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Tinsley LJ, Wong ND, Reusch JEB, Arnold SV, Kosiborod MN, Tang Y, Laffel LM, Mehta SN. Regional differences in the management of cardiovascular risk factors among adults with diabetes: An evaluation of the Diabetes Collaborative Registry. J Diabetes Complications 2020; 34:107591. [PMID: 32471789 PMCID: PMC7837386 DOI: 10.1016/j.jdiacomp.2020.107591] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 04/07/2020] [Accepted: 04/07/2020] [Indexed: 01/03/2023]
Abstract
AIMS To compare cardiovascular risk factor control in adults with diabetes participating in a national diabetes registry to those in the general population and to ascertain regional differences in diabetes care. METHODS Adults with diagnosed diabetes in the Diabetes Collaborative Registry (DCR) were compared with those in the National Health and Nutrition Examination Survey (NHANES) from 2015 to 2016; standardized mean difference (SMD) > 0.2 defined significance. Regional differences were assessed in the DCR cohort; p < .05 defined significance. RESULTS The DCR cohort was older (61 vs. 57 years, SMD = 0.38), more insured (99.7% vs. 91.0%, SMD = 0.42), and less ethnically diverse (83% non-Hispanic white vs. 76%, SMD = 0.30) compared with NHANES. The proportion of overweight/obesity, A1c < 7% (<53 mmol/mol), and BP < 140/90 were similar, but DCR participants had higher proportion with LDL < 2.59 mmol/L (61% vs. 41%, SMD = 0.39) and fewer tobacco users (17% vs. 32%, SMD = 0.35). Regionally, obesity, lack of glycaemic control, and tobacco use were highest in the Midwest, BP control was the lowest in the South, and LDL control was lowest in the Northeast. CONCLUSIONS Significant regional differences in diabetes care delivery and outcomes were identified using a national diabetes registry. Serial analyses of the DCR may supplement national evaluations to deepen our understanding of diabetes care in the US.
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Affiliation(s)
- Liane J Tinsley
- Clinical, Behavioral, and Outcomes Research Section, Joslin Diabetes Center, Boston, MA, USA.
| | - Nathan D Wong
- Division of Cardiology, University of California Irvine, Irvine, CA, USA.
| | - Jane E B Reusch
- Endocrinology, Metabolism and Diabetes, University of Colorado, Aurora, CO, USA.
| | | | | | - Yuanyuan Tang
- Saint Luke's Mid America Heart Institute, Kansas City, MO, USA.
| | - Lori M Laffel
- Clinical, Behavioral, and Outcomes Research Section, Joslin Diabetes Center, Boston, MA, USA.
| | - Sanjeev N Mehta
- Clinical, Behavioral, and Outcomes Research Section, Joslin Diabetes Center, Boston, MA, USA.
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2
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Andrews MR, Tamura K, Claudel SE, Xu S, Ceasar JN, Collins BS, Langerman S, Mitchell VM, Baumer Y, Powell-Wiley TM. Geospatial Analysis of Neighborhood Deprivation Index (NDI) for the United States by County. JOURNAL OF MAPS 2020; 16:101-112. [PMID: 32855653 PMCID: PMC7447192 DOI: 10.1080/17445647.2020.1750066] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 01/12/2020] [Accepted: 02/29/2020] [Indexed: 05/21/2023]
Abstract
Little is known about the spatial clustering of neighborhood deprivation across the United States (U.S.). Using data from the 2010 U.S. Census Bureau, we created a neighborhood deprivation index (NDI: higher NDI indicates higher deprivation/ lower neighborhood socioeconomic status) for each county within the U.S. County level scores were loaded into ArcGIS 10.5.1 where they were mapped and analyzed using Moran's I and Anselin Local Moran's I. Ultimately, NDI varies spatially across the US. The highest NDI scores were found in the Southeastern and Southwestern U.S. states, and inland regions of Southern California. This information is critical for public health initiative development as planners may need to tailor the scale of their efforts based on the higher NDI neighborhoods of the county or geographic region with potentially greater chronic disease burden.
