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Pearson TA, Vitalis D, Pratt C, Campo R, Armoundas AA, Au D, Beech B, Brazhnik O, Chute CG, Davidson KW, Diez-Roux AV, Fine LJ, Gabriel D, Groenveld P, Hall J, Hamilton AB, Hu H, Ji H, Kind A, Kraus WE, Krumholz H, Mensah GA, Merchant RM, Mozaffarian D, Murray DM, Neumark-Sztainer D, Petersen M, Goff D. The Science of Precision Prevention: Research Opportunities and Clinical Applications to Reduce Cardiovascular Health Disparities. JACC Adv 2024; 3:100759. [PMID: 38375059 PMCID: PMC10876066 DOI: 10.1016/j.jacadv.2023.100759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
Precision prevention embraces personalized prevention but includes broader factors such as social determinants of health to improve cardiovascular health. The quality, quantity, precision, and diversity of data relatable to individuals and communities continue to expand. New analytical methods can be applied to these data to create tools to attribute risk, which may allow a better understanding of cardiovascular health disparities. Interventions using these analytic tools should be evaluated to establish feasibility and efficacy for addressing cardiovascular disease disparities in diverse individuals and communities. Training in these approaches is important to create the next generation of scientists and practitioners in precision prevention. This state-of-the-art review is based on a workshop convened to identify current gaps in knowledge and methods used in precision prevention intervention research, discuss opportunities to expand trials of implementation science to close the health equity gaps, and expand the education and training of a diverse precision prevention workforce.
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Affiliation(s)
- Thomas A. Pearson
- College of Medicine and College of Public Health and Health Professions, University of Florida Health Science Center, Gainesville, Florida, USA
| | - Debbie Vitalis
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Charlotte Pratt
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Rebecca Campo
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Antonis A. Armoundas
- Cardiovascular Research Center, Massachusetts General Hospital and Broad Institute, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - David Au
- Center of Innovation for Veteran-Centered and Value-Driven Care, University of Washington, Seattle, Washington, USA
| | - Bettina Beech
- UH Population Health, University of Houston, Houston, Texas, USA
| | - Olga Brazhnik
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Christopher G. Chute
- Johns Hopkins Medicine, Institute for Clinical and Translational Research, Baltimore, Maryland, USA
| | - Karina W. Davidson
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, New Hyde Park, New York, USA
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA
| | - Ana V. Diez-Roux
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, Pennsylvania, USA
| | - Lawrence J. Fine
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Davera Gabriel
- Biomedical Informatics and Data Science Section, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Peter Groenveld
- Center for Health Care Transformation and Innovation, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Jaclyn Hall
- Department of Health Outcomes and Biomedical Informatics, Institute for Child Health Policy, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Alison B. Hamilton
- Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Hui Hu
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Heng Ji
- Department of Computer Science, University of Illinois Urbana-Champaign, Champaign, Illinois, USA
| | - Amy Kind
- Center for Health Disparities Research (CHDR), University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - William E. Kraus
- Duke Molecular Physiology Institute, School of Medicine, Duke University, Durham, North Carolina, USA
| | - Harlan Krumholz
- Institute for Social and Policy Studies, of Investigative Medicine and of Public Health (Health Policy), Yale University, New Haven, Connecticut, USA
| | - George A. Mensah
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Raina M. Merchant
- Center for Health Care Transformation and Innovation, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science & Policy, Tufts University, Medford, Massachusetts, USA
| | - David M. Murray
- Office of Disease Prevention, National Institutes of Health, Bethesda, Maryland, USA
| | - Dianne Neumark-Sztainer
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Maya Petersen
- Division of Biostatistics, and UCSF-UC Berkeley Program in Computational Precision Health, School of Public Health, University of California-Berkeley, Berkeley, California, USA
- University of California-San Francisco, San Francisco, California, USA
| | - David Goff
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
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Watkins SH, Testa C, Simpkin AJ, Smith GD, Coull B, De Vivo I, Tilling K, Waterman PD, Chen JT, Diez-Roux AV, Krieger N, Suderman M, Relton C. An epigenome-wide analysis of DNA methylation, racialized and economic inequities, and air pollution. bioRxiv 2023:2023.12.07.570610. [PMID: 38105971 PMCID: PMC10723401 DOI: 10.1101/2023.12.07.570610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Importance DNA methylation (DNAm) provides a plausible mechanism by which adverse exposures become embodied and contribute to health inequities, due to its role in genome regulation and responsiveness to social and biophysical exposures tied to societal context. However, scant epigenome-wide association studies (EWAS) have included structural and lifecourse measures of exposure, especially in relation to structural discrimination. Objective Our study tests the hypothesis that DNAm is a mechanism by which racial discrimination, economic adversity, and air pollution become biologically embodied. Design A series of cross-sectional EWAS, conducted in My Body My Story (MBMS, biological specimens collected 2008-2010, DNAm assayed in 2021); and the Multi Ethnic Study of Atherosclerosis (MESA; biological specimens collected 2010-2012, DNAm assayed in 2012-2013); using new georeferenced social exposure data for both studies (generated in 2022). Setting MBMS was recruited from four community health centers in Boston; MESA was recruited from four field sites in: Baltimore, MD; Forsyth County, NC; New York City, NY; and St. Paul, MN. Participants Two population-based samples of US-born Black non-Hispanic (Black NH), white non-Hispanic (white NH), and Hispanic individuals (MBMS; n=224 Black NH and 69 white NH) and (MESA; n=229 Black NH, n=555 white NH and n=191 Hispanic). Exposures Eight social exposures encompassing racial discrimination, economic adversity, and air pollution. Main outcome Genome-wide changes in DNAm, as measured using the Illumina EPIC BeadChip (MBMS; using frozen blood spots) and Illumina 450k BeadChip (MESA; using purified monocytes). Our hypothesis was formulated after data collection. Results We observed the strongest associations with traffic-related air pollution (measured via black carbon and nitrogen oxides exposure), with evidence from both studies suggesting that air pollution exposure may induce epigenetic changes related to inflammatory processes. We also found suggestive associations of DNAm variation with measures of structural racial discrimination (e.g., for Black NH participants, born in a Jim Crow state; adult exposure to racialized economic residential segregation) situated in genes with plausible links to effects on health. Conclusions and Relevance Overall, this work suggests that DNAm is a biological mechanism through which structural racism and air pollution become embodied and may lead to health inequities.
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Affiliation(s)
- Sarah Holmes Watkins
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Christian Testa
- Department of Social and Behavioral Sciences, Harvard T H Chan School of Public Health, Harvard University, Boston, MA 02115, USA
- Department of Biostatistics, Harvard School of Public Health, Boston, MA 02115, USA
| | - Andrew J. Simpkin
- School of Mathematical and Statistical Sciences, University of Galway, Galway, Ireland
| | - George Davey Smith
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Brent Coull
- Department of Biostatistics, Harvard School of Public Health, Boston, MA 02115, USA
| | - Immaculata De Vivo
- Program in Genetic Epidemiology and Statistical Genetics, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Kate Tilling
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Pamela D. Waterman
- Department of Social and Behavioral Sciences, Harvard T H Chan School of Public Health, Harvard University, Boston, MA 02115, USA
| | - Jarvis T. Chen
- Department of Social and Behavioral Sciences, Harvard T H Chan School of Public Health, Harvard University, Boston, MA 02115, USA
| | - Ana V. Diez-Roux
- Department of Epidemiology and Biostatistics and Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, USA
| | - Nancy Krieger
- Department of Social and Behavioral Sciences, Harvard T H Chan School of Public Health, Harvard University, Boston, MA 02115, USA
| | - Matthew Suderman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Caroline Relton
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Coelho DM, de Souza Andrade AC, Silva UM, Lazo M, Slesinski SC, Quistberg A, Diez-Roux AV, de Lima Friche AA, Caiaffa WT. Gender differences in the association of individual and contextual socioeconomic status with hypertension in 230 Latin American cities from the SALURBAL study: a multilevel analysis. BMC Public Health 2023; 23:1532. [PMID: 37568082 PMCID: PMC10416382 DOI: 10.1186/s12889-023-16480-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 08/08/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Despite global interest in gender disparities and social determinants of hypertension, research in urban areas and regions with a high prevalence of hypertension, such as Latin America, is very limited. The objective of this study was to examine associations of individual- and area-level socioeconomic status with hypertension in adults living in 230 cities in eight Latin America countries. METHODS In this cross-sectional study, we used harmonized data from 109,184 adults (aged 18-97 years) from the SALURBAL (Salud Urbana en America Latina/Urban Health in Latin America) project. Hypertension was assessed by self-report. Individual-, sub-city- and city-level education were used as proxies of socioeconomic status. All models were stratified by gender. RESULTS Higher individual-level education was associated with lower odds of hypertension among women (university education or higher versus lower than primary: odds ratio [OR] = 0.67, 95% confidence interval [CI] = 0.61-0.74) but higher odds among men (OR = 1.65; 95%CI 1.47-1.86), although in men an inverse association emerged when measured blood pressure was used (OR = 0.86; 95%CI 0.76-0.97). For both genders, living in sub-city areas with higher educational achievement was associated with higher odds of hypertension (OR per standard deviation [SD] = 1.07, 95%CI = 1.02-1.12; OR = 1.11 per SD, 95%CI = 1.05-1.18, for women and men, respectively). The association of city-level education with hypertension varied across countries. In Peru, there was an inverse association (higher city level education was associated with lower odds of hypertension) in women and men, but in other countries no association was observed. In addition, the inverse association of individual-level education with hypertension became stronger (in women) or emerged (in men) as city or sub-city education increased. CONCLUSION The social patterning of hypertension differs by gender and by the level of analysis highlighting the importance of context- and gender-sensitive approaches and policies to reduce the prevalence of hypertension in Latin America.
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Affiliation(s)
- Débora Moraes Coelho
- Faculty of Medicine, Federal University of Minas Gerais, Avenida Alfredo Balena 190, Belo Horizonte, 30130-100, Brazil.
- Belo Horizonte Observatory for Urban Health, Avenida Alfredo Balena 190, Belo Horizonte, 30130-100, Brazil.
