, age-specific death rates of NH White persons in 10 age groups were multiplied by the NH Black population in each age group. A secondary analysis used Hispanic and NH Asian populations as the reference groups. RESULTS In 2013, overall age-adjusted mortality rates for neurologic diseases began increasing, with the NH Black population experiencing higher rates than NH White, NH American Indian and Alaska Native, Hispanic, and NH Asian populations (in decreasing order). Other populations with higher mortality rates for neurologic diseases included older adults, the male population, and adults older than 25 years without a high school diploma. The gap in mortality rates for neurologic diseases between the NH Black and NH White populations widened from 4.2 individuals per 100,000 in 2011 to 7.0 per 100,000 in 2019. Over 2010 to 2019, had the NH Black population experienced the neurologic mortality rates of NH White, Hispanic, or NH Asian populations, 29,986, 88,407, or 117,519 deaths, respectively, would have been averted. DISCUSSION Death rates for neurologic diseases are increasing. Disproportionately higher neurologic mortality rates in the NH Black population are responsible for a large number of excess deaths, making research and policy efforts to address the systemic causes increasingly urgent.
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Affiliation(s)
- Steven H Woolf
- From the Center on Society and Health (S.H.W., D.A.C.), Division of Epidemiology (D.A.C., J.H.L.), Department of Family Medicine and Population Health, and Division of General Internal Medicine (W.R.S.), Virginia Commonwealth University, Richmond; Department of Neurology (K.C.J.), University of Virginia, Charlottesville; Office of Global Health and Health Disparities (R.T.B.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; Vanderbilt Institute for Global Health (E.T.), Departments of Pediatrics and Neurology, Vanderbilt University, Nashville, TN; and Department of Health Policy and Management (D.J.G.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
| | - Derek A Chapman
- From the Center on Society and Health (S.H.W., D.A.C.), Division of Epidemiology (D.A.C., J.H.L.), Department of Family Medicine and Population Health, and Division of General Internal Medicine (W.R.S.), Virginia Commonwealth University, Richmond; Department of Neurology (K.C.J.), University of Virginia, Charlottesville; Office of Global Health and Health Disparities (R.T.B.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; Vanderbilt Institute for Global Health (E.T.), Departments of Pediatrics and Neurology, Vanderbilt University, Nashville, TN; and Department of Health Policy and Management (D.J.G.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Jong Hyung Lee
- From the Center on Society and Health (S.H.W., D.A.C.), Division of Epidemiology (D.A.C., J.H.L.), Department of Family Medicine and Population Health, and Division of General Internal Medicine (W.R.S.), Virginia Commonwealth University, Richmond; Department of Neurology (K.C.J.), University of Virginia, Charlottesville; Office of Global Health and Health Disparities (R.T.B.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; Vanderbilt Institute for Global Health (E.T.), Departments of Pediatrics and Neurology, Vanderbilt University, Nashville, TN; and Department of Health Policy and Management (D.J.G.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Karen C Johnston
- From the Center on Society and Health (S.H.W., D.A.C.), Division of Epidemiology (D.A.C., J.H.L.), Department of Family Medicine and Population Health, and Division of General Internal Medicine (W.R.S.), Virginia Commonwealth University, Richmond; Department of Neurology (K.C.J.), University of Virginia, Charlottesville; Office of Global Health and Health Disparities (R.T.B.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; Vanderbilt Institute for Global Health (E.T.), Departments of Pediatrics and Neurology, Vanderbilt University, Nashville, TN; and Department of Health Policy and Management (D.J.G.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Richard T Benson
- From the Center on Society and Health (S.H.W., D.A.C.), Division of Epidemiology (D.A.C., J.H.L.), Department of Family Medicine and Population Health, and Division of General Internal Medicine (W.R.S.), Virginia Commonwealth University, Richmond; Department of Neurology (K.C.J.), University of Virginia, Charlottesville; Office of Global Health and Health Disparities (R.T.B.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; Vanderbilt Institute for Global Health (E.T.), Departments of Pediatrics and Neurology, Vanderbilt University, Nashville, TN; and Department of Health Policy and Management (D.J.G.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Edwin Trevathan