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Affiliation(s)
- Marcus R Andrews
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kosuke Tamura
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Sophie E Claudel
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Samantha Xu
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Joniqua N Ceasar
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Billy S Collins
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Steven Langerman
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Valerie M Mitchell
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Yvonne Baumer
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Tiffany M Powell-Wiley
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
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3
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Man REK, Gan AHW, Fenwick EK, Gan ATL, Gupta P, Sabanayagam C, Tan N, Wong KH, Wong TY, Cheng CY, Lamoureux EL. Prevalence, determinants and association of unawareness of diabetes, hypertension and hypercholesterolemia with poor disease control in a multi-ethnic Asian population without cardiovascular disease. Popul Health Metr 2019; 17:17. [PMID: 31806040 PMCID: PMC6896313 DOI: 10.1186/s12963-019-0197-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 11/06/2019] [Indexed: 01/08/2023] Open
Abstract
Background To explore the prevalence and determinants of unawareness of diabetes, hypertension and hypercholesterolemia and its association with poor disease control in a multi-ethnic Asian population without cardiovascular disease (CVD). Methods We included 6904 Chinese, Malay and Indian individuals (mean age [SD] 58.2 [10.2] years; 52.6% female) with diabetes, hypertension and/or hypercholesterolemia from the cross-sectional population-based Singapore Epidemiology of Eye Diseases study (2004–2011). Diabetes was defined as random blood glucose ≥ 11.1 mmol/L or HbA1c > 6.5% or self-reported use of diabetes medication; hypertension as systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg or self-reported use of anti-hypertensive treatment; and hypercholesterolemia as total cholesterol ≥ 6.2 mmol/L or self-reported use of lipid-lowering medications. Unawareness was based on participants’ answers to the questions: “Did your medical practitioner ever tell you that you have diabetes/hypertension/high cholesterol?” The determinants of unawareness, and its association with poor disease control, were assessed using multivariable binary logistic regression models adjusted for known potential confounders. Results Of the 2380 (34.5%), 5386 (78.0%) and 3607 (52.2%) with diabetes, hypertension and hypercholesterolemia, respectively, unawareness rates were 30.7%, 43.1% and 40.9%, respectively. Having a higher BMI, particularly if obese, and Malay ethnicity were associated with greater unawareness of diabetes; Malay and Indian ethnicities and current smoking with greater unawareness of hypertension; and education ≤6 years, current smoking, and blue collar jobs or unemployment with greater unawareness of hypercholesterolemia (all P < 0.05). Lack of awareness of each condition was independently associated with poorer disease control in the case of hypertension and hypercholesterolemia, while the converse was true for diabetes (all P < 0.05). Conclusions Unawareness of diabetes, hypertension, or hypercholesterolemia is high in Singapore, with risk factors varying across all three diseases, although Malay ethnicity is a consistent one. Unawareness was also associated with poor management for hypertension and hypercholesterolemia. Public health education and screening programs should target at-risk individuals, especially Malays, to reduce the likelihood of incident CVD.