| | - Amanda Cristina de Souza Andrade
- Belo Horizonte Observatory for Urban Health, Avenida Alfredo Balena 190, Belo Horizonte, 30130-100, Brazil
- Institute of Public Health, Federal University of Mato Grosso, Avenida Fernando Corrêa 2367, Cuiabá, 78060-900, Brazil
| | - Uriel Moreira Silva
- Faculty of Medicine, Federal University of Minas Gerais, Avenida Alfredo Balena 190, Belo Horizonte, 30130-100, Brazil
- Belo Horizonte Observatory for Urban Health, Avenida Alfredo Balena 190, Belo Horizonte, 30130-100, Brazil
| | - Mariana Lazo
- Dornsife School of Public Health, Drexel University, 3215 Market Street, Philadelphia, PA, 19104, USA
| | - S Claire Slesinski
- Dornsife School of Public Health, Drexel University, 3215 Market Street, Philadelphia, PA, 19104, USA
| | - Alex Quistberg
- Dornsife School of Public Health, Drexel University, 3215 Market Street, Philadelphia, PA, 19104, USA
| | - Ana V Diez-Roux
- Dornsife School of Public Health, Drexel University, 3215 Market Street, Philadelphia, PA, 19104, USA
| | - Amélia Augusta de Lima Friche
- Faculty of Medicine, Federal University of Minas Gerais, Avenida Alfredo Balena 190, Belo Horizonte, 30130-100, Brazil
- Belo Horizonte Observatory for Urban Health, Avenida Alfredo Balena 190, Belo Horizonte, 30130-100, Brazil
| | - Waleska Teixeira Caiaffa
- Faculty of Medicine, Federal University of Minas Gerais, Avenida Alfredo Balena 190, Belo Horizonte, 30130-100, Brazil
- Belo Horizonte Observatory for Urban Health, Avenida Alfredo Balena 190, Belo Horizonte, 30130-100, Brazil
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Baldovino-Chiquillo L, Sarmiento OL, O'Donovan G, Wilches-Mogollon MA, Aguilar AF, Florez-Pregonero A, Martínez PA, Arellana J, Guzmán LA, Yamada G, Rodriguez DA, Diez-Roux AV. Effects of an urban cable car intervention on physical activity: the TrUST natural experiment in Bogotá, Colombia. Lancet Glob Health 2023; 11:e1290-e1300. [PMID: 37474235 PMCID: PMC10369015 DOI: 10.1016/s2214-109x(23)00274-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/17/2023] [Accepted: 06/05/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND Cable cars are part of the transport system in several cities in Latin America, but no evaluations of their effects on physical activity are available. TransMiCable is the first cable car in Bogotá, Colombia, and the wider intervention includes renovated parks and playgrounds. We assessed the effects of TransMiCable and the wider intervention on physical activity. METHODS The Urban Transformations and Health natural experiment was a prospective quasi-experimental study conducted from Feb 1, 2018, to Dec 18, 2018 (baseline, pre-intervention) and from July 2, 2019, to March 15, 2020 (post-intervention follow-up) in the TransMiCable intervention area (Ciudad Bolívar settlement) and a control area without TransMiCable (San Cristóbal settlement). A multistage strategy was used to sample households in each area, with one adult (aged ≥18 years) per household invited to participate. Eligible participants had lived in the intervention or control areas for at least 2 years and were not planning to move within the next 2 years. Physical activity was assessed among participants in the intervention and control areas before and after the inauguration of TransMiCable in Ciudad Bolívar with the International Physical Activity Questionnaire (long form) and with wearable accelerometers. Complete cases (those with baseline and follow-up data) were included in analyses. Respondents were classed as being physically active if they met 2020 WHO guidelines (≥150 min per week of moderate activity, ≥75 min per week of vigorous activity, or equivalent combinations); and accelerometery data were classified with the Freedson cut-points for adults. Data were also gathered in zonal parks (area ≥10 000 m2) and neighbourhood parks (area <10 000 m2) in the intervention and control areas by direct observation with the System for Observing Play and Recreation in Communities, to assess levels of physical activity before and after the TransMiCable intervention. Multilevel regression models were used to assess changes in physical activity associated with the TransMiCable intervention. FINDINGS Physical activity questionnaires were completed by 2052 adult participants (1289 [62·8%] women and 763 [37·2%] men; mean age 43·5 years [SD 17·7]) before the inauguration of TransMiCable. After the inauguration, the follow-up (final) questionnaire sample comprised 825 adults in the intervention group and 854 in the control group, including 357 adults in the intervention group and 334 in the control group with valid accelerometery data. 334 (40·5%) of 825 participants in the intervention group reported levels of physical activity that met the 2020 WHO guidelines during walking for transport before the intervention, and 426 (51·6%) afterwards (change 11·1 percentage points [95% CI 6·4 to 15·9]). A similar change was observed in the control group (change 8·0 percentage points [3·4 to 12·5]; adjusted odds ratio [OR] for the time-by-group interaction, intervention vs control group: 1·1 [95% CI 0·8 to 1·5], p=0·38). Time spent doing moderate-to-vigorous physical activity, measured with accelerometers, did not change in the intervention group after the inauguration of TransMiCable (change -0·8 min per day [-4·6 to 3·0]) and did not change compared with the control group (adjusted β for the time-by-group interaction: 1·4 min per day [95% CI -2·0 to 4·9], p=0·41). Moderate-to-vigorous physical activity was 52·1 min per day (SD 24·7) before and 59·4 min per day (35·2) after the inauguration of TransMiCable in new regular users who reported using TransMiCable during mandatory trips for work or education (n=32; change 7·3 min per day [-22·5 to 7·9]). After the intervention, an increase in the proportion of male individuals engaging in moderate or vigorous physical activity was observed in a renovated zonal park (adjusted OR for the time-by-group interaction, intervention vs control park: 2·7 [1·1 to 6·8], p=0·033). Female users of a renovated neighbourhood park were less likely to become engaged in moderate or vigorous physical activity than female users of the control area neighbourhood park (adjusted OR for the time-by-group interaction: 0·4 [0·1 to 0·6], p=0·019). INTERPRETATION It is encouraging that walking for transport remained high in the TransMiCable intervention area when the use of private motorised transport had increased elsewhere in Bogotá. In low-income urban areas, where transport-related walking is a necessity, transport interventions should be focused on efforts to maintain participation in active travel while improving conditions under which it occurs. FUNDING Wellcome Trust (as part of the Urban Health in Latin America project); Bogotá Urban Planning Department; Ministry of Science, Technology, and Innovation of Colombia; Universidad de Los Andes; Fundación Santa Fe de Bogotá; and Universidad del Norte. TRANSLATION For the Spanish translation of the abstract see Supplementary Materials section.
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Affiliation(s)
| | | | - Gary O'Donovan
- School of Medicine, Universidad de los Andes, Bogotá, Colombia; BrainLat, Universidad Adolfo Ibáñez, Santiago, Chile; Instituto Masira, Universidad de Santander, Bucaramanga, Colombia
| | - Maria A Wilches-Mogollon
- School of Medicine, Universidad de los Andes, Bogotá, Colombia; Department of Industrial Engineering, School of Engineering, Universidad de los Andes, Bogotá, Colombia
| | | | | | | | - Julian Arellana
- Department of Civil and Environmental Engineering, Universidad del Norte, Barranquilla, Colombia
| | - Luis A Guzmán
- Grupo de Sostenibilidad Urbana y Regional, Department of Civil and Environmental Engineering, School of Engineering, Universidad de los Andes, Bogotá, Colombia
| | - Goro Yamada
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Daniel A Rodriguez
- Department of City and Regional Planning and Institute for Transportation Studies, University of California Berkeley, Berkeley, CA, USA
| | - Ana V Diez-Roux
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA; Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
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de Lima Friche AA, Silva UM, Bilal U, Sarmiento OL, de Salles Dias MA, Prado-Galbarro FJ, Briceño-León R, Alazraqui M, Diez-Roux AV, Caiaffa WT. Variation in youth and young adult homicide rates and their association with city characteristics in Latin America: the SALURBAL study. Lancet Reg Health Am 2023; 20:100476. [PMID: 36970493 PMCID: PMC10033737 DOI: 10.1016/j.lana.2023.100476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 02/25/2023] [Accepted: 03/07/2023] [Indexed: 03/28/2023]
Abstract
BACKGROUND Latin America and the Caribbean (LAC) is one of the most urbanized and violent regions worldwide. Homicides in youth (15-24 years old, yo) and young adults (25-39yo) are an especially pressing public health problem. Yet there is little research on how city characteristics relate to homicide rates in youth and young adults. We aimed to describe homicide rates among youth and young adults, as well as their association with socioeconomic and built environment factors across 315 cities in eight LAC countries. METHODS This is an ecological study. We estimated homicide rates in youth and young adults for the period 2010-2016. We investigated associations of homicide rates with sub-city education and GDP, Gini, density, landscape isolation, population and population growth using sex-stratified negative binomial models with city and sub-city level random intercepts, and country-level fixed effects. FINDINGS The mean sub-city homicide rate per 100,000 in persons aged 15-24 was 76.9 (SD = 95.9) in male and 6.7 (SD = 8.5) in female, and in persons aged 25-39 was 69.4 (SD = 68.9) in male and 6.0 (SD = 6.7) in female. Rates were higher in Brazil, Colombia, Mexico and El Salvador than in Argentina, Chile, Panama and Peru. There was significant variation in rates across cities and sub-cities, even after accounting for the country. In fully adjusted models, higher sub-city education scores and higher city GDP were associated with a lower homicide rate among male and female (rate ratios (RR) per SD higher value in male and female, respectively, 0.87 (CI 0.84-0.90) and 0.90 (CI 0.86-0.93) for education and 0.87 (CI 0.81-0.92) and 0.92 (CI 0.87-0.97) for GDP). A higher city Gini index was associated with higher homicide rates (RR 1.28 (CI 1.10-1.48) and 1.21 (CI 1.07-1.36) in male and female, respectively). Greater isolation da was also associated with higher homicide rates (RR 1.13 (CI 1.07-1.21) and 1.07 (CI 1.02-1.12) in male and female, respectively). INTERPRETATION City and sub-city factors are associated with homicide rates. Improvements to education, social conditions and inequality and physical integration of cities may contribute to the reduction of homicides in the region. FUNDING The Wellcome Trust [205177/Z/16/Z].
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Affiliation(s)
- Amélia Augusta de Lima Friche
- Observatory for Urban Health in Belo Horizonte, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Department of Speech, Language and Hearing Sciences, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Corresponding author. Observatory for Urban Health in Belo Horizonte, School of Medicine, Federal University of Minas Gerais, Av. Alfredo Balena, 190, sala 730, Belo Horizonte, Minas Gerais, 30190-100, Brazil.
| | - Uriel Moreira Silva
- Observatory for Urban Health in Belo Horizonte, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Usama Bilal
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | | | - Maria Angélica de Salles Dias
- Observatory for Urban Health in Belo Horizonte, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Francisco Javier Prado-Galbarro
- Population Health Research Center, National Institute of Public Health, Cuernavaca, Mexico
- Department of Research, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - Roberto Briceño-León
- Federal University of Ceará, Fortaleza, Brazil & Venezuelan Observatory of Violence, Caracas, Venezuela
| | - Marcio Alazraqui
- Instituto de Salud Colectiva, Universidad Nacional de Lanús, Buenos Aires, Argentina
| | - Ana V. Diez-Roux
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Waleska Teixeira Caiaffa
- Observatory for Urban Health in Belo Horizonte, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Morales-Betancourt R, Wilches-Mogollon MA, Sarmiento OL, Mendez Molano D, Angulo D, Filigrana P, Arellana J, Guzman LA, Garzon G, Gouveia N, Levy P, Diez-Roux AV. Commuter's personal exposure to air pollutants after the implementation of a cable car for public transport: Results of the natural experiment TrUST. Sci Total Environ 2023; 865:160880. [PMID: 36516922 DOI: 10.1016/j.scitotenv.2022.160880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/19/2022] [Accepted: 12/08/2022] [Indexed: 06/17/2023]
Abstract
Commuters in urban settlements are frequently exposed to high concentrations of air pollutants due to their proximity to mobile sources, making exposure to traffic-related air pollutants an important public health issue. Recent trends in urban transport towards zero- and low-tailpipe emission alternatives will likely result in decreased exposure to air pollutants. The TrUST (Urban transformations and health) study offers a unique opportunity to understand the impacts of a new cable car (TransMiCable) in underserved communities within Bogotá, Colombia. The aims of this study are to assess the personal exposure to fine particulate matter (PM2.5), equivalent Black Carbon (eBC), and Carbon Monoxide (CO) in transport micro-environments and to estimate the inhaled dose per trip during mandatory multimodal trips before and after the implementation of the TransMiCable. We collected personal exposure data for Bus-Rapid-Transit (BRT) feeder buses, regular buses, informal transport, pedestrians, and TransMiCable. TransMiCable showed lower exposure concentration compared to BRT feeder and regular buses (PM2.5: 23.6 vs. 87.0 μg m-3 (P ≤ 0.001) and eBC: 5.2 vs. 28.2 μg m-3 (P ≤ 0.001), respectively). The mean concentration of PM2.5 and eBC inside the TransMiCable cabins were 62 % and 82 % lower than the mean concentrations in buses. Furthermore, using a Monte Carlo simulation model, we found that including the TransMiCable as a feeder is related to a 54.4 μg/trip reduction in PM2.5 inhaled dose and 35.8 μg/trip in eBC per trip. Those changes represent a 27 % and 34 % reduction in an inhaled dose per trip, respectively. Our results show that PM2.5, eBC, and CO inhaled dose for TransMiCable users is reduced due to lower exposure concentration inside its cabins and shorter travel time. The implementation of a cable car in Bogotá is likely to reduce air pollution exposure in transport micro-environments used by vulnerable populations living in semi-informal settlements.
