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Garcia L, Feinglass J, Marfatia H, Adekola K, Moreira J. Evaluating Socioeconomic, Racial, and Ethnic Disparities in Survival Among Patients Undergoing Allogeneic Hematopoietic Stem Cell Transplants. J Racial Ethn Health Disparities 2024; 11:1330-1338. [PMID: 37126157 PMCID: PMC10618412 DOI: 10.1007/s40615-023-01611-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/18/2023] [Accepted: 04/21/2023] [Indexed: 05/02/2023]
Abstract
This study was undertaken to monitor potential disparities in survival after allogeneic hematopoietic stem cell transplantation (HSCT) with the aim of optimizing access and outcomes for minority and low-income patients. We analyzed 463 patients transplanted over a 72-month study period with a median 19-month follow-up, focused on differences by individual patient race/ethnicity and patients' household income derived from geocoded addresses at the census block group level. Patient sociodemographic and clinical characteristics were abstracted from electronic health records and our HSCT registry, including disease category and status, donor age, transplant type, and conditioning. Approximately, 15% of HSCT patients were non-Hispanic Black or Hispanic with a similar proportion from block groups below the median metropolitan Index of Concentration at the Extremes income score. The overall survival probability was 61.8% at 36 months. Non-Hispanic white (63.6%) and especially Hispanic patients (49.2%) had lower survival probabilities at 36 months than non-Hispanic Black patients (75.6%, p = 0.04). There were no other patient characteristics significantly associated with survival at the p < 0.01 level. The lack of significant differences likely reflects the careful selection of patients for transplants. However, the proportion of minority and low-income patients relative to expected disease prevalence in our area population raises important considerations about which patients successfully make it to transplant. We conclude with recommendations to increase the diversity of patients who receive HSCT by reviewing potential barriers in the transplant referral and selection process and advocating for needed psychosocial and community resources.
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Affiliation(s)
- Lawrence Garcia
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Joe Feinglass
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, 750 Lakeshore Dr., 10th Floor, Chicago, IL, 60611, USA.
| | - Hardik Marfatia
- Economics Department, Northeastern Illinois University, Chicago, IL, USA
| | - Kehinde Adekola
- Division of Hematology and Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jonathan Moreira
- Division of Hematology and Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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2
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Tarar BI, Knox A, Dean CA, Brown EC. Resistance training responses across race and ethnicity: a narrative review. ETHNICITY & HEALTH 2023; 28:1221-1237. [PMID: 37183720 DOI: 10.1080/13557858.2023.2212147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 05/04/2023] [Indexed: 05/16/2023]
Abstract
OBJECTIVES Although the physiological mechanisms are not fully understood, race/ethnicity differences vary across cardiometabolic disease risk factors. Resistance training (RT) is an effective therapy for improving these risk factors in addition to body composition and physical performance. Thus, the purpose of this study was to determine the effects of RT over time on different racial and ethnic populations across cardiometabolic, body composition, and physical performance outcomes. DESIGN Electronic databases Scopus and PubMed were searched for studies that compared different racial/ethnic responses to RT across cardiometabolic, body composition, and physical performance parameters. Inclusion criteria for the studies were as follows: (1) published in the English language; (2) compared races or ethnicities across cardiometabolic risk factors, body composition, or physical performance variables following a RT intervention; (3) included adults 18 years or older, and (4) included an isolated RT intervention group. RESULTS Nine studies were found that met the inclusion criteria. The identified studies involved cohorts of White American (WA), South Asian, European Chilean, Mapuche Chilean, White Scottish, and African American (AA) males and females. Race/ethnicity differences following a RT intervention were found for fat-free mass preservation and changes in blood pressure, endothelial function, brachial artery stiffness, cardiac autonomic function, inflammatory and oxidative stress markers, insulin sensitivity, body mass index, waist circumference, % body fat, and muscular strength. With the exception of changes in systolic blood pressure and brachial artery stiffness, AAs consistently showed more beneficial adaptations compared to WAs to RT across studies. CONCLUSION Race and ethnicity play a role in how adults adapt to chronic RT. These data may aid in better understanding the social, biological, and environmental factors that likely influenced these racial/ethnic differences in response to RT, assist in creating tailored exercise prescriptions for various racial/ethnic populations, and inform policies for determining resource allocations to address health inequities.
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Affiliation(s)
- Bilal Ihsan Tarar
- Department of Interdisciplinary Health Sciences, School of Health Sciences, Oakland University, Rochester, MI, USA
| | - Allan Knox
- Department of Exercise Science, College of Arts and Sciences, California Lutheran University, Thousand Oaks, CA, USA
| | - Caress Alithia Dean
- Department of Public and Environmental Wellness, School of Health Sciences, Oakland University, Rochester, MI, USA
| | - Elise Catherine Brown
- Department of Public and Environmental Wellness, School of Health Sciences, Oakland University, Rochester, MI, USA
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3
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Huang H. Moderating Effects of Racial Segregation on the Associations of Cardiovascular Outcomes with Walkability in Chicago Metropolitan Area. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14252. [PMID: 36361132 PMCID: PMC9657023 DOI: 10.3390/ijerph192114252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 10/01/2022] [Accepted: 10/13/2022] [Indexed: 06/16/2023]
Abstract
Cardiovascular diseases (CVDs), as the leading cause of death in the U.S., pose a disproportionate burden to racial/ethnic minorities. Walkability, as a key concept of the built environment, reflecting walking and physical activity, is associated with health behaviors that help to reduce CVDs risk. While the unequal social variation and spatial distribution inequality of the CVDs and the role of walkability in preventing CVDs have been explored, the moderating factors through which walkability affects CVDs have not been quantitatively analyzed. In this paper, the spatial statistical techniques combined with the regression model are conducted to study the distribution of the CVDs' health outcomes and factors influencing their variation in the Chicago metropolitan area. The spatial statistical results for the CVDs' health outcomes reveal that clusters of low-value incidence are concentrated in the suburban rural areas and areas on the north side of the city, while the high-value clusters are concentrated in the west and south sides of the city and areas extending beyond the western and southern city boundaries. The regression results indicate that racial segregation reduced the positive association between health outcomes and walkability, although both racial segregation and walkability factors were positively associated with CVDs' health outcomes.