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Affiliation(s)
- Ryan E K Man
- Singapore Eye Research Institute, Singapore National Eye Centre, 20 College Rd, The Academia, Discovery Tower Level 6, Singapore, 169856, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Alvin Hong Wei Gan
- Singapore Eye Research Institute, Singapore National Eye Centre, 20 College Rd, The Academia, Discovery Tower Level 6, Singapore, 169856, Singapore
| | - Eva K Fenwick
- Singapore Eye Research Institute, Singapore National Eye Centre, 20 College Rd, The Academia, Discovery Tower Level 6, Singapore, 169856, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Alfred Tau Liang Gan
- Singapore Eye Research Institute, Singapore National Eye Centre, 20 College Rd, The Academia, Discovery Tower Level 6, Singapore, 169856, Singapore
| | - Preeti Gupta
- Singapore Eye Research Institute, Singapore National Eye Centre, 20 College Rd, The Academia, Discovery Tower Level 6, Singapore, 169856, Singapore
| | - Charumathi Sabanayagam
- Singapore Eye Research Institute, Singapore National Eye Centre, 20 College Rd, The Academia, Discovery Tower Level 6, Singapore, 169856, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Nicholas Tan
- National University of Singapore, Singapore, Singapore
| | - Kah Hie Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, 20 College Rd, The Academia, Discovery Tower Level 6, Singapore, 169856, Singapore.,National University of Singapore, Singapore, Singapore
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, 20 College Rd, The Academia, Discovery Tower Level 6, Singapore, 169856, Singapore.,Duke-NUS Medical School, Singapore, Singapore.,Singapore National Eye Centre, Singapore, Singapore.,National University of Singapore, Singapore, Singapore
| | - Ching-Yu Cheng
- Singapore Eye Research Institute, Singapore National Eye Centre, 20 College Rd, The Academia, Discovery Tower Level 6, Singapore, 169856, Singapore.,Duke-NUS Medical School, Singapore, Singapore.,Singapore National Eye Centre, Singapore, Singapore.,National University of Singapore, Singapore, Singapore
| | - Ecosse L Lamoureux
- Singapore Eye Research Institute, Singapore National Eye Centre, 20 College Rd, The Academia, Discovery Tower Level 6, Singapore, 169856, Singapore. .,Duke-NUS Medical School, Singapore, Singapore. .,National University of Singapore, Singapore, Singapore.
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4
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Singh A, Brooks DD, Abrams TA, Poorak MD, Gunio D, Kandhal PK, Lakhanpal A, Sethuraman SN, Bruno A. Pre-stroke glycemia in patients with diabetes. Diabetes Metab Syndr 2017; 11 Suppl 2:S891-S893. [PMID: 28705459 DOI: 10.1016/j.dsx.2017.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 07/01/2017] [Indexed: 10/19/2022]
Abstract
AIMS Hyperglycemia in type 2 diabetes mellitus (T2D) remains uncontrolled in approximately 50% of patients in the United States. Uncontrolled T2D is associated with various vascular complications, including stroke. We studied demographic and clinical factors association with pre-stroke glycemia, indicated by glycated hemoglobin (HbA1c), in acute stroke patients with T2D. METHODS Using a questionnaire, we collected demographic, socioeconomic, and clinical information from 300 acute ischemic and hemorrhagic stroke patients in one hospital. We analyzed factors associated with HbA1c in patients with history of T2D. RESULTS There were 111 patients with history of T2D and HbA1c measured on admission. In multivariable analyses factors associated with higher HbA1c were treatment with insulin (p=0.05), history of hyperlipidemia (p=0.01), and total cholesterol level (p=0.02). Poor adherence to T2D treatment was associated with higher HbA1c levels (p=0.006) only in a subgroup of patients with HbA1c ≥8%. CONCLUSION Insulin treatment and hyperlipidemia are associated with higher HbA1c levels in acute stroke patients with T2D. Poor adherence to diabetes treatment is associated with higher HbA1c levels only among patients with HbA1c ≥8%.
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Affiliation(s)
- Amrinder Singh
- Department of Neurology, Medical College of Georgia, United States
| | | | - Taryn A Abrams
- Medical College of Georgia, Augusta University, United States
| | - Mitra D Poorak
- Medical College of Georgia, Augusta University, United States
| | - Drew Gunio
- Medical College of Georgia, Augusta University, United States
| | | | | | | | - Askiel Bruno
- Department of Neurology, Medical College of Georgia, United States.