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Affiliation(s)
- Ricardo Morales-Betancourt
- Department of Civil and Environmental Engineering, School of Engineering, Universidad de Los Andes, Cra 1 18ª-12, Bogotá, Colombia.
| | - Maria A Wilches-Mogollon
- Department of Industrial Engineering, School of Engineering, Universidad de Los Andes, Cra 1 18ª-12, Bogotá, Colombia
| | - Olga L Sarmiento
- School of Medicine, Universidad de Los Andes, Cra 1 18ª-12, Bogotá, Colombia
| | - Daniela Mendez Molano
- Department of Civil and Environmental Engineering, School of Engineering, Universidad de Los Andes, Cra 1 18ª-12, Bogotá, Colombia; Universidad Manuela Beltrán, Unidad de Ingenieria Ambiental, Cra. 1 #No. 60-00, Bogotá, Colombia
| | - Daniela Angulo
- Department of Industrial Engineering, School of Engineering, Universidad de Los Andes, Cra 1 18ª-12, Bogotá, Colombia
| | - Paola Filigrana
- School of Medicine, Universidad de Los Andes, Cra 1 18ª-12, Bogotá, Colombia
| | - Julian Arellana
- Department of Civil and Environmental Engineering, College of Engineering, Universidad del Norte, Barranquilla, Colombia
| | - Luis A Guzman
- Department of Civil and Environmental Engineering, School of Engineering, Universidad de Los Andes, Cra 1 18ª-12, Bogotá, Colombia
| | - Gabriela Garzon
- Department of Industrial Engineering, School of Engineering, Universidad de Los Andes, Cra 1 18ª-12, Bogotá, Colombia
| | - Nelson Gouveia
- Department of Preventive Medicine, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Paul Levy
- School of Medicine, Universidad de Los Andes, Cra 1 18ª-12, Bogotá, Colombia
| | - Ana V Diez-Roux
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States; Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States
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7
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Zierath R, Claggett B, Hall ME, Correa A, Barber S, Gao Y, Talegawkar S, Ezekwe EI, Tucker K, Diez-Roux AV, Sims M, Shah AM. Measures of Food Inadequacy and Cardiovascular Disease Risk in Black Individuals in the US From the Jackson Heart Study. JAMA Netw Open 2023; 6:e2252055. [PMID: 36689225 PMCID: PMC9871801 DOI: 10.1001/jamanetworkopen.2022.52055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 11/10/2022] [Indexed: 01/24/2023] Open
Abstract
Importance Food insecurity disproportionately affects Black individuals in the US. Its association with coronary heart disease (CHD), heart failure (HF), and stroke is unclear. Objective To evaluate the associations of economic food insecurity and proximity with unhealthy food options with risk of incident CHD, HF, and stroke and the role of diet quality and stress. Design, Setting, and Participants This cohort study was a time-to-event analysis of 3024 Black adult participants in the Jackson Heart Study (JHS) without prevalent cardiovascular disease (CVD) at visit 1 (2000-2004). Data analysis was conducted from September 1, 2020, to November 30, 2021. Exposures Economic food insecurity, defined as receiving food stamps or self-reported not enough money for groceries, and high frequency of unfavorable food stores (>2.5 unfavorable food stores [fast food restaurants, convenience stores] within 1 mile). Main Outcomes and Measures The main outcomes were incident CVD including incident CHD, stroke, and HF with preserved ejection fraction and with reduced ejection fraction (HFrEF). During a median follow-up of 13.8 (IQR, 12.8-14.6) years, the associations of measures of food inadequacy with incident CVD (CHD, stroke, and HF) were assessed using multivariable Cox proportional hazards regression models. Results Among the 3024 study participants, the mean (SD) age was 54 (12) years, 1987 (66%) were women, 630 (21%) were economically food insecure, and 50% (by definition) had more than 2.5 unfavorable food stores within 1 mile. In analyses adjusted for cardiovascular risk and socioeconomic factors, economic food insecurity was associated with higher risk of incident CHD (hazard ratio [HR], 1.76; 95% CI, 1.06-2.91) and incident HFrEF (HR, 2.07; 95% CI, 1.16-3.70), but not stroke. These associations persisted after further adjustment for diet quality and perceived stress. In addition, economic food insecurity was associated with higher high-sensitivity C-reactive protein and renin concentrations. High frequency of unfavorable food stores was not associated with CHD, HF, or stroke. Conclusions and Relevance The findings of this cohort study suggest that economic food insecurity, but not proximity to unhealthy food options, was associated with risk of incident CHD and HFrEF independent of socioeconomic factors, traditional cardiovascular risk factors, diet quality, perceived stress, and other health behaviors. Economic food insecurity was also associated with markers of inflammation and neurohormonal activation. Economic food insecurity may be a promising potential target for the prevention of CVD.
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Affiliation(s)
- Rani Zierath
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Brian Claggett
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | | | | | - Sharrelle Barber
- Drexel Dornsife School of Public Health, Philadelphia, Pennsylvania
| | - Yan Gao
- University of Mississippi Medical Center, Jackson
| | - Sameera Talegawkar
- Milken Institute of Public Health at the George Washington University, Washington, DC
| | | | - Katherine Tucker
- Department of Biomedical and Nutritional Sciences, University of Massachusetts, Lowell
| | - Ana V. Diez-Roux
- Drexel Dornsife School of Public Health, Philadelphia, Pennsylvania
| | - Mario Sims
- University of Mississippi Medical Center, Jackson
| | - Amil M. Shah
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
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Bakhtsiyarava M, Schinasi LH, Sánchez BN, Dronova I, Kephart JL, Ju Y, Gouveia N, Caiaffa WT, O'Neill MS, Yamada G, Arunachalam S, Diez-Roux AV, Rodríguez DA. Modification of temperature-related human mortality by area-level socioeconomic and demographic characteristics in Latin American cities. Soc Sci Med 2023; 317:115526. [PMID: 36476939 PMCID: PMC9870751 DOI: 10.1016/j.socscimed.2022.115526] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 11/07/2022] [Accepted: 11/08/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND In Latin America, where climate change and rapid urbanization converge, non-optimal ambient temperatures contribute to excess mortality. However, little is known about area-level characteristics that confer vulnerability to temperature-related mortality. OBJECTIVES Explore city-level socioeconomic and demographic characteristics associated with temperature-related mortality in Latin American cities. METHODS The dependent variables quantify city-specific associations between temperature and mortality: heat- and cold-related excess death fractions (EDF, or percentages of total deaths attributed to cold/hot temperatures), and the relative mortality risk (RR) associated with 1 °C difference in temperature in 325 cities during 2002-2015. Random effects meta-regressions were used to investigate whether EDFs and RRs associated with heat and cold varied by city-level characteristics, including population size, population density, built-up area, age-standardized mortality rate, poverty, living conditions, educational attainment, income inequality, and residential segregation by education level. RESULTS We find limited effect modification of cold-related mortality by city-level demographic and socioeconomic characteristics and several unexpected associations for heat-related mortality. For example, cities in the highest compared to the lowest tertile of income inequality have all-age cold-related excess mortality that is, on average, 3.45 percentage points higher (95% CI: 0.33, 6.56). Higher poverty and higher segregation were also associated with higher cold EDF among those 65 and older. Large, densely populated cities, and cities with high levels of poverty and income inequality experience smaller heat EDFs compared to smaller and less densely populated cities, and cities with little poverty and income inequality. DISCUSSION Evidence of effect modification of cold-related mortality in Latin American cities was limited, and unexpected patterns of modification of heat-related mortality were observed. Socioeconomic deprivation may impact cold-related mortality, particularly among the elderly. The findings of higher levels of poverty and income inequality associated with lower heat-related mortality deserve further investigation given the increasing importance of urban adaptation to climate change.
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Affiliation(s)
- Maryia Bakhtsiyarava
- Institute of Transportation Studies, University of California, Berkeley, CA, USA.
| | - Leah H Schinasi
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, USA; Department of Environmental and Occupational Health, Drexel Dornsife School of Public Health, Philadelphia, USA
| | - Brisa N Sánchez
- Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Philadelphia, USA
| | - Iryna Dronova
- Department of Environmental Science, Policy & Management, University of California, Berkeley, USA; Department of Landscape Architecture & Environmental Planning, University of California, Berkeley, USA
| | - Josiah L Kephart
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, USA
| | - Yang Ju
- School of Architecture and Urban Planning, Nanjing University, Nanjing, China
| | - Nelson Gouveia
- Department of Preventive Medicine, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Waleska Teixeira Caiaffa
- Observatório de Saúde Urbana de Belo Horizonte, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Marie S O'Neill
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, USA
| | - Goro Yamada
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, USA
| | - Sarav Arunachalam
- Institute for the Environment, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Ana V Diez-Roux
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, USA; Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, Philadelphia, USA
| | - Daniel A Rodríguez
- Institute of Transportation Studies, University of California, Berkeley, CA, USA; Department of City and Regional Planning and Institute Transportation Studies, University of California, Berkeley, USA
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Li J, Peterson A, Auchincloss AH, Hirsch JA, Rodriguez DA, Melly SJ, Moore KA, Diez-Roux AV, Sánchez BN. Comparing effects of Euclidean buffers and network buffers on associations between built environment and transport walking: the Multi-Ethnic Study of Atherosclerosis. Int J Health Geogr 2022; 21:12. [PMID: 36115992 PMCID: PMC9482303 DOI: 10.1186/s12942-022-00310-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Transport walking has drawn growing interest due to its potential to increase levels of physical activities and reduce reliance on vehicles. While existing studies have compared built environment-health associations between Euclidean buffers and network buffers, no studies have systematically quantified the extent of bias in health effect estimates when exposures are measured in different buffers. Further, prior studies have done the comparisons focusing on only one or two geographic regions, limiting generalizability and restricting ability to test whether direction or magnitude of bias are different by context. This study aimed to quantify the degree of bias in associations between built environment exposures and transport walking when exposures were operationalized using Euclidean buffers rather than network buffers in diverse contexts. METHODS We performed a simulations study to systematically evaluate the degree of bias in associations between built environment exposures in Euclidean buffers and network buffers and transport walking, assuming network buffers more accurately captured true exposures. Additionally, we used empirical data from a multi-ethnic, multi-site cohort to compare associations between built environment amenities and walking for transport where built environment exposures were derived using Euclidean buffers versus network buffers. RESULTS Simulation results found that the bias induced by using Euclidean buffer models was consistently negative across the six study sites (ranging from -80% to -20%), suggesting built environment exposures measured using Euclidean buffers underestimate health effects on transport walking. Percent bias was uniformly smaller for the larger 5 km scale than the 1 km and 0.25 km spatial scales, independent of site or built environment categories. Empirical findings aligned with the simulation results: built environment-health associations were stronger for built environment exposures operationalized using network buffers than using Euclidean buffers. CONCLUSION This study is the first to quantify the extent of bias in the magnitude of the associations between built environment exposures and transport walking when the former are measured in Euclidean buffers vs. network buffers, informing future research to carefully conceptualize appropriate distance-based buffer metrics in order to better approximate real geographic contexts. It also helps contextualize existing research in the field that used Euclidean buffers when that were the only option. Further, this study provides an example of the uncertain geographic context problem.