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Affiliation(s)
- Hao Huang
- Department of Social Sciences, Illinois Institute of Technology, Chicago, IL 60616, USA
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4
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Racial residential segregation shapes the relationship between early childhood lead exposure and fourth-grade standardized test scores. Proc Natl Acad Sci U S A 2022; 119:e2117868119. [PMID: 35969764 PMCID: PMC9407651 DOI: 10.1073/pnas.2117868119] [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] [Indexed: 11/24/2022] Open
Abstract
Racial residential segregation (RRS) – defined here as the geographic separation of Black individuals and communities from other racial/ethnic groups into separate, unequal neighborhoods – fosters environments inimical to health through disinvestment of resources and concentration of disadvantages. Neighborhood environments influence children’s health and development, but relationships between RRS and cognitive development are poorly understood. We find that: (1) non-Hispanic Black children were more likely to experience multiple adverse exposures in early childhood, and (2) among non-Hispanic Black children, high levels of RRS augmented the detrimental effect of elevated blood levels on reading test scores. Non-linear models were used to model exposure to lead and RRS, and their interaction. Racial/ethnic disparities in academic performance may result from a confluence of adverse exposures that arise from structural racism and accrue to specific subpopulations. This study investigates childhood lead exposure, racial residential segregation, and early educational outcomes. Geocoded North Carolina birth data is linked to blood lead surveillance data and fourth-grade standardized test scores (n = 25,699). We constructed a census tract-level measure of racial isolation (RI) of the non-Hispanic Black (NHB) population. We fit generalized additive models of reading and mathematics test scores regressed on individual-level blood lead level (BLL) and neighborhood RI of NHB (RINHB). Models included an interaction term between BLL and RINHB. BLL and RINHB were associated with lower reading scores; among NHB children, an interaction was observed between BLL and RINHB. Reading scores for NHB children with BLLs of 1 to 3 µg/dL were similar across the range of RINHB values. For NHB children with BLLs of 4 µg/dL, reading scores were similar to those of NHB children with BLLs of 1 to 3 µg/dL at lower RINHB values (less racial isolation/segregation). At higher RINHB levels (greater racial isolation/segregation), children with BLLs of 4 µg/dL had lower reading scores than children with BLLs of 1 to 3 µg/dL. This pattern becomes more marked at higher BLLs. Higher BLL was associated with lower mathematics test scores among NHB and non-Hispanic White (NHW) children, but there was no evidence of an interaction. In conclusion, NHB children with high BLLs residing in high RINHB neighborhoods had worse reading scores.
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5
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Mercado C, Beckles G, Cheng Y, Bullard KM, Saydah S, Gregg E, Imperatore G. Trends and socioeconomic disparities in all-cause mortality among adults with diagnosed diabetes by race/ethnicity: a population-based cohort study - USA, 1997-2015. BMJ Open 2021; 11:e044158. [PMID: 33947732 PMCID: PMC8098944 DOI: 10.1136/bmjopen-2020-044158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES By race/ethnicity and socioeconomic position (SEP), to estimate and examine changes over time in (1) mortality rate, (2) mortality disparities and (3) excess mortality risk attributed to diagnosed diabetes (DM). DESIGN Population-based cohort study using National Health Interview Survey data linked to mortality status from the National Death Index from survey year up to 31 December 2015 with 5 years person-time. PARTICIPANTS US adults aged ≥25 years with (31 586) and without (332 451) DM. PRIMARY OUTCOME Age-adjusted all-cause mortality rate for US adults with DM in each subgroup of SEP (education attainment and income-to-poverty ratio (IPR)) and time (1997-2001, 2002-2006 and 2007-2011). RESULTS Among adults with DM, mortality rates fell from 23.5/1000 person-years (p-y) in 1997-2001 to 18.1/1000 p-y in 2007-2011 with changes of -5.2/1000 p-y for non-Hispanic whites; -5.2/1000 p-y for non-Hispanic blacks; and -5.4/1000 p-y for Hispanics. Rates significantly declined within SEP groups, measured as education attainment (<high school=-5.7/1000 p-y; high school graduate=-4.2/1000 p-y; and >high school=-4.8/1000 p-y) and IPR group (poor=-7.9/1000 p-y; middle income=-4.7/1000 p-y; and high income=-6.2/1000 p-y; but not for near poor). For adults with DM, statistically significant all-cause mortality disparity showed greater mortality rates for the lowest than the highest SEP level (education attainment and IPR) in each time period. However, patterns in mortality trends and disparity varied by race/ethnicity. The excess mortality risk attributed to DM significantly decreased from 1997-2001 to 2007-2011, within SEP levels, and among Hispanics and non-Hispanic whites; but no statistically significant changes among non-Hispanic blacks. CONCLUSIONS There were substantial improvements in all-cause mortality among US adults. However, we observed SEP disparities in mortality across race/ethnic groups or for adults with and without DM despite targeted efforts to improve access and quality of care among disproportionately affected populations.