- From the Center on Society and Health (S.H.W., D.A.C.), Division of Epidemiology (D.A.C., J.H.L.), Department of Family Medicine and Population Health, and Division of General Internal Medicine (W.R.S.), Virginia Commonwealth University, Richmond; Department of Neurology (K.C.J.), University of Virginia, Charlottesville; Office of Global Health and Health Disparities (R.T.B.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; Vanderbilt Institute for Global Health (E.T.), Departments of Pediatrics and Neurology, Vanderbilt University, Nashville, TN; and Department of Health Policy and Management (D.J.G.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Wally R Smith
- From the Center on Society and Health (S.H.W., D.A.C.), Division of Epidemiology (D.A.C., J.H.L.), Department of Family Medicine and Population Health, and Division of General Internal Medicine (W.R.S.), Virginia Commonwealth University, Richmond; Department of Neurology (K.C.J.), University of Virginia, Charlottesville; Office of Global Health and Health Disparities (R.T.B.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; Vanderbilt Institute for Global Health (E.T.), Departments of Pediatrics and Neurology, Vanderbilt University, Nashville, TN; and Department of Health Policy and Management (D.J.G.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Darrell J Gaskin
- From the Center on Society and Health (S.H.W., D.A.C.), Division of Epidemiology (D.A.C., J.H.L.), Department of Family Medicine and Population Health, and Division of General Internal Medicine (W.R.S.), Virginia Commonwealth University, Richmond; Department of Neurology (K.C.J.), University of Virginia, Charlottesville; Office of Global Health and Health Disparities (R.T.B.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; Vanderbilt Institute for Global Health (E.T.), Departments of Pediatrics and Neurology, Vanderbilt University, Nashville, TN; and Department of Health Policy and Management (D.J.G.), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Cai M, Lin X, Wang X, Zhang S, Qian ZM, McMillin SE, Aaron HE, Lin H, Wei J, Zhang Z, Pan J. Ambient particulate matter pollution of different sizes associated with recurrent stroke hospitalization in China: A cohort study of 1.07 million stroke patients. Sci Total Environ 2023; 856:159104. [PMID: 36208745 DOI: 10.1016/j.scitotenv.2022.159104] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 09/22/2022] [Accepted: 09/24/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND To estimate the associations between ambient particulate matter (PM) pollution of different sizes (PM1, PM2.5, and PM10) and risk of rehospitalization among stroke patients, as well as the attributable burden in China. METHODS We built a cohort of 1,066,752 participants with an index stroke hospitalization in Sichuan, China from 2017 to 2019. Seven-day and annual average exposures to PM pollution prior to the date of the index hospitalization were linked with residential address using a bilinear interpolation approach. Cox proportional hazard models were constructed to assess the association between ambient PM and the risk of rehospitalization. The burden of stroke rehospitalization was estimated using a counterfactual approach. RESULTS 245,457 (23.0 %) participants experienced rehospitalization during a mean of 1.15 years (SD: 0.90 years) of follow-up. Seven-day average concentrations of PM were associated with increased risk of rehospitalization: the hazard ratios (HRs) per 10 μg/m3 were 1.034 (95 % confidence interval [CI]: 1.029-1.038) for PM1, 1.033 (1.031-1.036) for PM2.5, and 1.030 (1.028-1.031) for PM10; the hazard ratios were larger for annual average concentrations: 1.082 (1.074-1.090) for PM1, 1.109 (1.104-1.114) for PM2.5, and 1.103 (1.099-1.106) for PM10. The associations were stronger in participants who were female, of minority ethnicity (non-Han Chinese), who suffered from an ischemic stroke, and those admitted under normal conditions. Population attributable fractions for stroke rehospitalization ranged from 4.66 % (95 % CI: 1.69 % to 7.63 %) for the 7-day average of PM1 to 17.05 % (14.27 % to 19.83 %) for the annual average of PM10; the reducible average cost of rehospitalization per participant attributable to PM ranged from 492.09 (178.19 to 806) RMB for the 7-day average of PM1 to 1801.65 (1507.89 to 2095.41) RMB for the annual average of PM10. CONCLUSIONS Ambient PM pollution may increase the risk of rehospitalization in stroke patients and is responsible for a significant burden of stroke rehospitalization.