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Affiliation(s)
- Jingjing Li
- Department of Land Resources Management, School of Public Administration, China University of Geosciences, 388 Lumo Rd., Hubei, 430074, Wuhan, China.
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, 3600 Market St. 7th Floor, PA, 19104, Philadelphia, USA.
| | - Adam Peterson
- Department of Biostatistics, the University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - Amy H Auchincloss
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, 3600 Market St. 7th Floor, PA, 19104, Philadelphia, USA
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, 3215 Market St, Nesbitt HallPhiladelphia, PA, 19104, USA
| | - Jana A Hirsch
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, 3600 Market St. 7th Floor, PA, 19104, Philadelphia, USA
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, 3215 Market St, Nesbitt HallPhiladelphia, PA, 19104, USA
| | - Daniel A Rodriguez
- Department of City & Regional Planning and Institute for Transportation Studies, University of California Berkeley, 230 Wurster Hall #1820, Berkeley, CA, 94720, USA
| | - Steven J Melly
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, 3600 Market St. 7th Floor, PA, 19104, Philadelphia, USA
| | - Kari A Moore
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, 3600 Market St. 7th Floor, PA, 19104, Philadelphia, USA
| | - Ana V Diez-Roux
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, 3600 Market St. 7th Floor, PA, 19104, Philadelphia, USA
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, 3215 Market St, Nesbitt HallPhiladelphia, PA, 19104, USA
| | - Brisa N Sánchez
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, 3215 Market St, Nesbitt HallPhiladelphia, PA, 19104, USA
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10
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Post WS, Watson KE, Hansen S, Folsom AR, Szklo M, Shea S, Barr RG, Burke G, Bertoni AG, Allen N, Pankow JS, Lima JA, Rotter JI, Kaufman JD, Johnson WC, Kronmal RA, Diez-Roux AV, McClelland RL. Racial and Ethnic Differences in All-Cause and Cardiovascular Disease Mortality: The MESA Study. Circulation 2022; 146:229-239. [PMID: 35861763 PMCID: PMC9937428 DOI: 10.1161/circulationaha.122.059174] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Despite improvements in population health, marked racial and ethnic disparities in longevity and cardiovascular disease (CVD) mortality persist. This study aimed to describe risks for all-cause and CVD mortality by race and ethnicity, before and after accounting for socioeconomic status (SES) and other factors, in the MESA study (Multi-Ethnic Study of Atherosclerosis). METHODS MESA recruited 6814 US adults, 45 to 84 years of age, free of clinical CVD at baseline, including Black, White, Hispanic, and Chinese individuals (2000-2002). Using Cox proportional hazards modeling with time-updated covariates, we evaluated the association of self-reported race and ethnicity with all-cause and adjudicated CVD mortality, with progressive adjustments for age and sex, SES (neighborhood SES, income, education, and health insurance), lifestyle and psychosocial risk factors, clinical risk factors, and immigration history. RESULTS During a median of 15.8 years of follow-up, 22.8% of participants (n=1552) died, of which 5.3% (n=364) died of CVD. After adjusting for age and sex, Black participants had a 34% higher mortality hazard (hazard ratio [HR], 1.34 [95% CI, 1.19-1.51]), Chinese participants had a 21% lower mortality hazard (HR, 0.79 [95% CI, 0.66-0.95]), and there was no mortality difference in Hispanic participants (HR, 0.99 [95% CI, 0.86-1.14]) compared with White participants. After adjusting for SES, the mortality HR for Black participants compared with White participants was reduced (HR, 1.16 [95% CI, 1.01-1.34]) but still statistically significant. With adjustment for SES, the mortality hazards for Chinese and Hispanic participants also decreased in comparison with White participants. After further adjustment for additional risk factors and immigration history, Hispanic participants (HR, 0.77 [95% CI, 0.63-0.94]) had a lower mortality risk than White participants, and hazard ratios for Black participants (HR, 1.08 [95% CI, 0.92-1.26]) and Chinese participants (HR, 0.81 [95% CI, 0.60-1.08]) were not significantly different from those of White participants. Similar trends were seen for CVD mortality, although the age- and sex-adjusted HR for CVD mortality for Black participants compared with White participants was greater than all-cause mortality (HR, 1.72 [95% CI, 1.34-2.21] compared with HR, 1.34 [95% CI, 1.19-1.51]). CONCLUSIONS These results highlight persistent racial and ethnic differences in overall and CVD mortality, largely attributable to social determinants of health, and support the need to identify and act on systemic factors that shape differences in health across racial and ethnic groups.
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Affiliation(s)
- Wendy S. Post
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Karol E Watson
- Division of Cardiology, Department of Internal Medicine, UCLA, Los Angeles, CA
| | - Spencer Hansen
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Aaron R. Folsom
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, MN
| | - Moyses Szklo
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Steven Shea
- Department of Medicine, Vagelos College of Physicians & Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - R. Graham Barr
- Department of Medicine, Vagelos College of Physicians & Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Gregory Burke
- Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Alain G. Bertoni
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Norrina Allen
- Department of Preventive Medicine, Northwestern University, Chicago, IL
| | - James S. Pankow
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, MN
| | - Joao A.C. Lima
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD
| | - Jerome I. Rotter
- The Lundquist Institute, Harbor-UCLA Medical Center, Torrance, CA
| | - Joel D. Kaufman
- Environmental & Occupational Health Sciences, University of Washington, Seattle, WA, USA
| | - W, Craig Johnson
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | | | - Ana V. Diez-Roux
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA
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11
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Rodríguez López S, Bilal U, Ortigoza AF, Diez-Roux AV. Educational inequalities, urbanicity and levels of non-communicable diseases risk factors: evaluating trends in Argentina (2005-2013). BMC Public Health 2021; 21:1572. [PMID: 34416876 PMCID: PMC8379776 DOI: 10.1186/s12889-021-11617-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 08/08/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND We investigated a) whether urbanicity is associated with individual-level non-communicable diseases (NCD) risk factors and whether urbanicity modifies trends over time in risk factors; and (b) whether educational inequalities in NCD risk factors change over time or are modified by province urbanicity. METHODS We used data from three large national surveys on NCD risk factors (Encuesta Nacional de Factores de Riesgo; ENFR2005-2009-2013) conducted in urban areas of Argentina (n = 108,489). We used gender-stratified logistic random-intercept models (individuals nested within provinces) to determine adjusted associations of self-reported individual NCD risk factors (hypertension, diabetes, obesity, and current smoking) with education and urbanicity. RESULTS In both men and women, the prevalence of obesity and diabetes increased over time but smoking decreased. Hypertension prevalence increased over time in men. Higher urbanicity was associated with higher odds of smoking and lower odds of hypertension in women but was not associated with NCD risk factors in men. Obesity increased more over time in more compared to less urbanized provinces (in men) while smoking decreased more over time in less urbanized provinces. All risk factors had a higher prevalence in persons with lower education (stronger in women than in men), except for diabetes in men and smoking in women. Educational inequalities in obesity (in men) and hypertension (in men and women) became stronger over time, while an initial inverse social gradient in smoking for women reverted and became similar to other risk factors over time. In general, the inverse associations of education with the risk factors became stronger with increasing levels of province urbanicity. CONCLUSION Increasing prevalence of diabetes and obesity over time and growing inequities by education highlight the need for policies aimed at reducing NCD risk factors among lower socioeconomic populations in urban environments in Argentina.
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Affiliation(s)
- Santiago Rodríguez López
- Centro de Investigaciones y Estudios sobre Cultura y Sociedad, Consejo Nacional de Investigaciones Científicas y Técnicas (CIECS, CONICET y UNC), Córdoba, Argentina
- Cátedra de Antropología, Facultad de Ciencias Exactas, Físicas y Naturales, Universidad Nacional de Córdoba (FCEFyN – UNC), Córdoba, Argentina
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, USA
| | - Usama Bilal
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, USA
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, USA
| | - Ana F. Ortigoza
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, USA
| | - Ana V. Diez-Roux
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, USA
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, USA
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12
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López-Olmedo N, Diez-Roux AV, Pérez-Ferrer C, Prado-Galbarro FJ, Riojas-Rodríguez H, Rivera-Dommarco J, Barrientos-Gutierrez T. Climate Trends and Consumption of Foods and Beverages by Processing Level in Mexican Cities. Front Nutr 2021; 8:647497. [PMID: 34368204 PMCID: PMC8334732 DOI: 10.3389/fnut.2021.647497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 06/18/2021] [Indexed: 11/26/2022] Open
Abstract
Background: Little is known about the potential impact of climate change on food systems and diet. We aimed to estimate the association of changes in rainfall and temperatures with consumption of unprocessed and processed foods among residents of Mexican cities by climate region. Methods: We analyzed 3,312 participants of the 2012 Mexican National Health and Nutrition Survey with dietary intake and sociodemographic information linked to historical rainfall and temperature data collected by the Mexican National Weather Service. We classified foods as unprocessed, processed, or ultra-processed. We performed multilevel linear regression to estimate the association of annual change in rainfalls (for each 0.5 mm decrease) and temperatures (for each 0.1°C increase) at municipality level over the past 5 years with consumption of processed and unprocessed foods measured as the contribution to total energy intake. We investigated whether associations differed by climate region (tropical, temperate, and arid). Results: Each 0.5 mm annual decrease in precipitation was associated with lower consumption of unprocessed foods and higher consumption of ultra-processed foods [mean differences in percent contribution to total energy intake −0.009% (95% CI: −0.019, < −0.001) and 0.011% (95% CI: 0.001, 0.021), respectively]. Each 0.1 degree Celsius annual increase in temperature was also associated with lower consumption of unprocessed and higher consumption of ultra-processed foods [mean differences in percent contribution to total energy intake was −0.03 (95% CI: −0.05, −0.01) and 0.03% (95% CI: <0.01, 0.05)]. When stratified by climate region these associations were only observed in tropical regions. Conclusions: Decreases in rainfalls and increases in temperature were associated with lower consumption of unprocessed foods but higher consumption of ultra-processed foods, especially in tropical regions. Previous studies have established how food production affects the climate, our study suggests that climate change could, in turn, reinforce modern food production, closing a vicious circle with clear negative implications for planetary health.
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Affiliation(s)
- Nancy López-Olmedo
- Center for Population and Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Ana V Diez-Roux
- Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States
| | - Carolina Pérez-Ferrer
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Mexico.,National Council for Science and Technology, Mexico City, Mexico
| | | | - Horacio Riojas-Rodríguez
- Center for Population and Health Research, National Institute of Public Health, Cuernavaca, Mexico
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Gouveia N, Kephart JL, Dronova I, McClure L, Granados JT, Betancourt RM, O'Ryan AC, Texcalac-Sangrador JL, Martinez-Folgar K, Rodriguez D, Diez-Roux AV. Ambient fine particulate matter in Latin American cities: Levels, population exposure, and associated urban factors. Sci Total Environ 2021; 772:145035. [PMID: 33581538 PMCID: PMC8024944 DOI: 10.1016/j.scitotenv.2021.145035] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 01/04/2021] [Accepted: 01/04/2021] [Indexed: 05/06/2023]
Abstract
BACKGROUND Exposure to particulate matter (PM2.5) is a major risk factor for morbidity and mortality. Yet few studies have examined patterns of population exposure and investigated the predictors of PM2.5 across the rapidly growing cities in lower- and middle-income countries. OBJECTIVES Characterize PM2.5 levels, describe patterns of population exposure, and investigate urban factors as predictors of PM2.5 levels. METHODS We used data from the Salud Urbana en America Latina/Urban Health in Latin America (SALURBAL) study, a multi-country assessment of the determinants of urban health in Latin America, to characterize PM2.5 levels in 366 cities comprising over 100,000 residents using satellite-derived estimates. Factors related to urban form and transportation were explored. RESULTS We found that about 172 million or 58% of the population studied lived in areas with air pollution levels above the defined WHO-AQG of 10 μg/m3 annual average. We also found that larger cities, cities with higher GDP, higher motorization rate and higher congestion tended to have higher PM2.5. In contrast cities with higher population density had lower levels of PM2.5. In addition, at the sub-city level, higher intersection density was associated with higher PM2.5 and more green space was associated with lower PM2.5. When all exposures were examined adjusted for each other, higher city per capita GDP and higher sub-city intersection density remained associated with higher PM2.5 levels, while higher city population density remained associated with lower levels. The presence of mass transit was also associated with lower PM2.5 after adjustment. The motorization rate also remained associated with PM2.5 and its inclusion attenuated the effect of population density. DISCUSSION These results show that PM2.5 exposures remain a major health risk in Latin American cities and suggest that urban planning and transportation policies could have a major impact on ambient levels.