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Affiliation(s)
- Carla Mercado
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Gloria Beckles
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Yiling Cheng
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kai McKeever Bullard
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sharon Saydah
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Giuseppina Imperatore
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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6
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Cummings DM, Patil SP, Long DL, Guo B, Cherrington A, Safford MM, Judd SE, Howard VJ, Howard G, Carson AP. Does the Association Between Hemoglobin A 1c and Risk of Cardiovascular Events Vary by Residential Segregation? The REasons for Geographic And Racial Differences in Stroke (REGARDS) Study. Diabetes Care 2021; 44:1151-1158. [PMID: 33958425 PMCID: PMC8132333 DOI: 10.2337/dc20-1710] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 02/16/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To examine if the association between higher A1C and risk of cardiovascular disease (CVD) among adults with and without diabetes is modified by racial residential segregation. RESEARCH DESIGN AND METHODS The study used a case-cohort design, which included a random sample of 2,136 participants at baseline and 1,248 participants with incident CVD (i.e., stroke, coronary heart disease [CHD], and fatal CHD during 7-year follow-up) selected from 30,239 REasons for Geographic And Racial Differences in Stroke (REGARDS) study participants originally assessed between 2003 and 2007. The relationship of A1C with incident CVD, stratified by baseline diabetes status, was assessed using Cox proportional hazards models adjusting for demographics, CVD risk factors, and socioeconomic status. Effect modification by census tract-level residential segregation indices (dissimilarity, interaction, and isolation) was assessed using interaction terms. RESULTS The mean age of participants in the random sample was 64.2 years, with 44% African American, 59% female, and 19% with diabetes. In multivariable models, A1C was not associated with CVD risk among those without diabetes (hazard ratio [HR] per 1% [11 mmol/mol] increase, 0.94 [95% CI 0.76-1.16]). However, A1C was associated with an increased risk of CVD (HR per 1% increase, 1.23 [95% CI 1.08-1.40]) among those with diabetes. This A1C-CVD association was modified by the dissimilarity (P < 0.001) and interaction (P = 0.001) indices. The risk of CVD was increased at A1C levels between 7 and 9% (53-75 mmol/mol) for those in areas with higher residential segregation (i.e., lower interaction index). In race-stratified analyses, there was a more pronounced modifying effect of residential segregation among African American participants with diabetes. CONCLUSIONS Higher A1C was associated with increased CVD risk among individuals with diabetes, and this relationship was more pronounced at higher levels of residential segregation among African American adults. Additional research on how structural determinants like segregation may modify health effects is needed.
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Affiliation(s)
- Doyle M Cummings
- Department of Family Medicine, East Carolina University Brody School of Medicine, Greenville, NC .,Center for Health Disparities, East Carolina University Brody School of Medicine, Greenville, NC
| | - Shivajirao P Patil
- Department of Family Medicine, East Carolina University Brody School of Medicine, Greenville, NC
| | - D Leann Long
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL
| | - Boyi Guo
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL
| | - Andrea Cherrington
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Monika M Safford
- Department of Internal Medicine, Weill Cornell Medical Center, New York, NY
| | - Suzanne E Judd
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL
| | - Virginia J Howard
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL
| | - George Howard
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL
| | - April P Carson
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL
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7
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Buscemi J, Saiyed N, Silva A, Ghahramani F, Benjamins MR. Diabetes mortality across the 30 biggest U.S. cities: Assessing overall trends and racial inequities. Diabetes Res Clin Pract 2021; 173:108652. [PMID: 33422585 DOI: 10.1016/j.diabres.2021.108652] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 12/21/2020] [Accepted: 01/04/2021] [Indexed: 11/18/2022]
Abstract
AIMS National data suggest that diabetes mortality disproportionately affects Blacks compared to whites. We aimed to (1) calculate diabetes mortality rates (where diabetes was an underlying cause of death) among the general population of the U.S. and the largest 30 cities; (2) calculate Black/white mortality rate ratios and rate differences; and (3) compare changes in mortality rates and inequities across two 5-year periods (2008-2012 (T1) and 2013-2017 (T2)). METHODS We used vital statistics mortality data and American Community Survey population estimates. RESULTS The U.S. diabetes mortality rate at T1 was 20.91 per 100,000, and significantly increased to 21.05 at T2. El Paso had the highest diabetes mortality rate at both time points (T1 = 33.06; T2 = 35.98), while San Francisco had the lowest rate (T1 = 11.41; T2 = 13.18). The U.S. Black mortality rate was 2.21 times higher than the white rate at T2 (95%CI [2.19-2.23]). Eleven cities had significantly higher rate ratios than the U.S. at T2. The Black:white rate ratio in Washington, D.C. was approximately three times higher than the national rate ratio. CONCLUSIONS This city-level data is important to inform more targeted local policy interventions and programming to promote health equity, particularly within cities with the greatest inequities.
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Affiliation(s)
- Joanna Buscemi
- DePaul University, 2219 N Kenmore Ave, Chicago, IL 60647, United States.
| | - Nazia Saiyed
- Sinai Urban Health Institute, 1500 S Fairfield Ave, Chicago, IL 60608, United States
| | - Abigail Silva
- Department of Public Health Sciences, Loyola University Chicago, 2160 S N 1st Ave, Maywood, IL 60153, United States
| | | | - Maureen R Benjamins
- Sinai Urban Health Institute, 1500 S Fairfield Ave, Chicago, IL 60608, United States
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8
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Mayne SL, Loizzo L, Bancks MP, Carnethon MR, Barber S, Gordon-Larsen P, Carson AP, Schreiner PJ, Bantle AE, Whitaker KM, Kershaw KN. Racial residential segregation, racial discrimination, and diabetes: The Coronary Artery Risk Development in Young Adults study. Health Place 2020; 62:102286. [PMID: 32479363 PMCID: PMC7266830 DOI: 10.1016/j.healthplace.2020.102286] [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: 08/29/2019] [Revised: 12/21/2019] [Accepted: 01/13/2020] [Indexed: 12/23/2022]
Abstract
Although racial residential segregation and interpersonal racial discrimination are associated with cardiovascular disease, few studies have examined their link with diabetes risk or management. We used longitudinal data from 2,175 black participants in the Coronary Artery Risk Development in Young Adults (CARDIA) Study to examine associations of racial residential segregation (Gi* statistic) and experiences of racial discrimination with diabetes incidence and management. Multivariable Cox models estimated associations for incident diabetes and GEE logistic regression estimated associations with diabetes management (meeting targets for HbA1c, systolic blood pressure, and LDL cholesterol). Neither segregation nor discrimination were associated with diabetes incidence or management.