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Wang J, Ma JJ, Liu J, Zeng DD, Song C, Cao Z. Prevalence and Risk Factors of Comorbidities among Hypertensive Patients in China. Int J Med Sci 2017; 14:201-212. [PMID: 28367080 PMCID: PMC5370282 DOI: 10.7150/ijms.16974] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 01/23/2017] [Indexed: 01/24/2023] Open
Abstract
Hypertension is a severe threat to human being's health due to its association with many comorbidities. Many research works have explored hypertension's prevalence and treatment. However, few considered impact of patient's socioeconomic status and geographical disparities. We intended to fulfill that research gap by analyzing the association of the prevalence of hypertension and three important comorbidities with various socioeconomic and geographical factors. We also investigated the prevalence of those comorbidities if the patient has been diagnosed with hypertension. We obtained a large collection of medical records from 29 hospitals across China. We utilized Bayes' Theorem, Pearson's chi-squared test, univariate and multivariate regression methods and geographical detector methods to analyze the association between disease prevalence and risk factors. We first attempted to quantified and analyzed the spatial stratified heterogeneity of the prevalence of hypertension comorbidities by q-statistic using geographical detector methods. We found that the demographic and socioeconomic factors, and hospital class and geographical factors would have an enhanced interactive influence on the prevalence of hypertension comorbidities. Our findings can be leveraged by public health policy makers to allocate medical resources more effectively. Healthcare practitioners can also be benefited by our analysis to offer customized disease prevention for populations with different socioeconomic status.
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Affiliation(s)
- Jiaojiao Wang
- The State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Jian James Ma
- College of Business, University of Colorado, Colorado Springs, CO, USA
| | - Jiaqi Liu
- The State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Daniel Dajun Zeng
- The State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, Beijing, China.; University of Chinese Academy of Sciences, Beijing, China
| | - Cynthia Song
- Internal Medicine Physician, Abington Hospital - Jefferson Health, Abington, PA, USA
| | - Zhidong Cao
- The State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, Beijing, China
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6
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Goetz ME, Judd SE, Safford MM, Hartman TJ, McClellan WM, Vaccarino V. Dietary flavonoid intake and incident coronary heart disease: the REasons for Geographic and Racial Differences in Stroke (REGARDS) study. Am J Clin Nutr 2016; 104:1236-1244. [PMID: 27655439 PMCID: PMC5081714 DOI: 10.3945/ajcn.115.129452] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 08/25/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Flavonoids are dietary polyphenolic compounds with a variety of proposed beneficial cardiovascular effects, but rigorous prospective studies that examine the association between flavonoid intake and incident coronary heart disease (CHD) in geographically and racially diverse US samples are limited. OBJECTIVE With the use of the new, expanded USDA flavonoid database, we assessed the association between total flavonoid and flavonoid subclass intakes with incident CHD in a biracial and geographically diverse cohort, as well as effect modification by age, sex, race, and region of residence. DESIGN Participants were 16,678 black and white men and women enrolled in the REGARDS (REasons for Geographic and Racial Differences in Stroke) study, a national prospective cohort study. All participants were without CHD at baseline, and all completed a Block98 food-frequency questionnaire. Flavonoid intakes were estimated from USDA flavonoid databases, which were recently improved to address missing values for cooked foods and to adjust for flavonoid losses due to processing. Incident CHD events were participant reported and adjudicated by experts. Quintiles of flavonoid intake were examined as predictors of incident CHD by using Cox proportional hazards regression to obtain HRs. Tests for trend used the quintile medians. RESULTS Over a mean ± SD follow-up of 6.0 ± 1.9 y, 589 CHD events occurred. High flavonoid intake was associated with self-identified white race, exercise, not smoking, more education, and higher income. In models that adjusted for sociodemographic, health behavior, and dietary factors, there was an inverse association between anthocyanidin and proanthocyanidin intakes and incident CHD (HRs for quintile 5 compared with quintile 1-anthocyanidins: 0.71; 95% CI: 0.52, 0.98; P-trend = 0.04; proanthocyanidins: 0.63; 95% CI: 0.47, 0.84; P-trend = 0.02). There was no association between total flavonoid or other flavonoid subclass intakes and incident CHD. CONCLUSIONS Reported anthocyanidin and proanthocyanidin intakes were inversely associated with incident CHD. There was no significant effect modification by age, sex, race, or region of residence.