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Affiliation(s)
- Nelson Gouveia
- Department of Preventive Medicine, University of Sao Paulo Medical School, Sao Paulo, Brazil.
| | - Josiah L Kephart
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA, USA
| | - Iryna Dronova
- Department of Landscape Architecture & Environmental Planning, College of Environmental Design, University of California Berkeley, Berkeley, CA, USA
| | - Leslie McClure
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - José Tapia Granados
- Department of Politics, College of Arts & Sciences, Drexel University, Philadelphia, PA, USA
| | | | - Andrea Cortínez O'Ryan
- Pontificia Universidad Católica de Chile, Department of Public Health, School of Medicine, Chile; Universidad de La Frontera, Department of Physical Education, Sports and Recreation, Chile
| | | | - Kevin Martinez-Folgar
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA; Instituto de Nutrición de Centroamérica y Panamá (INCAP), Guatemala
| | - Daniel Rodriguez
- Department of City and Regional Planning and Institute for Transportation Studies, University of California, Berkeley, CA, USA
| | - Ana V Diez-Roux
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA, USA; Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
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Rodríguez López S, Tumas N, Ortigoza A, de Lima Friche AA, Diez-Roux AV. Urban social environment and low birth weight in 360 Latin American cities. BMC Public Health 2021; 21:795. [PMID: 33902522 PMCID: PMC8073945 DOI: 10.1186/s12889-021-10886-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 04/19/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Using data compiled by the SALURBAL project (Urban Health in Latin America; 'Salud Urbana en América Latina') we quantified variability in low birth weight (LBW) across cities in Latin America, and evaluated the associations of socio-economic characteristics at various levels (maternal, sub-city and city) with the prevalence of LBW. METHODS The sample included 8 countries, 360 cities, 1321 administrative areas within cities (sub-city units) and birth registers of more than 4.5 million births for the year 2014. We linked maternal education from birth registers to data on socioeconomic characteristics of sub-cities and cities using the closest available national population census in each country. We applied linear and Poisson random-intercept multilevel models for aggregated data. RESULTS The median prevalence of city LBW by country ranged from a high of 13% in Guatemala to a low of 5% in Peru (median across all cities was 7.8%). Most of the LBW variability across sub-cities was between countries, but there were also significant proportions between cities within a country, and within cities. Low maternal education was associated with higher prevalence of LBW (Prevalence rate ratios (PRR) for less than primary vs. completed secondary or more 1.12 95% CI 1.10, 1.13) in the fully adjusted model. In contrast, higher sub-city education and a better city social environment index were independently associated with higher LBW prevalence after adjustment for maternal education and age, city population size and city gross domestic product (PRR 1.04 95% CI 1.03, 1.04 per SD higher sub-city education and PRR 1.02 95% CI 1.00, 1.04 per SD higher SEI). Larger city size was associated with a higher prevalence of LBW (PRR 1.06; 95% CI 1.01, 1.12). CONCLUSION Our findings highlight the presence of heterogeneity in the distribution of LBW and the importance of maternal education, local and broader social environments in shaping LBW in urban settings of Latin America. Implementing context-sensitive interventions guided to improve women's education is recommended to tackle LBW in the region.
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Affiliation(s)
- Santiago Rodríguez López
- Centro de Investigaciones y Estudios sobre Cultura y Sociedad, Consejo Nacional de Investigaciones Científicas y Técnicas y Universidad Nacional de Córdoba, Córdoba, Argentina.
- Facultad de Ciencias Exactas, Físicas y Naturales, Universidad Nacional de Córdoba, Córdoba, Argentina.
| | - Natalia Tumas
- Centro de Investigaciones y Estudios sobre Cultura y Sociedad, Consejo Nacional de Investigaciones Científicas y Técnicas y Universidad Nacional de Córdoba, Córdoba, Argentina
- Facultad de Ciencias de la Salud, Universidad Católica de Córdoba, Córdoba, Argentina
- Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Ana Ortigoza
- Dornsife School of Public Health, Drexel University, Philadelphia, USA
| | | | - Ana V Diez-Roux
- Dornsife School of Public Health, Drexel University, Philadelphia, USA
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, USA
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Mudd AE, Michael YL, Diez-Roux AV, Maltenfort M, Moore K, Melly S, Lê-Scherban F, Forrest CB. Primary Care Accessibility Effects on Health Care Utilization Among Urban Children. Acad Pediatr 2020; 20:871-878. [PMID: 32492576 PMCID: PMC7261359 DOI: 10.1016/j.acap.2020.05.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 05/19/2020] [Accepted: 05/22/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Evidence suggests that spatial accessibility to primary care is a contributing factor to appropriate health care utilization, with limited primary care access resulting in avoidable hospitalizations and emergency department visits which are burdensome on individuals and our health care system. Limited research, however, has examined the effects on children. METHODS We evaluated associations of spatial accessibility to primary care on health care utilization among a sample of 16,709 children aged 0 to 3 years in Philadelphia who were primarily non-White and publicly insured. Log-Poisson models with generalized estimating equations were used to estimate incidence rate ratios (RR) and 95% confidence intervals (CI), while accounting for 3 levels of clustering (within individual, within primary care practice, within neighborhood). RESULTS In age-adjusted models, the lowest level of spatial accessibility was associated with 7% fewer primary care visits (RR 0.93, 95% CI 0.91, 0.95), 15% more emergency department visits (RR 1.15, 95% CI 1.09, 1.22), and 18% more avoidable hospitalizations (RR 1.18, 95% CI 1.01, 1.37). After adjustment for individual- (race/ethnicity, sex, number of chronic conditions, insurance status) and neighborhood-level (racial composition and proportion of housing units with no vehicle), spatial accessibility was not significantly associated with rate of health care utilization. CONCLUSIONS Individual-level predisposing factors, such as age, race, and need, attenuate the association between accessibility to primary care and use of primary care, emergency department visits, and avoidable hospitalization. Given the possibility of modifying access to primary care unlike immutable individual factors, a focus on spatial accessibility to primary care may promote appropriate health care utilization.
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Affiliation(s)
- Abigail E. Mudd
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University (AE Mudd, YL Michael, AV Diez-Roux, and F Lê-Scherban), Philadelphia, Pa
| | - Yvonne L. Michael
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University (AE Mudd, YL Michael, AV Diez-Roux, and F Lê-Scherban), Philadelphia, Pa,Address correspondence to Yvonne L. Michael, ScD, SM, Drexel University, Dornsife School of Public Health, 3215 Market St, Philadelphia, PA 19104
| | - Ana V. Diez-Roux
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University (AE Mudd, YL Michael, AV Diez-Roux, and F Lê-Scherban), Philadelphia, Pa
| | - Mitchell Maltenfort
- Applied Clinical Research Center, Children's Hospital of Philadelphia (M Maltenfort and CB Forrest), Philadelphia, Pa
| | - Kari Moore
- The Urban Health Collaborative, Dornsife School of Public Health, Drexel University (K Moore and S Melly), Philadelphia, Pa
| | - Steve Melly
- The Urban Health Collaborative, Dornsife School of Public Health, Drexel University (K Moore and S Melly), Philadelphia, Pa
| | - Félice Lê-Scherban
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University (AE Mudd, YL Michael, AV Diez-Roux, and F Lê-Scherban), Philadelphia, Pa
| | - Christopher B. Forrest
- Applied Clinical Research Center, Children's Hospital of Philadelphia (M Maltenfort and CB Forrest), Philadelphia, Pa
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De Moraes ACF, Carvalho HB, McClelland RL, Diez-Roux AV, Szklo M. Sex and ethnicity modify the associations between individual and contextual socioeconomic indicators and ideal cardiovascular health: MESA study. J Public Health (Oxf) 2020; 41:e237-e244. [PMID: 30137558 DOI: 10.1093/pubmed/fdy145] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 07/13/2018] [Accepted: 07/27/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Low socioeconomic status (SES) is associated with cardiovascular disease (CVD) risk, but its association with different markers of SES may be heterogeneous by sex and race/ethnicity. METHODS We have examined the relationships of four SES markers (education, family income, occupation and neighborhood SES) to ideal cardiovascular health (ICH), an index formed by seven variables. A total of 6792 cohort participants from six regions in the USA: Baltimore City and Baltimore County, MD; Chicago, IL; Forsyth County, NC; Los Angeles County, CA; New York, NY; and St. Paul, MN of the Multi-Ethnic Study of Atherosclerosis (MESA) (52.8% women) were recruited at baseline (2000-2) and included in the present analysis. RESULTS ICH was classified as poor, intermediate or ideal. Level of education was significantly and inversely associated with ICH in non-Hispanic White men and women, in Chinese-American and Hispanic American men and African-American women. Family income was inversely and significantly associated with poor ICH in African-American men only. CONCLUSIONS We conclude that the strength of the associations between some SES markers and ICH differ between sexes and race/ethnic groups.
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Affiliation(s)
- Augusto César Ferreira De Moraes
- YCARE (Youth/Child cArdiovascular Risk and Environmental) Research Group Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Heráclito Barbosa Carvalho
- YCARE (Youth/Child cArdiovascular Risk and Environmental) Research Group Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
| | | | - Ana V Diez-Roux
- Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Moyses Szklo
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Brown KM, Diez-Roux AV, Smith JA, Needham BL, Mukherjee B, Ware EB, Liu Y, Cole SW, Seeman TE, Kardia SLR. Social regulation of inflammation related gene expression in the multi-ethnic study of atherosclerosis. Psychoneuroendocrinology 2020; 117:104654. [PMID: 32387875 PMCID: PMC7685527 DOI: 10.1016/j.psyneuen.2020.104654] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 02/11/2020] [Accepted: 03/11/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Exposure to adverse social factors has been associated with an altered inflammatory profile, a risk factor for several acute and chronic diseases. Differential gene expression may be a biological mediator in the relationship. In this study, associations between a range of social factors and expression of inflammation-related genes were investigated. METHODS Social factor and gene expression data were collected from 1,264 individuals in the Multi-Ethnic Study of Atherosclerosis (MESA). Inflammation-related genes were identified from the Gene Ontology database. The associations between social factors and gene expression were first assessed using the Global Analysis of Covariance (Global ANCOVA) gene set enrichment test. When the global test was significant, linear regression and elastic net penalized regression were employed to identify the individual gene transcripts within each gene set associated with the social factor. RESULTS Loneliness (p = 0.003), chronic burden (p = 0.002), and major or lifetime discrimination (p = 0.045) were significantly associated with global expression of the chronic inflammatory gene set. Of the 20 transcripts that comprise this gene set, elastic net selected 12 transcripts for loneliness, 8 for chronic burden, and 3 for major or lifetime discrimination. Major or lifetime discrimination was also associated with the inflammatory response (p = 0.029), regulation of the inflammatory response (p = 0.041), and immune response (p = 0.025) gene sets in global analyses, and 53, 136, and 26 transcripts were selected via elastic net for these gene sets respectively. There were no significant associations in linear regression analyses after adjustment for multiple testing. CONCLUSIONS This study highlights gene expression as a biological mechanism through which social factors may affect inflammation.