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Affiliation(s)
- Stephanie L Mayne
- Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Luigi Loizzo
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Michael P Bancks
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Mercedes R Carnethon
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sharrelle Barber
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - Penny Gordon-Larsen
- Department of Nutrition, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - April P Carson
- Department of Epidemiology, University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA
| | - Pamela J Schreiner
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Anne E Bantle
- Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Kara M Whitaker
- Department of Health and Human Physiology, University of Iowa College of Liberal Arts and Sciences, Iowa City, IA, USA
| | - Kiarri N Kershaw
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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9
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Lin CY, Cheung MKT, Hung ATF, Poon PKK, Chan SCC, Chan CCH. Can a modified theory of planned behavior explain the effects of empowerment education for people with type 2 diabetes? Ther Adv Endocrinol Metab 2020; 11:2042018819897522. [PMID: 31934326 PMCID: PMC6945455 DOI: 10.1177/2042018819897522] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 12/07/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The effectiveness of the Patient Empowerment Program (PEP) has been demonstrated in people with diabetes mellitus (DM); however, the underlying reasons for its effectiveness remain unclear. To improve effectiveness, we need to study the psychological mechanism(s) of PEP to understand why it is effective. This study hypothesized that the Theory of Planned Behavior (TPB), modified specifically for people with DM, could describe the mechanism explaining PEP effects. METHODS A longitudinal design was used. Patients with type 2 DM (n = 365; 151 males; mean age = 62.9 ± 9.6 years) received two education sessions (i.e. seminars delivered by registered nurses to provide disease-specific knowledge), and some (n = 210) further enrolled afterwards in five empowerment sessions (i.e. small-group interactive workshops conducted by social workers to practice action planning, problem solving, and experience sharing). Validated questionnaires were used to measure risk perception, health literacy, attitude, subjective norm, perceived behavioral control and behavioral intention on diabetes self-care behaviors, and four diabetes self-care behaviors (diet control, exercise, blood glucose monitoring, and foot care) at baseline. Three months later (i.e. at the end of PEP), all participants completed the behavioral intention and diabetes self-care behaviors measures again. Attitude, subjective norm, perceived behavioral control, behavioral intention, and diabetes self-care behaviors were assessed to represent the TPB constructs. Risk perception and health literacy elements relevant to people with DM were assessed and added to modify the TPB. RESULTS The behavioral intention was associated with three diabetes self-care behaviors: exercise, blood glucose monitoring, and foot care. The behavioral intention was found to be a significant mediator in the following relationships: empowerment session participation and exercise (β = 0.045, p = 0.04), and empowerment session participation and foot care (β = 0.099, p < 0.001). CONCLUSIONS The effects of enrollment of empowerment sessions in PEP on exercise and foot care were likely to be mediated through behavioral intention.
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Affiliation(s)
- Chung-Ying Lin
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | | | | | | | - Sam C. C. Chan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Chetwyn C. H. Chan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
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10
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Kim D, Li AA, Cholankeril G, Kim SH, Ingelsson E, Knowles JW, Harrington RA, Ahmed A. Trends in overall, cardiovascular and cancer-related mortality among individuals with diabetes reported on death certificates in the United States between 2007 and 2017. Diabetologia 2019; 62:1185-1194. [PMID: 31011776 PMCID: PMC7063897 DOI: 10.1007/s00125-019-4870-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 03/14/2019] [Indexed: 01/09/2023]
Abstract
AIMS/HYPOTHESIS The determination of diabetes as underlying cause of death by using the death certificate may result in inaccurate estimation of national mortality attributed to diabetes, because individuals who die with diabetes generally have other conditions that may contribute to their death. We investigated the trends in age-standardised mortality due to diabetes as underlying or contributing cause of death and cause-specific mortality from cardiovascular disease (CVD), complications of diabetes and cancer among individuals with diabetes listed on death certificates in the USA from 2007 to 2017. METHODS Using the US Census and national mortality database, we calculated age-standardised mortality due to diabetes as underlying or contributing cause of death and cause-specific mortality rates among adults over 20 years with diabetes listed on death certificates. A total of 2,686,590 deaths where diabetes was underlying or contributing cause of death were analysed. We determined temporal mortality rate patterns by joinpoint regression analysis with estimates of annual percentage change (APC). RESULTS Age-standardised diabetes mortality rates compared among underlying cause of death, contributing cause of death and all-cause mortality were 32.2 vs 75.7 vs 105.1 per 100,000 individuals during the study period. The age-standardised mortality rates due to diabetes as underlying or contributing cause of death declined from 112.2 per 100,000 individuals in 2007 to 104.3 per 100,000 individuals in 2017 with the most pronounced decline noted from 2007 to 2014 (APC -1.4%; 95% CI -1.9%, -1.0%) and stabilisation in decline from 2014 to 2017 (APC 1.1%; 95% CI -0.6%, 2.8%). In terms of cause-specific mortality among individuals with diabetes listed on death certificates, the age-standardised mortality rates for CVD declined at an annual rate of 1.2% with a marked decline of 2.3% between 2007 and 2014. Age-standardised diabetes-specific mortality rates as underlying cause of death decreased from 2007 to 2009 (APC -4.5%) and remained stable from 2009 to 2017. Age-standardised mortality rates for cancer steadily decreased with an average APC of -1.4% (95% CI -1.8%, -1.0%) during the 11-year period. Mortality in the subcategory of CVD demonstrated significant differences. CONCLUSIONS/INTERPRETATION Current national estimates capture about 30% of all-cause mortality among individuals with diabetes listed as underlying or contributing cause of death on death certificates. The age-standardised mortality due to diabetes as underlying or contributing cause of death and cause-specific mortality from CVD in individuals with diabetes listed as underlying or contributing cause of death plateaued from 2014 onwards except for hypertensive heart disease and heart failure.