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Affiliation(s)
| | - Suzanne E Judd
- Department of Epidemiology, Rollins School of Public Health
- Department of Biostatistics, School of Public Health, and
| | - Monika M Safford
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Terryl J Hartman
- Department of Epidemiology, Rollins School of Public Health
- Winship Cancer Institute; and
| | - William M McClellan
- Department of Epidemiology, Rollins School of Public Health
- Renal Division and
| | - Viola Vaccarino
- Department of Epidemiology, Rollins School of Public Health
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Emory University, Atlanta, GA; and
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Vaughan AS, Quick H, Pathak EB, Kramer MR, Casper M. Disparities in Temporal and Geographic Patterns of Declining Heart Disease Mortality by Race and Sex in the United States, 1973-2010. J Am Heart Assoc 2015; 4:e002567. [PMID: 26672077 PMCID: PMC4845281 DOI: 10.1161/jaha.115.002567] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 10/27/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Examining small-area differences in the strength of declining heart disease mortality by race and sex provides important context for current racial and geographic disparities and identifies localities that could benefit from targeted interventions. We identified and described temporal trends in declining county-level heart disease mortality by race, sex, and geography between 1973 and 2010. METHODS AND RESULTS Using a Bayesian hierarchical model, we estimated age-adjusted mortality with diseases of the heart listed as the underlying cause for 3099 counties. County-level percentage declines were calculated by race and sex for 3 time periods (1973-1985, 1986-1997, 1998-2010). Strong declines were statistically faster or no different than the total national decline in that time period. We observed county-level race-sex disparities in heart disease mortality trends. Continual (from 1973 to 2010) strong declines occurred in 73.2%, 44.6%, 15.5%, and 17.3% of counties for white men, white women, black men, and black women, respectively. Delayed (1998-2010) strong declines occurred in 15.4%, 42.0%, 75.5%, and 76.6% of counties for white men, white women, black men, and black women, respectively. Counties with the weakest patterns of decline were concentrated in the South. CONCLUSIONS Since 1973, heart disease mortality has declined substantially for these race-sex groups. Patterns of decline differed by race and geography, reflecting potential disparities in national and local drivers of these declines. Better understanding of racial and geographic disparities in the diffusion of heart disease prevention and treatment may allow us to find clues to progress toward racial and geographic equity in heart disease mortality.
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Affiliation(s)
- Adam S. Vaughan
- Department of EpidemiologyRollins School of Public HealthEmory UniversityAtlantaGA
- Division for Heart Disease and Stroke PreventionCenters for Disease Control and PreventionAtlantaGA
| | - Harrison Quick
- Division for Heart Disease and Stroke PreventionCenters for Disease Control and PreventionAtlantaGA
| | | | - Michael R. Kramer
- Department of EpidemiologyRollins School of Public HealthEmory UniversityAtlantaGA
- Division for Heart Disease and Stroke PreventionCenters for Disease Control and PreventionAtlantaGA
| | - Michele Casper
- Division for Heart Disease and Stroke PreventionCenters for Disease Control and PreventionAtlantaGA
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Soomann M, Vibo R, Kõrv J. Do Stroke Patients Know Their Risk Factors? J Stroke Cerebrovasc Dis 2015; 25:523-6. [PMID: 26654663 DOI: 10.1016/j.jstrokecerebrovasdis.2015.10.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 09/23/2015] [Accepted: 10/31/2015] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Risk factor management is the key to stroke prevention. Although several studies have assessed the awareness of different risk factors in the general public, there are limited data available on how well acute stroke patients know their own risk factors. The aim of this study was to assess stroke patients' informedness of their own stroke risk factors. METHODS All consecutive eligible acute stroke and transient ischemic attack patients hospitalized at the Tartu University Hospital, Department of Neurology, during 9 months in 2010 were interviewed about different stroke risk factors within 72 hours from hospitalization. The respective information was also retrieved from medical records. RESULTS Of the 341 patients admitted during the study period, 195 were eligible for the interview. Diabetes was the best known risk factor (89%) followed by hypertension (80%), atrial fibrillation (78%), previous stroke (77%), and heart failure and/or ischemic heart disease (66%). CONCLUSIONS We found that acute stroke patients are best informed of their diabetes and worst informed of their ischemic heart disease and/or heart failure. There is, however, room for amelioration in the awareness of all of the studied risk factors. More attention should be addressed to explaining the risks and treatment options to patients at risk of stroke and the general population.