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Affiliation(s)
- Kristen M Brown
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, United States; Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA, 30322, United States.
| | - Ana V Diez-Roux
- Department of Epidemiology, Dornsife School of Public Health, Drexel University, Nesbitt Hall, 3215 Market Street, Philadelphia, PA, 19104, United States.
| | - Jennifer A Smith
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, United States; Survey Research Center, Institute for Social Research, University of Michigan, 426 Thompson Street, Ann Arbor, MI, 48104, United States.
| | - Belinda L Needham
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, United States.
| | - Bhramar Mukherjee
- Department of Biostatistics, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, United States.
| | - Erin B Ware
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, United States.
| | - Yongmei Liu
- Department of Medicine, Division of Cardiology, Duke University Medical Center, 300 N Duke St, Durham, NC 27701.
| | - Steven W Cole
- Department of Medicine, Division of Hematology-Oncology, University of California-Los Angeles, 11-934 Factor Building, UCLA School of Medicine Campus - 167817, Los Angeles, CA, 90095, United States.
| | - Teresa E Seeman
- Department of Medicine, University of California-Los Angeles, UCLA Med-Geri, BOX 951687, 2339 PVUB, Los Angeles, CA, 90095, United States.
| | - Sharon L R Kardia
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, United States.
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Abstract
Background Current literature examining the prospective relationship between depression and other measures of negative affect with atrial fibrillation (AF) are limited. We determined the relationships of depression, anger, anxiety, and chronic stress with incident AF in a multiethnic cohort of middle‐ and older‐aged adults. Methods and Results This analysis included 6644 MESA (Multi‐Ethnic Study of Atherosclerosis) study participants who were free of AF at baseline. Depressive symptoms were assessed at baseline and defined as either a 20‐item Center for Epidemiologic Studies Depression Scale score ≥16 or use of antidepressant medications. The Spielberger Trait Anger Scale, Spielberger Trait Anxiety Scale, and Chronic Burden Scale were also administered at baseline to assess anger, anxiety, and chronic stress, respectively. The primary outcome was incident AF, identified by follow‐up study visit ECGs, hospital discharge diagnoses, or Medicare claims data. A total of 875 (13%) incident AF cases were detected over a median follow‐up of nearly 13 years. A Center for Epidemiologic Studies Depression Scale score ≥16 (referent, Center for Epidemiologic Studies Depression Scale score <2) and antidepressant use were associated with a 34% and 36% higher risk of AF, respectively, in separate adjusted Cox proportional hazards analyses (hazard ratio, 1.34; 95% CI 1.04–1.74 for Center for Epidemiologic Studies Depression Scale ≥16; hazard ratio, 1.36; 95% CI, 1.04–1.77 for antidepressant use). No significant associations were observed for anger, anxiety, or chronic stress with development of AF. Conclusions Depressive symptoms are associated with an increased risk of incident AF. Further study into whether improving depressive symptoms reduces AF incidence is important.
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Affiliation(s)
- Parveen K Garg
- 1 Division of Cardiology University of Southern California Keck School of Medicine Los Angeles CA
| | - Wesley T O'Neal
- 2 Division of Cardiology Emory University School of Medicine Atlanta GA
| | - Ana V Diez-Roux
- 3 Urban Health Collaborative, and Office of Dean Dornsife School of Public Health Drexel University Philadelphia PA
| | - Alvaro Alonso
- 4 Department of Epidemiology Rollins School of Public Health Emory University Atlanta GA
| | - Elsayed Z Soliman
- 5 Department of Epidemiology and Prevention Epidemiological Cardiology Research Center (EPICARE) Wake Forest School of Medicine Winston-Salem NC.,6 Section on Cardiology Department of Medicine Wake Forest School of Medicine Winston-Salem NC
| | - Susan Heckbert
- 7 Department of Epidemiology University of Washington Seattle WA
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Glover LM, Cain-Shields LR, Wyatt SB, Gebreab SY, Diez-Roux AV, Sims M. Life Course Socioeconomic Status and Hypertension in African American Adults: The Jackson Heart Study. Am J Hypertens 2020; 33:84-91. [PMID: 31420642 DOI: 10.1093/ajh/hpz133] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 06/23/2019] [Accepted: 08/12/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Limited research has examined the association of life-course socioeconomic status (SES) with hypertension prevalence and incidence in a large cohort of African Americans. METHODS Among 4,761 participants from the Jackson Heart Study (JHS), we examined the association of SES indicators with prevalent and incident hypertension. We used multivariable Poisson regression to estimate prevalence ratios (PR, 95% confidence interval-CI) of baseline (2000-2004) hypertension by adult (education, income, occupation, wealth) and childhood (mother's education) SES. Cox proportional hazards regression was used to estimate hazard ratios (HR, 95% CI) of incident hypertension by adult and childhood SES (2005-2013; 7.21 median years of follow-up). We also examined the association of childhood-to-adult SES mobility (parent-to-adult education) with prevalent and incident hypertension. Model 1 adjusted for age and sex. Model 2 added waist circumference, behaviors (smoking, alcohol, physical activity, diet), and diabetes prevalence. RESULTS High (vs. low) adult SES measures were associated with a lower prevalence of hypertension, with the exception of having a college degree and upper-middle income (PR: 1.04, 95% CI: 1.01, 1.07; PR: 1.05, 95% CI: 1.01, 1.09, respectively). Higher childhood SES was associated with a lower prevalence and risk of hypertension (PR: 0.83, 95%: CI 0.75, 0.91; HR: 0.76, 95% CI: 0.65, 0.89, respectively). Upward mobility and consistent high SES (vs. consistent low SES) from childhood to adulthood was associated with a greater prevalence, but lower incidence of hypertension. CONCLUSION Efforts to prevent hypertension among African Americans should consider childhood and current SES status.
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Affiliation(s)
- Láshauntá M Glover
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill North Carolina, USA
| | - Loretta R Cain-Shields
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Sharon B Wyatt
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | | | - Ana V Diez-Roux
- Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Mario Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
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Bilal U, Alazraqui M, Caiaffa WT, Lopez-Olmedo N, Martinez-Folgar K, Miranda JJ, Rodriguez DA, Vives A, Diez-Roux AV. Inequalities in life expectancy in six large Latin American cities from the SALURBAL study: an ecological analysis. Lancet Planet Health 2019; 3:e503-e510. [PMID: 31836433 PMCID: PMC6926471 DOI: 10.1016/s2542-5196(19)30235-9] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 11/13/2019] [Accepted: 11/14/2019] [Indexed: 05/26/2023]
Abstract
BACKGROUND Latin America is one of the most unequal regions in the world, but evidence is lacking on the magnitude of health inequalities in urban areas of the region. Our objective was to examine inequalities in life expectancy in six large Latin American cities and its association with a measure of area-level socioeconomic status. METHODS In this ecological analysis, we used data from the Salud Urbana en America Latina (SALURBAL) study on six large cities in Latin America (Buenos Aires, Argentina; Belo Horizonte, Brazil; Santiago, Chile; San José, Costa Rica; Mexico City, Mexico; and Panama City, Panama), comprising 266 subcity units, for the period 2011-15 (expect for Panama city, which was for 2012-16). We calculated average life expectancy at birth by sex and subcity unit with life tables using age-specific mortality rates estimated from a Bayesian model, and calculated the difference between the ninth and first decile of life expectancy at birth (P90-P10 gap) across subcity units in cities. We also analysed the association between life expectancy at birth and socioeconomic status at the subcity-unit level, using education as a proxy for socioeconomic status, and whether any geographical patterns existed in cities between subcity units. FINDINGS We found large spatial differences in average life expectancy at birth in Latin American cities, with the largest P90-P10 gaps observed in Panama City (15·0 years for men and 14·7 years for women), Santiago (8·9 years for men and 17·7 years for women), and Mexico City (10·9 years for men and 9·4 years for women), and the narrowest in Buenos Aires (4·4 years for men and 5·8 years for women), Belo Horizonte (4·0 years for men and 6·5 years for women), and San José (3·9 years for men and 3·0 years for women). Higher area-level socioeconomic status was associated with higher life expectancy, especially in Santiago (change in life expectancy per P90-P10 change unit-level of educational attainment 8·0 years [95% CI 5·8-10·3] for men and 11·8 years [7·1-16·4] for women) and Panama City (7·3 years [2·6-12·1] for men and 9·0 years [2·4-15·5] for women). We saw an increase in life expectancy at birth from east to west in Panama City and from north to south in core Mexico City, and a core-periphery divide in Buenos Aires and Santiago. Whereas for San José the central part of the city had the lowest life expectancy and in Belo Horizonte the central part of the city had the highest life expectancy. INTERPRETATION Large spatial differences in life expectancy in Latin American cities and their association with social factors highlight the importance of area-based approaches and policies that address social inequalities in improving health in cities of the region. FUNDING Wellcome Trust.
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Affiliation(s)
- Usama Bilal
- Department of Epidemiology and Biostatistics, Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA, USA.
| | - Marcio Alazraqui
- Instituto de Salud Colectiva, Universidad Nacional de Lanús, Buenos Aires, Argentina
| | - Waleska T Caiaffa
- Observatório de Saúde Urbana de Belo Horizonte, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Nancy Lopez-Olmedo
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Kevin Martinez-Folgar
- Department of Epidemiology and Biostatistics, Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA, USA; Instituto de Nutrición de Centroamérica y Panamá (INCAP), Guatemala
| | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases and School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Daniel A Rodriguez
- Department of City and Regional Planning and Institute for Transportation Studies, University of California Berkeley, Berkeley, CA, USA
| | - Alejandra Vives
- Departamento de Salud Pública, Escuela de Medicina, and CEDEUS, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ana V Diez-Roux
- Department of Epidemiology and Biostatistics, Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA, USA
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Wang M, Aaron CP, Madrigano J, Hoffman EA, Angelini E, Yang J, Laine A, Vetterli TM, Kinney PL, Sampson PD, Sheppard LE, Szpiro AA, Adar SD, Kirwa K, Smith B, Lederer DJ, Diez-Roux AV, Vedal S, Kaufman JD, Barr RG. Association Between Long-term Exposure to Ambient Air Pollution and Change in Quantitatively Assessed Emphysema and Lung Function. JAMA 2019; 322:546-556. [PMID: 31408135 PMCID: PMC6692674 DOI: 10.1001/jama.2019.10255] [Citation(s) in RCA: 202] [Impact Index Per Article: 40.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
IMPORTANCE While air pollutants at historical levels have been associated with cardiovascular and respiratory diseases, it is not known whether exposure to contemporary air pollutant concentrations is associated with progression of emphysema. OBJECTIVE To assess the longitudinal association of ambient ozone (O3), fine particulate matter (PM2.5), oxides of nitrogen (NOx), and black carbon exposure with change in percent emphysema assessed via computed tomographic (CT) imaging and lung function. DESIGN, SETTING, AND PARTICIPANTS This cohort study included participants from the Multi-Ethnic Study of Atherosclerosis (MESA) Air and Lung Studies conducted in 6 metropolitan regions of the United States, which included 6814 adults aged 45 to 84 years recruited between July 2000 and August 2002, and an additional 257 participants recruited from February 2005 to May 2007, with follow-up through November 2018. EXPOSURES Residence-specific air pollutant concentrations (O3, PM2.5, NOx, and black carbon) were estimated by validated spatiotemporal models incorporating cohort-specific monitoring, determined from 1999 through the end of follow-up. MAIN OUTCOMES AND MEASURES Percent emphysema, defined as the percent of lung pixels less than -950 Hounsfield units, was assessed up to 5 times per participant via cardiac CT scan (2000-2007) and equivalent regions on lung CT scans (2010-2018). Spirometry was performed up to 3 times per participant (2004-2018). RESULTS Among 7071 study participants (mean [range] age at recruitment, 60 [45-84] years; 3330 [47.1%] were men), 5780 were assigned outdoor residential air pollution concentrations in the year of their baseline examination and during the follow-up period and had at least 1 follow-up CT scan, and 2772 had at least 1 follow-up spirometric assessment, over a median of 10 years. Median percent emphysema was 3% at baseline and increased a mean of 0.58 percentage points per 10 years. Mean ambient concentrations of PM2.5 and NOx, but not O3, decreased substantially during follow-up. Ambient concentrations of O3, PM2.5, NOx, and black carbon at study baseline were significantly associated with greater increases in percent emphysema per 10 years (O3: 0.13 per 3 parts per billion [95% CI, 0.03-0.24]; PM2.5: 0.11 per 2 μg/m3 [95% CI, 0.03-0.19]; NOx: 0.06 per 10 parts per billion [95% CI, 0.01-0.12]; black carbon: 0.10 per 0.2 μg/m3 [95% CI, 0.01-0.18]). Ambient O3 and NOx concentrations, but not PM2.5 concentrations, during follow-up were also significantly associated with greater increases in percent emphysema. Ambient O3 concentrations, but not other pollutants, at baseline and during follow-up were significantly associated with a greater decline in forced expiratory volume in 1 second per 10 years (baseline: 13.41 mL per 3 parts per billion [95% CI, 0.7-26.1]; follow-up: 18.15 mL per 3 parts per billion [95% CI, 1.59-34.71]). CONCLUSIONS AND RELEVANCE In this cohort study conducted between 2000 and 2018 in 6 US metropolitan regions, long-term exposure to ambient air pollutants was significantly associated with increasing emphysema assessed quantitatively using CT imaging and lung function.