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Affiliation(s)
- Donghee Kim
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 750 Welch Road no. 210, Palo Alto, CA, 94304, USA
| | - Andrew A Li
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - George Cholankeril
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 750 Welch Road no. 210, Palo Alto, CA, 94304, USA
| | - Sun H Kim
- Division of Endocrinology, Gerontology and Metabolism, Stanford University School of Medicine, Stanford, CA, USA
| | - Erik Ingelsson
- Cardiovascular Medicine and Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
- Stanford Diabetes Research Center, Stanford University School of Medicine, Stanford, CA, USA
| | - Joshua W Knowles
- Cardiovascular Medicine and Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
- Stanford Diabetes Research Center, Stanford University School of Medicine, Stanford, CA, USA
| | - Robert A Harrington
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Aijaz Ahmed
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 750 Welch Road no. 210, Palo Alto, CA, 94304, USA.
- Stanford Diabetes Research Center, Stanford University School of Medicine, Stanford, CA, USA.
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11
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Kolak M, Abraham G, Talen MR. Mapping Census Tract Clusters of Type 2 Diabetes in a Primary Care Population. Prev Chronic Dis 2019; 16:E59. [PMID: 31095922 PMCID: PMC6549437 DOI: 10.5888/pcd16.180502] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
| | - Geethi Abraham
- McGaw Medical Center of Northwestern University, 710 N Lake Shore Dr, Abbott Hall, 4th Floor, Chicago, IL 60611-2909. .,Erie Family Health Center, Chicago, Illinois
| | - Mary R Talen
- McGaw Medical Center of Northwestern University, Chicago, Illinois.,Erie Family Health Center, Chicago, Illinois
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Lange-Maia BS, De Maio F, Avery EF, Lynch EB, Laflamme EM, Ansell DA, Shah RC. Association of community-level inequities and premature mortality: Chicago, 2011-2015. J Epidemiol Community Health 2018; 72:1099-1103. [PMID: 30171083 DOI: 10.1136/jech-2018-210916] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 07/31/2018] [Accepted: 08/05/2018] [Indexed: 11/04/2022]
Abstract
BACKGROUND Substantial disparities in life expectancy exist between Chicago's 77 defined community areas, ranging from approximately 69 to 85 years. Prior work in New York City and Boston has shown that community-level racial and economic segregation as measured by the Index of Concentration at the Extremes (ICE) is strongly related to premature mortality. This novel metric allows for the joint assessment of area-based income and racial polarisation. This study aimed to assess the relationships between racial and economic segregation and economic hardship with premature mortality in Chicago. METHODS Annual age-adjusted premature mortality rates (deaths <65 years) from 2011 to 2015 were calculated for Chicago's 77 community areas. ICE measures for household income (<US$25 000 vs ≥US$100 000), race (black vs non-Hispanic white), combined ICE measure incorporating income and race, and hardship index were calculated from 2015 American Community Survey 5-year estimates. RESULTS Average annual premature mortality rates ranged from 94 (95% CI 61 to 133) deaths per 100 000 population age <65 to 699 (95% CI 394 to 1089). Compared with the highest ICE quintiles, communities in the lowest quintiles had significantly higher rates of premature mortality (ICEIncomerate ratio (RR)=3.06, 95% CI 2.51 to 3.73; ICERaceRR=3.07, 95% CI 2.62 to 3.58; ICEIncome+RaceRR=3.27, 95% CI 2.84 to 3.77). Similarly, compared with communities in the lowest hardship index quintile, communities in the highest quintile had significantly higher premature mortality rates (RR=2.79, 95% CI 2.18 to 3.57). CONCLUSIONS The strong relationships observed between ICE measures and premature mortality-particularly the combined ICE metric encompassing race and income-support the use of ICE in public health monitoring.
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Affiliation(s)
- Brittney S Lange-Maia
- Center for Community Health Equity, Rush University Medical Center, Chicago, Illinois, USA.,Department of Preventive Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Fernando De Maio
- Center for Community Health Equity, DePaul University, Chicago, Illinois, USA.,Department of Sociology, DePaul University, Chicago, Illinois, USA
| | - Elizabeth F Avery
- Center for Community Health Equity, Rush University Medical Center, Chicago, Illinois, USA.,Department of Preventive Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Elizabeth B Lynch
- Center for Community Health Equity, Rush University Medical Center, Chicago, Illinois, USA.,Department of Preventive Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Emily M Laflamme
- Office of Epidemiology, Chicago Department of Public Health, City of Chicago, Chicago, Illinois, USA
| | - David A Ansell
- Center for Community Health Equity, Rush University Medical Center, Chicago, Illinois, USA.,Department of Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Raj C Shah
- Center for Community Health Equity, Rush University Medical Center, Chicago, Illinois, USA.,Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA.,Department of Family Medicine, Rush University Medical Center, Chicago, Illinois, USA
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Bravo MA, Anthopolos R, Kimbro RT, Miranda ML. Residential Racial Isolation and Spatial Patterning of Type 2 Diabetes Mellitus in Durham, North Carolina. Am J Epidemiol 2018; 187:1467-1476. [PMID: 29762649 DOI: 10.1093/aje/kwy026] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 02/01/2018] [Indexed: 12/17/2022] Open
Abstract
Neighborhood characteristics such as racial segregation may be associated with type 2 diabetes mellitus, but studies have not examined these relationships using spatial models appropriate for geographically patterned health outcomes. We constructed a local, spatial index of racial isolation (RI) for black residents in a defined area, measuring the extent to which they are exposed only to one another, to estimate associations of diabetes with RI and examine how RI relates to spatial patterning in diabetes. We obtained electronic health records from 2007-2011 from the Duke Medicine Enterprise Data Warehouse. Patient data were linked to RI based on census block of residence. We used aspatial and spatial Bayesian models to assess spatial variation in diabetes and relationships with RI. Compared with spatial models with patient age and sex, residual geographic heterogeneity in diabetes in spatial models that also included RI was 29% and 24% lower for non-Hispanic white and black residents, respectively. A 0.20-unit increase in RI was associated with an increased risk of diabetes for white (risk ratio = 1.24, 95% credible interval: 1.17, 1.31) and black (risk ratio = 1.07, 95% credible interval: 1.05, 1.10) residents. Improved understanding of neighborhood characteristics associated with diabetes can inform development of policy interventions.