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Affiliation(s)
- Miao Cai
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, No. 74, Zhongshan 2rd Road, Yuexiu District, Guangzhou, Guangdong 510080, China
| | - Xiaojun Lin
- HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16, Section 3, Ren Min Nan Road, Chengdu, Sichuan 610041, China; Institute for Healthy Cities and West China Research Center for Rural Health Development, Sichuan University, No. 17, Section 3, Ren Min Nan Road, Chengdu, Sichuan 610041, China; West China-PUMC C.C. Chen Institute of Health, Sichuan University, No. 17, Section 3, Ren Min Nan Road, Chengdu, Sichuan 610041, China
| | - Xiaojie Wang
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, No. 74, Zhongshan 2rd Road, Yuexiu District, Guangzhou, Guangdong 510080, China
| | - Shiyu Zhang
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, No. 74, Zhongshan 2rd Road, Yuexiu District, Guangzhou, Guangdong 510080, China
| | - Zhengmin Min Qian
- Department of Epidemiology and Biostatistics, College for Public Health & Social Justice, Saint Louis University, 3545 Lafayette Avenue, Saint Louis, MO 63104, USA
| | - Stephen Edward McMillin
- School of Social Work, College for Public Health and Social Justice, Saint Louis University, Tegeler Hall, 3550 Lindell Boulevard, St. Louis, MO 63103, USA
| | - Hannah E Aaron
- Department of Epidemiology and Biostatistics, College for Public Health & Social Justice, Saint Louis University, 3545 Lafayette Avenue, Saint Louis, MO 63104, USA
| | - Hualiang Lin
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, No. 74, Zhongshan 2rd Road, Yuexiu District, Guangzhou, Guangdong 510080, China
| | - Jing Wei
- Department of Atmospheric and Oceanic Science, Earth System Science Interdisciplinary Center, University of Maryland, College Park, MD 20740, USA.
| | - Zilong Zhang
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, No. 74, Zhongshan 2rd Road, Yuexiu District, Guangzhou, Guangdong 510080, China.
| | - Jay Pan
- HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16, Section 3, Ren Min Nan Road, Chengdu, Sichuan 610041, China; West China-PUMC C.C. Chen Institute of Health, Sichuan University, No. 17, Section 3, Ren Min Nan Road, Chengdu, Sichuan 610041, China; School of Public Administration, Sichuan University, No.24 South Section I, YihuanRoad, Chengdu, Sichuan 610065, China.
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Lu HY, Ho UC, Kuo LT. Impact of Nutritional Status on Outcomes of Stroke Survivors: A Post Hoc Analysis of the NHANES. Nutrients 2023; 15:nu15020294. [PMID: 36678164 PMCID: PMC9864300 DOI: 10.3390/nu15020294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 12/19/2022] [Accepted: 12/28/2022] [Indexed: 01/11/2023] Open
Abstract
Stroke, a neurological emergency, is a leading cause of death and disability in adults worldwide. In acute or rehabilitative stages, stroke survivors sustain variable neurological recovery with long-term disabilities. The influence of post-stroke nutritional status on long-term survival has not been confirmed. Using the United States National Health and Nutrition Examination Survey data (2001−2010), we conducted a matched-cohort analysis (929 and 1858 participants in stroke and non-stroke groups, respectively) to investigate the influence of nutritional elements on post-stroke survival. With significantly lower nutrient consumption, the mortality risk was 2.2 times higher in stroke patients compared to non-stroke patients (Kaplan−Meier method with Cox proportional hazards model: adjusted hazard ratio, 2.208; 95% confidence interval: 1.887−2.583; p < 0.001). For several nutritional elements, the lower consumption group had significantly shorter survival than the higher consumption stroke subgroup; moreover, stroke patients with the highest 25% nutritional intake for each nutritional element, except moisture and total fat, had significantly shorter survival than non-stroke patients with the lowest 25% nutrition. Malnutrition is highly prevalent in stroke patients and is associated with high mortality rates. The dynamic change in energy requirements throughout the disease course necessitates dietary adjustment to ensure adequate nutritional intake.
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Affiliation(s)
- Hsueh-Yi Lu
- Department of Industrial Engineering and Management, National Yunlin University of Science and Technology, Yunlin 640, Taiwan
| | - Ue-Cheung Ho
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital Yunlin Branch, Yunlin 640, Taiwan
| | - Lu-Ting Kuo
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital Yunlin Branch, Yunlin 640, Taiwan
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei 100, Taiwan
- Correspondence: ; Tel.: +886-2-2312-3456
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