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Affiliation(s)
- Meng Wang
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York
- Research and Education in Energy, Environment and Water Institute, University at Buffalo, Buffalo, New York
| | | | - Jaime Madrigano
- Department of Environmental Health Sciences, Epidemiology, Mailman School of Public Health; Columbia University, New York, New York
- RAND Corporation, Arlington, Virginia
| | | | - Elsa Angelini
- Department of Biomedical Engineering, Columbia University, New York, New York
| | - Jie Yang
- Department of Biomedical Engineering, Columbia University, New York, New York
| | - Andrew Laine
- Department of Biomedical Engineering, Columbia University, New York, New York
| | - Thomas M. Vetterli
- Department of Biomedical Engineering, Columbia University, New York, New York
| | - Patrick L. Kinney
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts
| | | | - Lianne E. Sheppard
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle
- Department of Biostatistics, School of Public Health, University of Washington, Seattle
| | - Adam A. Szpiro
- Department of Biostatistics, School of Public Health, University of Washington, Seattle
| | - Sara D. Adar
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor
| | - Kipruto Kirwa
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle
| | - Benjamin Smith
- Department of Medicine, Columbia University Medical Center, New York, New York
- Department of Medicine, McGill University Health Centre, Montréal, Canada
| | - David J. Lederer
- Department of Medicine, Columbia University Medical Center, New York, New York
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Ana V. Diez-Roux
- Department of Epidemiology, School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - Sverre Vedal
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle
| | - Joel D. Kaufman
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle
- Departments of Medicine and Epidemiology, University of Washington, Seattle
| | - R. Graham Barr
- Department of Medicine, Columbia University Medical Center, New York, New York
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
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Garg PK, Jorgensen N, Diez-Roux AV, O'Neal W, Mujahid M, Moore K, Soliman EZ, Heckbert SR. Neighborhood environments and risk of incident atrial fibrillation: The Multi-Ethnic Study of Atherosclerosis. Eur J Prev Cardiol 2019; 27:2116-2118. [PMID: 31349772 DOI: 10.1177/2047487319866020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Parveen K Garg
- Division of Cardiology, University of Southern California Keck School of Medicine, Los Angeles, USA
| | - Neal Jorgensen
- Department of Biostatistics, University of Washington, Seattle, USA
| | - Ana V Diez-Roux
- Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, USA
| | - Wesley O'Neal
- Division of Cardiology, Emory University School of Medicine, Atlanta, USA
| | - Mahasin Mujahid
- Department of Epidemiology, School of Public Health, University of California, Berkeley, USA
| | - Kari Moore
- Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, USA
| | - Elsayed Z Soliman
- Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention, and Department of Medicine, Section on Cardiology, Wake Forest School of Medicine, Winston-Salem, USA
| | - Susan R Heckbert
- Department of Epidemiology, University of Washington, Seattle, USA
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Carroll JE, Irwin MR, Seeman TE, Diez-Roux AV, Prather AA, Olmstead R, Epel E, Lin J, Redline S. Obstructive sleep apnea, nighttime arousals, and leukocyte telomere length: the Multi-Ethnic Study of Atherosclerosis. Sleep 2019; 42:zsz089. [PMID: 30994174 PMCID: PMC6612669 DOI: 10.1093/sleep/zsz089] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 02/28/2019] [Indexed: 02/07/2023] Open
Abstract
STUDY OBJECTIVES Sleep disturbances and sleep apnea are associated with increased vulnerability to age-related disease, altering molecular pathways affecting biological aging. Telomere length captures one component of biological aging. We evaluated whether objectively assessed sleep and sleep apnea relate to leukocyte telomere length (LTL) in the Multi-Ethnic Study of Atherosclerosis (MESA). METHODS Men and women aged 44-84 years (n = 672) from the MESA Stress and MESA Sleep studies underwent polysomnography and 7 day actigraphy (at Exam 5) and assessment of LTL (at baseline [Exam 1] and about 10 years later [Exam 5]). RESULTS General linear models adjusting for age, sex, race/ethnicity, BMI, physical activity, and smoking found that severe obstructive sleep apnea (OSA; apnea-hypopnea index > 30) was cross-sectionally associated with shorter LTL (p = 0.007). Modest associations of shorter LTL with less rapid eye movement sleep, more stage 1 sleep, wake after sleep onset >30 min, and long sleep duration were found, but these effects were diminished after adjusting for lifestyle and OSA. Exploratory analyses found that higher arousal index at Exam 5 was associated with greater LTL decline over the prior 10 years (p = 0.004). CONCLUSIONS OSA was associated with shorter LTL. Individuals with high-arousal frequency had greater leukocyte telomere attrition over the prior decade. These findings suggest that sleep apnea and sleep fragmentation are associated with accelerated biological aging.
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Affiliation(s)
- Judith E Carroll
- Department of Psychiatry and Biobehavioral Sciences, Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA
| | - Michael R Irwin
- Department of Psychiatry and Biobehavioral Sciences, Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA
| | - Teresa E Seeman
- Department of Medicine, Division of Geriatrics, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Ana V Diez-Roux
- Department of Epidemiology, School of Public Health, Drexel University, Philadelphia, PA
| | - Aric A Prather
- Department of Psychiatry, Univeristy of California, San Francisco, CA
| | - Richard Olmstead
- Department of Psychiatry and Biobehavioral Sciences, Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA
| | - Elissa Epel
- Department of Psychiatry, Univeristy of California, San Francisco, CA
| | - Jue Lin
- Department of Biochemistry and Biophysics, University of California, San Francisco, CA
| | - Susan Redline
- Department of Medicine, Brigham and Women’s Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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Brown KM, Diez-Roux AV, Smith JA, Needham BL, Mukherjee B, Ware EB, Liu Y, Cole SW, Seeman TE, Kardia SLR. Expression of socially sensitive genes: The multi-ethnic study of atherosclerosis. PLoS One 2019; 14:e0214061. [PMID: 30973896 PMCID: PMC6459532 DOI: 10.1371/journal.pone.0214061] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 03/05/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Gene expression may be an important biological mediator in associations between social factors and health. However, previous studies were limited by small sample sizes and use of differing cell types with heterogeneous expression patterns. We use a large population-based cohort with gene expression measured solely in monocytes to investigate associations between seven social factors and expression of genes previously found to be sensitive to social factors. METHODS We employ three methodological approaches: 1) omnibus test for the entire gene set (Global ANCOVA), 2) assessment of each association individually (linear regression), and 3) machine learning method that performs variable selection with correlated predictors (elastic net). RESULTS In global analyses, significant associations with the a priori defined socially sensitive gene set were detected for major or lifetime discrimination and chronic burden (p = 0.019 and p = 0.047, respectively). Marginally significant associations were detected for loneliness and adult socioeconomic status (p = 0.066, p = 0.093, respectively). No associations were significant in linear regression analyses after accounting for multiple testing. However, a small percentage of gene expressions (up to 11%) were associated with at least one social factor using elastic net. CONCLUSION The Global ANCOVA and elastic net findings suggest that a small percentage of genes may be "socially sensitive," (i.e. demonstrate differential expression by social factor), yet single gene approaches such as linear regression may be ill powered to capture this relationship. Future research should further investigate the biological mechanisms through which social factors act to influence gene expression and how systemic changes in gene expression affect overall health.
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Affiliation(s)
- Kristen M. Brown
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, United States of America
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Ana V. Diez-Roux
- Department of Epidemiology, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, United States of America
| | - Jennifer A. Smith
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, United States of America
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Belinda L. Needham
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Bhramar Mukherjee
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Erin B. Ware
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Yongmei Liu
- Department of Epidemiology and Prevention, Wake Forest University, Winston-Salem, North Carolina, United States of America
| | - Steven W. Cole
- Department of Medicine, Division of Hematology-Oncology, University of California-Los Angeles, Los Angeles, California, United States of America
| | - Teresa E. Seeman
- Department of Medicine, University of California-Los Angeles, Los Angeles, California, United States of America
| | - Sharon L. R. Kardia
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, United States of America
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Brenner AB, Diez-Roux AV, Gebreab SY, Schulz AJ, Sims M. The Epidemiology of Coping in African American Adults in the Jackson Heart Study (JHS). J Racial Ethn Health Disparities 2018; 5:978-994. [PMID: 29218498 PMCID: PMC6060024 DOI: 10.1007/s40615-017-0445-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 10/02/2017] [Accepted: 10/30/2017] [Indexed: 10/18/2022]
Abstract
Differences in coping within the African American population are not well understood, yet these differences may be critical to reducing stress, improving health, and reducing racial health disparities. Using a descriptive, exploratory analysis of the Jackson Heart Study (N = 5301), we examine correlations between coping responses and associations between coping and demographic, socioeconomic, psychosocial, and neighborhood factors. Overall, coping responses were not strongly correlated and patterns of associations between covariates and coping responses were largely inconsistent. The results suggest that coping varies substantially within this African American population and is driven mainly by psychosocial factors such as spirituality and interpersonal support. Understanding these complex relationships may inform strategies by which to intervene in the stress process to mitigate the effects of stress on health and to identify vulnerable subgroups of African Americans that might need targeted interventions to reduce exposure to stressors and improve coping capacities.