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Affiliation(s)
| | - Rebecca Anthopolos
- Children’s Environmental Health Initiative, Rice University, Houston, Texas
| | | | - Marie Lynn Miranda
- Department of Statistics, Rice University, Houston, Texas
- Children’s Environmental Health Initiative, Rice University, Houston, Texas
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14
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Saffari M, Lin CY, O’Garo K, Koenig HG, Sanaeinasab H, Pakpour AH. Psychometric properties of Persian Diabetes-Mellitus Specific Quality of Life (DMQoL) questionnaire in a population-based sample of Iranians. Int J Diabetes Dev Ctries 2018. [DOI: 10.1007/s13410-018-0648-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
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Jiang L, Chang J, Beals J, Bullock A, Manson SM. Neighborhood characteristics and lifestyle intervention outcomes: Results from the Special Diabetes Program for Indians. Prev Med 2018; 111:216-224. [PMID: 29534990 PMCID: PMC5930056 DOI: 10.1016/j.ypmed.2018.03.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 03/02/2018] [Accepted: 03/09/2018] [Indexed: 10/17/2022]
Abstract
Growing evidence reveals various neighborhood conditions are associated with the risk of developing type 2 diabetes. It is unknown, however, whether the effectiveness of diabetes prevention interventions is also influenced by neighborhood characteristics. The purpose of the current study is to examine the impact of neighborhood characteristics on the outcomes of a lifestyle intervention to prevent diabetes in American Indians and Alaska Natives (AI/ANs). Year 2000 US Census Tract data were linked with those from the Special Diabetes Program for Indians Diabetes Prevention Program (SDPI-DP), an evidence-based lifestyle intervention implemented in 36 AI/AN grantee sites across the US. A total of 3394 participants started the intervention between 01/01/2006 and 07/31/2009 and were followed by 07/31/2016. In 2016-2017, data analyses were conducted to evaluate the relationships of neighborhood characteristics with intervention outcomes, controlling for individual level socioeconomic status. AI/ANs from sites located in neighborhoods with higher median household income had 38% lower risk of developing diabetes than those from sites with lower neighborhood income (adjusted hazard ratio = 0.65, 95% CI: 0.47-0.90). Further, those from sites with higher neighborhood concentrations of AI/ANs achieved less BMI reduction and physical activity increase. Meanwhile, participants from sites with higher neighborhood level of vehicle occupancy made more improvement in BMI and diet. Lifestyle intervention effectiveness was not optimal when the intervention was implemented at sites with disadvantaged neighborhood characteristics. Meaningful improvements in socioeconomic and other neighborhood disadvantages of vulnerable populations could be important in stemming the global epidemic of diabetes.
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Affiliation(s)
- Luohua Jiang
- Department of Epidemiology, School of Medicine, University of California Irvine, California, United States.
| | - Jenny Chang
- Department of Epidemiology, School of Medicine, University of California Irvine, California, United States
| | - Janette Beals
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Ann Bullock
- Division of Diabetes Treatment and Prevention, Indian Health Service, Rockville, MD, United States
| | - Spero M Manson
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
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16
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Shaikh S, Jagai JS, Ashley C, Zhou S, Sargis RM. Underutilized and Under Threat: Environmental Policy as a Tool to Address Diabetes Risk. Curr Diab Rep 2018; 18:25. [PMID: 29582168 PMCID: PMC6360085 DOI: 10.1007/s11892-018-0993-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
PURPOSE OF REVIEW Diabetes is a burgeoning threat to public health in the USA. Importantly, the burden of diabetes is not equally borne across society with marked disparities based on geography, race/ethnicity, and income. The etiology of global and population-specific diabetes risk remains incompletely understood; however, evidence linking environmental toxicants acting as endocrine-disrupting chemicals (EDCs), such as particulate matter and arsenic, with diabetes suggests that environmental policies could play an important role in diabetes risk reduction. RECENT FINDINGS Evidence suggests that disproportionate exposures to EDCs may contribute to subgroup-specific diabetes risk; however, no federal policies regulate EDCs linked to diabetes based upon diabetogenic potential. Nevertheless, analyses of European Union data indicate that such regulation could reduce diabetes-associated costs and disease burden. Federal laws only regulate EDCs indirectly. The accumulating evidence linking these chemicals with diabetes risk should encourage policymakers to adopt stricter environmental standards that consider both health and economic impacts.
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Affiliation(s)
- Sabina Shaikh
- Program on Global Environment, Social Science Collegiate Division, University of Chicago, Chicago, IL, USA
| | - Jyotsna S Jagai
- Environmental and Occupational Health Sciences Division, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | - Colette Ashley
- Harris School of Public Policy, University of Chicago, Chicago, IL, USA
| | - Shuhan Zhou
- Harris School of Public Policy, University of Chicago, Chicago, IL, USA
| | - Robert M Sargis
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Illinois at Chicago, 835 S. Wolcott; Suite E625, Chicago, IL, 60612, USA.