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Affiliation(s)
- Maarja Soomann
- Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia.
| | - Riina Vibo
- Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia
| | - Janika Kõrv
- Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia
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9
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Bhatt H, Safford M, Stephen G. Coronary heart disease risk factors and outcomes in the twenty-first century: findings from the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study. Curr Hypertens Rep 2015; 17:541. [PMID: 25794955 PMCID: PMC4443695 DOI: 10.1007/s11906-015-0541-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
REasons for Geographic and Racial Differences in Stroke (REGARDS) is a longitudinal study supported by the National Institutes of Health to determine the disparities in stroke-related mortality across USA. REGARDS has published a body of work designed to understand the disparities in prevalence, awareness, treatment, and control of coronary heart disease (CHD) and its risk factors in a biracial national cohort. REGARDS has focused on racial and geographical disparities in the quality and access to health care, the influence of lack of medical insurance, and has attempted to contrast current guidelines in lipid lowering for secondary prevention in a nationwide cohort. It has described CHD risk from nontraditional risk factors such as chronic kidney disease, atrial fibrillation, and inflammation (i.e., high-sensitivity C-reactive protein) and has also assessed the role of depression, psychosocial, environmental, and lifestyle factors in CHD risk with emphasis on risk factor modification and ideal lifestyle factors. REGARDS has examined the utility of various methodologies, e.g., the process of medical record adjudication, proxy-based cause of death, and use of claim-based algorithms to determine CHD risk. Some valuable insight into less well-studied concepts such as the reliability of current troponin assays to identify "microsize infarcts," caregiving stress, and CHD, heart failure, and cognitive decline have also emerged. In this review, we discuss some of the most important findings from REGARDS in the context of the existing literature in an effort to identify gaps and directions for further research.
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Affiliation(s)
- Hemal Bhatt
- Division of Cardiovascular Medicine, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL 35294-0113, USA
| | - Monika Safford
- Division of Preventive Medicine, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL 35294-0113, USA
| | - Glasser Stephen
- Division of Preventive Medicine, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL 35294-0113, USA
- 1717 11th Avenue South, MT 634, Birmingham, AL 35205, USA
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10
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Sewell K, Andreae S, Luke E, Safford MM. Perceptions of and barriers to use of generic medications in a rural African American population, Alabama, 2011. Prev Chronic Dis 2012; 9:E142. [PMID: 22935144 PMCID: PMC3475503 DOI: 10.5888/pcd9.120010] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Introduction Using generic medications for chronic diseases provides efficacy similar to that of brand-name medication use, but at a lower price, potentially enhancing adherence. However, previous studies show that disadvantaged people, who may particularly benefit from cost savings, have low trust of generics and increased reluctance to switch to generics. The rural South includes areas of high poverty and minority communities whose members are at high risk for poor health outcomes; however, whether such beliefs exist in these communities has not been reported. We sought to obtain qualitative insight into beliefs about generic medication use among African Americans in the rural South. Methods Investigators conducted 4 focus groups with 30 community members from Alabama’s Black Belt area. Transcribed discussions were analyzed and common themes identified. Results Participants were primarily unemployed middle-aged women, one-fourth of whom were uninsured and more than half of whom had a high school education or less. Barriers to generic medication use included perceptions that generics are less potent than brand-name medications, require higher doses, and, therefore, result in more side effects; generics are not “real” medicine; generics are for minor but not serious illnesses; the medical system cannot be trusted; and poor people are forced to “settle” for generics. Conclusion Although education about generics could rectify misinformation, overcoming views such as mistrust of the medical system and the sense of having to settle for generics because of poverty may be more challenging. Policy makers and providers should consider these perspectives when working to increase generic drug use in these populations.
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Affiliation(s)
- Keri Sewell
- University of Alabama at Birmingham School of Medicine, 1717 11th Ave S, Ste 510D, Birmingham, AL 35233, USA.
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