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Barber S, Diez Roux AV, Cardoso L, Santos S, Toste V, James S, Barreto S, Schmidt M, Giatti L, Chor D. At the intersection of place, race, and health in Brazil: Residential segregation and cardio-metabolic risk factors in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Soc Sci Med 2018; 199:67-76. [DOI: 10.1016/j.socscimed.2017.05.047] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 05/20/2017] [Accepted: 05/23/2017] [Indexed: 10/19/2022]
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18
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Ruiz D, Becerra M, Jagai JS, Ard K, Sargis RM. Disparities in Environmental Exposures to Endocrine-Disrupting Chemicals and Diabetes Risk in Vulnerable Populations. Diabetes Care 2018; 41:193-205. [PMID: 29142003 PMCID: PMC5741159 DOI: 10.2337/dc16-2765] [Citation(s) in RCA: 134] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 09/23/2017] [Indexed: 02/03/2023]
Abstract
Burgeoning epidemiological, animal, and cellular data link environmental endocrine-disrupting chemicals (EDCs) to metabolic dysfunction. Disproportionate exposure to diabetes-associated EDCs may be an underappreciated contributor to disparities in metabolic disease risk. The burden of diabetes is not uniformly borne by American society; rather, this disease disproportionately affects certain populations, including African Americans, Latinos, and low-income individuals. The purpose of this study was to review the evidence linking unequal exposures to EDCs with racial, ethnic, and socioeconomic diabetes disparities in the U.S.; discuss social forces promoting these disparities; and explore potential interventions. Articles examining the links between chemical exposures and metabolic disease were extracted from the U.S. National Library of Medicine for the period of 1966 to 3 December 2016. EDCs associated with diabetes in the literature were then searched for evidence of racial, ethnic, and socioeconomic exposure disparities. Among Latinos, African Americans, and low-income individuals, numerous studies have reported significantly higher exposures to diabetogenic EDCs, including polychlorinated biphenyls, organochlorine pesticides, multiple chemical constituents of air pollution, bisphenol A, and phthalates. This review reveals that unequal exposure to EDCs may be a novel contributor to diabetes disparities. Efforts to reduce the individual and societal burden of diabetes should include educating clinicians on environmental exposures that may increase disease risk, strategies to reduce those exposures, and social policies to address environmental inequality as a novel source of diabetes disparities.
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Affiliation(s)
- Daniel Ruiz
- Committee on Molecular Metabolism and Nutrition, University of Chicago, Chicago, IL
| | - Marisol Becerra
- College of Food, Agricultural, and Environmental Sciences, School of Environment and Natural Resources, Ohio State University, Columbus, OH
| | - Jyotsna S Jagai
- Environmental and Occupational Health Sciences Division, School of Public Health, University of Illinois at Chicago, Chicago, IL
| | - Kerry Ard
- College of Food, Agricultural, and Environmental Sciences, School of Environment and Natural Resources, Ohio State University, Columbus, OH
| | - Robert M Sargis
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Illinois at Chicago, Chicago, IL
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Abstract
Persistent racial/ethnic disparities in obesity and type 2 diabetes mellitus seen in the US are likely due to a combination of social, biological, and environmental factors. A growing number of studies have examined the role of racial/ethnic residential segregation with respect to these outcomes because this macro-level process is believed to be a fundamental cause of many of the factors that contribute to these disparities. This review provides an overview of findings from studies of racial/ethnic residential segregation with obesity and diabetes published between 2013 and 2015. Findings for obesity varied by geographic scale of the segregation measure, gender, ethnicity, and racial identity (among Hispanics/Latinos). Recent studies found no association between racial/ethnic residential segregation and diabetes prevalence, but higher segregation of Blacks was related to higher diabetes mortality. Implications of these recent studies are discussed as well as promising areas of future research.
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Affiliation(s)
- Kiarri N Kershaw
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N Lake Shore, Suite 1400, Chicago, IL, 60611, USA.
| | - Ashley E Pender
- Department of Medicine, Northwestern University Feinberg School of Medicine, 251 E Huron St, Galter Suite 3-150, Chicago, IL, 60611, USA
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20
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Ethnic Enclaves and Type II Diabetes: a Focus on Latino/Hispanic Americans. CURRENT CARDIOVASCULAR RISK REPORTS 2016. [DOI: 10.1007/s12170-016-0518-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Nelson LA, Mayberry LS, Wallston K, Kripalani S, Bergner EM, Osborn CY. Development and Usability of REACH: A Tailored Theory-Based Text Messaging Intervention for Disadvantaged Adults With Type 2 Diabetes. JMIR Hum Factors 2016; 3:e23. [PMID: 27609738 PMCID: PMC5034151 DOI: 10.2196/humanfactors.6029] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 08/11/2016] [Accepted: 08/21/2016] [Indexed: 12/22/2022] Open
Abstract
Background Among adults with type 2 diabetes mellitus (T2DM), adherence to recommended self-care activities is suboptimal, especially among racial and ethnic minorities with low income. Self-care nonadherence is associated with having worse glycemic control and diabetes complications. Text messaging interventions are improving the self-care of adults with T2DM, but few have been tested with disadvantaged populations. Objective To develop Rapid Education/Encouragement And Communications for Health (REACH), a tailored, text messaging intervention to support the self-care adherence of disadvantaged patients with T2DM, based on the Information-Motivation-Behavioral skills model. We then tested REACH’s usability to make improvements before evaluating its effects. Methods We developed REACH’s content and functionality using an empirical and theory-based approach, findings from a previously pilot-tested intervention, and the expertise of our interdisciplinary research team. We recruited 36 adults with T2DM from Federally Qualified Health Centers to participate in 1 of 3 rounds of usability testing. For 2 weeks, participants received daily text messages assessing and promoting self-care, including tailored messages addressing users’ unique barriers to adherence, and weekly text messages with adherence feedback. We analyzed quantitative and qualitative user feedback and system-collected data to improve REACH. Results Participants were, on average, 52.4 (SD 9.5) years old, 56% (20/36) female, 63% (22/35) were a racial or ethnic minority, and 67% (22/33) had an income less than US $35,000. About half were taking insulin, and average hemoglobin A1c level was 8.2% (SD 2.2%). We identified issues (eg, user concerns with message phrasing, technical restrictions with responding to assessment messages) and made improvements between testing rounds. Overall, participants favorably rated the ease of understanding (mean 9.6, SD 0.7) and helpfulness (mean 9.3, SD 1.4) of self-care promoting text messages on a scale of 1-10, responded to 96% of assessment text messages, and rated the helpfulness of feedback text messages 8.5 (SD 2.7) on a scale of 1-10. User feedback led to refining our study enrollment process so that users understood the flexibility in message timing and that computers, not people, send the messages. Furthermore, research assistants’ feedback on the enrollment process helped improve participants’ engagement with study procedures. Conclusions Testing technology-delivered interventions with disadvantaged adults revealed preferences and concerns unique to this population. Through iterative testing and multiple data sources, we identified and responded to users’ intervention preferences, technical issues, and shortcomings in our research procedures.
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Affiliation(s)
- Lyndsay A Nelson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
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Racial Disparities in Prostate Cancer Mortality in the 50 Largest US Cities. Cancer Epidemiol 2016; 44:125-131. [PMID: 27566470 DOI: 10.1016/j.canep.2016.07.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 07/27/2016] [Accepted: 07/31/2016] [Indexed: 01/04/2023]
Abstract
INTRODUCTION This paper presents race-specific prostate cancer mortality rates and the corresponding disparities for the largest cities in the US over two decades. METHODS The 50 largest cities in the US were the units of analysis. Data from two 5-year periods were analyzed: 1990-1994 and 2005-2009. Numerator data were abstracted from national death files where the cause was malignant neoplasm of prostate (prostate cancer) (ICD9=185 and ICD10=C61). Population-based denominators were obtained from US Census data. To measure the racial disparity, we calculated non-Hispanic Black: non-Hispanic White rate ratios (RRs), rate differences (RDs), and corresponding confidence intervals for each 5-year period. We also calculated correlation and unadjusted regression coefficients for 11 city-level variables, such as segregation and median income, and the RDs. RESULTS At the final time point (2005-2009), the US and all 41 cities included in the analyses had a RR greater than 1 (indicating that the Black rate was higher than the White rate) (range=1.13 in Minneapolis to 3.24 in Los Angeles), 37 of them statistically significantly so. The US and 26 of the 41 cities saw an increase in the Black:White RR between the time points. The level of disparity within a city was associated with the degree of Black segregation. CONCLUSION This analysis revealed large disparities in Black:White prostate cancer mortality in the US and many of its largest cities over the past two decades. The data show considerable variation in the degree of disparity across cities, even among cities within the same state. This type of specific city-level data can be used to motivate public health professionals, government officials, cancer control agencies, and community-based organizations in cities with large or increasing disparities to demand more resources, focus research efforts, and implement effective policy and programmatic changes in order to combat this highly prevalent condition.
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Rawshani A, Svensson AM, Rosengren A, Eliasson B, Gudbjörnsdottir S. Impact of Socioeconomic Status on Cardiovascular Disease and Mortality in 24,947 Individuals With Type 1 Diabetes. Diabetes Care 2015; 38:1518-27. [PMID: 25972573 DOI: 10.2337/dc15-0145] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 03/28/2015] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Socioeconomic status (SES) is a powerful predictor of cardiovascular disease (CVD) and death. We examined the association in a large cohort of patients with type 1 diabetes. RESEARCH DESIGN AND METHODS Clinical data from the Swedish National Diabetes Register were linked to national registers, whereby information on income, education, marital status, country of birth, comorbidities, and events was obtained. Patients were followed until a first incident event, death, or end of follow-up. The association between socioeconomic variables and the outcomes was modeled using Cox regression, with rigorous covariate adjustment. RESULTS We included 24,947 patients. Mean (SD) age and follow-up was 39.1 (13.9) and 6.0 (1.0) years. Death and fatal/nonfatal CVD occurred in 926 and 1378 individuals. Compared with being single, being married was associated with 50% lower risk of death, cardiovascular (CV) death, and diabetes-related death. Individuals in the two lowest quintiles had twice as great a risk of fatal/nonfatal CVD, coronary heart disease, and stroke and roughly three times as great a risk of death, diabetes-related death, and CV death as individuals in the highest income quintile. Compared with having ≤9 years of education, individuals with a college/university degree had 33% lower risk of fatal/nonfatal stroke. Immigrants had 19%, 33%, and 45% lower risk of fatal/nonfatal CVD, all-cause death, and diabetes-related death, respectively, compared with Swedes. Men had 44%, 63%, and 29% greater risk of all-cause death, CV death, and diabetes-related death. CONCLUSIONS Low SES increases the risk of CVD and death by a factor of 2-3 in type 1 diabetes.
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Affiliation(s)
- Araz Rawshani
- Sahlgrenska University Hospital, Gothenburg, Sweden Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Ann-Marie Svensson
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden National Diabetes Register, Centre of Registers, Gothenburg, Sweden
| | - Annika Rosengren
- Sahlgrenska University Hospital, Gothenburg, Sweden Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Björn Eliasson
- Sahlgrenska University Hospital, Gothenburg, Sweden Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Soffia Gudbjörnsdottir
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden National Diabetes Register, Centre of Registers, Gothenburg, Sweden
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Abstract
A growing body of research has examined whether racial/ethnic residential segregation contributes to health disparities, but recent findings in the literature, particularly with respect to cardiovascular disease (CVD) risk, have not been summarized. This review provides an overview of findings from studies of racial/ethnic residential segregation of non-Hispanic blacks and Hispanics with CVD risk published between January 2011 and July 2014. The majority of studies of black segregation showed higher segregation was related to higher CVD risk, although relationships were less clear for certain outcomes. Relationships among Hispanics were more mixed and appeared to vary widely by factors such as gender, country of origin, racial identity, and acculturation. Implications for research on racial/ethnic disparities in CVD and lingering gaps in the literature are discussed as well.
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Ivanov LL, Wallace DC, Hernández C, Hyde Y. Diabetes risks and health literacy in southern African American and Latino women. J Community Health Nurs 2015; 32:12-23. [PMID: 25674971 PMCID: PMC4666304 DOI: 10.1080/07370016.2015.991664] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Minority women experience health disparities, especially related to diabetes. The purpose of this article is to examine diabetes risk in minority women. A survey design was used to recruit 52 African Americans (AA) and 48 Latina women. Participants described their health, health behaviors, and health literacy. Blood pressure and body mass index were measured. AA women had more diabetes risks than Latinas, and older women had more risks than younger women. All of the women had low health literacy. Women with higher numbers of diabetes risks had lower health literacy. Findings can be used to develop diabetes prevention and education programs.
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Affiliation(s)
- L Louise Ivanov
- a University of North Carolina at Greensboro , School of Nursing , Greensboro , North Carolina
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