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Affiliation(s)
- Allison B Brenner
- Institute for Social Research, Survey Research Center, University of Michigan, 426 Thompson Street, Ann Arbor, MI, 48106, USA.
| | - Ana V Diez-Roux
- Dornsife School of Public Health, Drexel University, 3215 Market Street, Philadelphia, PA, 19104, USA
| | - Samson Y Gebreab
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Amy J Schulz
- School of Public Health, University of Michigan, 2822 SPH I, 1415 Washington Heights, Ann Arbor, MI, 48109-2029, USA
| | - Mario Sims
- Department of Medicine, University of Mississippi Medical Center, 350 W. Woodrow Wilson Drive, Jackson, MS, 39213, USA
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Abstract
PURPOSE OF REVIEW The objective of this review is to highlight the evidence on the association between contextual characteristics of residential environments and type 2 diabetes, to provide an overview of the methodological challenges and to outline potential topics for future research in this field. RECENT FINDINGS The link between neighborhood socioeconomic status or deprivation and diabetes prevalence, incidence, and control is robust and has been replicated in numerous settings, including in experimental and quasi-experimental studies. The association between characteristics of the built environment that affect physical activity, other aspects of the built environment, and diabetes risk is robust. There is also evidence for an association between food environments and diabetes risk, but some conflicting results have emerged in this area. While the evidence base on the association of neighborhood socioeconomic status and built and physical environments and diabetes is large and robust, challenges remain related to confounding due to neighborhood selection. Moreover, we also outline five paths forward for future research on the role of neighborhood environments on diabetes.
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Affiliation(s)
- Usama Bilal
- Urban Health Collaborative, Drexel Dornsife School of Public Health, 3600 Market St, 7th floor, Philadelphia, PA, 19104, USA.
- Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, 3215 Market St, Philadelphia, PA, 19104, USA.
| | - Amy H Auchincloss
- Urban Health Collaborative, Drexel Dornsife School of Public Health, 3600 Market St, 7th floor, Philadelphia, PA, 19104, USA
- Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, 3215 Market St, Philadelphia, PA, 19104, USA
| | - Ana V Diez-Roux
- Urban Health Collaborative, Drexel Dornsife School of Public Health, 3600 Market St, 7th floor, Philadelphia, PA, 19104, USA
- Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, 3215 Market St, Philadelphia, PA, 19104, USA
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Affiliation(s)
- Usama Bilal
- Drexel Dornsife School of Public Health, Philadelphia, PA
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Andrade ACDS, Mingoti SA, Fernandes AP, de Andrade RG, Friche AADL, Xavier CC, Proietti FA, Diez-Roux AV, Caiaffa WT. Neighborhood-based physical activity differences: Evaluation of the effect of health promotion program. PLoS One 2018; 13:e0192115. [PMID: 29401506 PMCID: PMC5798787 DOI: 10.1371/journal.pone.0192115] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 01/18/2018] [Indexed: 11/19/2022] Open
Abstract
Introduction The practice of physical activity is an important factor in the prevention of health problems. However, a small portion of the population is physically active. Recent reviews show that physical activity classes in community settings have the potential to increase population levels of physical activity and reduce health inequalities. Objective To evaluate the effect of the Academias da Cidade Program in Belo Horizonte on the practice of physical activity in leisure time (PALT) by non-users living near the program centers. Methods We conducted a home-based health survey in Belo Horizonte (2008–2009) with 1,581 adults who were non-users of the program and who lived within a 1,500-meter radius of one active program center (exposed group) and two nonoperational centers with sites reserved for their construction (unexposed group). We collected data on PALT levels (≥150 minutes/week), which was measured with the Physical Activity International Questionnaire and analyzed with binary logistic regression using the Generalized Estimating Equations method. The propensity score was used as an adjustment variable to control the potential confusion in the measures of effect of exposure studied. Results The overall prevalence of the PALT was 26.5% in the exposed group and 22.7% in the unexposed group. The exposed group was more likely to be active in leisure time (OR = 1.05; CI 95%: 1.01–1.10). When considering the interaction between exposed group and distance, individuals in the exposed group who lived less than 500 meters from the program center were more likely to be active in leisure time (OR = 1.18, CI 95%: 1.03–1.35) compared to their counterparts. Conclusion Promoting physical activity in the community can favorably affect PALT levels among residents, especially those living closest to intervention centers. We believe the Academias da Cidade Program is a promising strategy to facilitate the access to appropriate spaces for the practice of physical activity and contribute to increase the levels physical activity within populations.
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Affiliation(s)
- Amanda Cristina de Souza Andrade
- Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
- Belo Horizonte Observatory for Urban Health, Belo Horizonte, Brazil
- * E-mail:
| | - Sueli Aparecida Mingoti
- Belo Horizonte Observatory for Urban Health, Belo Horizonte, Brazil
- Institute of Exact Sciences, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Amanda Paula Fernandes
- Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
- Belo Horizonte Observatory for Urban Health, Belo Horizonte, Brazil
| | - Roseli Gomes de Andrade
- Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
- Belo Horizonte Observatory for Urban Health, Belo Horizonte, Brazil
| | - Amélia Augusta de Lima Friche
- Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
- Belo Horizonte Observatory for Urban Health, Belo Horizonte, Brazil
| | - César Coelho Xavier
- Belo Horizonte Observatory for Urban Health, Belo Horizonte, Brazil
- Faculty of Health and Human Ecology, Vespasiano, Brazil
| | - Fernando Augusto Proietti
- Belo Horizonte Observatory for Urban Health, Belo Horizonte, Brazil
- Faculty of Health and Human Ecology, Vespasiano, Brazil
| | - Ana V. Diez-Roux
- School of Public Health, Drexel University, Philadelphia, Pennsylvania, United States of America
| | - Waleska Teixeira Caiaffa
- Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
- Belo Horizonte Observatory for Urban Health, Belo Horizonte, Brazil
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Gebreab SY, Hickson DA, Sims M, Wyatt SB, Davis SK, Correa A, Diez-Roux AV. Neighborhood social and physical environments and type 2 diabetes mellitus in African Americans: The Jackson Heart Study. Health Place 2016; 43:128-137. [PMID: 28033588 DOI: 10.1016/j.healthplace.2016.12.001] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 11/28/2016] [Accepted: 12/01/2016] [Indexed: 11/16/2022]
Abstract
Using data from Jackson Heart Study, we investigated the associations of neighborhood social and physical environments with prevalence and incidence of type 2 diabetes mellitus (T2DM) in African Americans (AA). Among non-diabetic participants at baseline (n=3670), 521 (14.2%) developed T2DM during a median follow-up of 7.3 years. Measures of neighborhood social environments, and food and physical activity resources were derived using survey-and GIS-based methods. Prevalence ratios (PR) and Hazard ratios (HR) were estimated using generalized estimating equations and Cox proportional hazards models. Higher neighborhood social cohesion was associated with a 22% lower incidence of T2DM while higher density of unfavorable food stores was associated with a 34% higher incidence of T2DM after adjusting for individual-level risk factors (HR=0.78 [95% CI:0.62, 0.99] and HR=1.34 [1.12, 1.60], respectively). In addition, neighborhood problems was also associated with prevalence of T2DM (PR=1.12 [1.03, 1.21]) independent of individual-level risk factors. Our findings suggest that efforts to strengthen community ties or to attract healthy food retail outlets might be important strategies to consider for prevention of T2DM in AA.
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Affiliation(s)
- Samson Y Gebreab
- National Human Genome Research Institute, Genomics of Metabolic, Cardiovascular and Inflammatory Branch, Cardiovascular Section, Social Epidemiology Research Unit, 10 Center Drive, Room 7N316, MSC 1644, Bethesda.
| | - DeMarc A Hickson
- School of Public Health Initiative, Jackson State University, Jackson, MS, USA
| | - Mario Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Sharon B Wyatt
- School of Nursing, University of Mississippi Medical Center, Jackson, MS, USA
| | - Sharon K Davis
- National Human Genome Research Institute, Genomics of Metabolic, Cardiovascular and Inflammatory Branch, Cardiovascular Section, Social Epidemiology Research Unit, 10 Center Drive, Room 7N320, MSC 1644, Bethesda, MD, USA
| | - Adolfo Correa
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Ana V Diez-Roux
- Center for Integrative Approaches to Health Disparities, Philadelphia, PA, USA; School of Public Health, Drexel University, Philadelphia, PA, USA
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Barber S, Hickson DA, Wang X, Sims M, Nelson C, Diez-Roux AV. Neighborhood Disadvantage, Poor Social Conditions, and Cardiovascular Disease Incidence Among African American Adults in the Jackson Heart Study. Am J Public Health 2016; 106:2219-2226. [PMID: 27736207 PMCID: PMC5105010 DOI: 10.2105/ajph.2016.303471] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2016] [Indexed: 01/31/2023]
Abstract
OBJECTIVES To examine the impact of neighborhood conditions resulting from racial residential segregation on cardiovascular disease (CVD) risk in a socioeconomically diverse African American sample. METHODS The study included 4096 African American women (n = 2652) and men (n = 1444) aged 21 to 93 years from the Jackson Heart Study (Jackson, Mississippi; 2000-2011). We assessed neighborhood disadvantage with a composite measure of 8 indicators from the 2000 US Census. We assessed neighborhood-level social conditions, including social cohesion, violence, and disorder, with self-reported, validated scales. RESULTS Among African American women, each standard deviation increase in neighborhood disadvantage was associated with a 25% increased risk of CVD after covariate adjustment (hazard ratio = 1.25; 95% confidence interval = 1.05, 1.49). Risk also increased as levels of neighborhood violence and physical disorder increased after covariate adjustment. We observed no statistically significant associations among African American men in adjusted models. CONCLUSIONS Worse neighborhood economic and social conditions may contribute to increased risk of CVD among African American women. Policies directly addressing these issues may alleviate the burden of CVD in this group.
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Affiliation(s)
- Sharrelle Barber
- Sharrelle Barber, Xu Wang, and Ana V. Diez-Roux are with Drexel University School of Public Health, Department of Epidemiology and Biostatistics, and Center for Integrative Approaches to Health Disparities, Philadelphia, PA. DeMarc A. Hickson and Mario Sims are with University of Mississippi Medical Center, Jackson. Cheryl Nelson is with National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - DeMarc A Hickson
- Sharrelle Barber, Xu Wang, and Ana V. Diez-Roux are with Drexel University School of Public Health, Department of Epidemiology and Biostatistics, and Center for Integrative Approaches to Health Disparities, Philadelphia, PA. DeMarc A. Hickson and Mario Sims are with University of Mississippi Medical Center, Jackson. Cheryl Nelson is with National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Xu Wang
- Sharrelle Barber, Xu Wang, and Ana V. Diez-Roux are with Drexel University School of Public Health, Department of Epidemiology and Biostatistics, and Center for Integrative Approaches to Health Disparities, Philadelphia, PA. DeMarc A. Hickson and Mario Sims are with University of Mississippi Medical Center, Jackson. Cheryl Nelson is with National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Mario Sims
- Sharrelle Barber, Xu Wang, and Ana V. Diez-Roux are with Drexel University School of Public Health, Department of Epidemiology and Biostatistics, and Center for Integrative Approaches to Health Disparities, Philadelphia, PA. DeMarc A. Hickson and Mario Sims are with University of Mississippi Medical Center, Jackson. Cheryl Nelson is with National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Cheryl Nelson
- Sharrelle Barber, Xu Wang, and Ana V. Diez-Roux are with Drexel University School of Public Health, Department of Epidemiology and Biostatistics, and Center for Integrative Approaches to Health Disparities, Philadelphia, PA. DeMarc A. Hickson and Mario Sims are with University of Mississippi Medical Center, Jackson. Cheryl Nelson is with National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Ana V Diez-Roux
- Sharrelle Barber, Xu Wang, and Ana V. Diez-Roux are with Drexel University School of Public Health, Department of Epidemiology and Biostatistics, and Center for Integrative Approaches to Health Disparities, Philadelphia, PA. DeMarc A. Hickson and Mario Sims are with University of Mississippi Medical Center, Jackson. Cheryl Nelson is with National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
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Yang Y, Diez-Roux AV. Adults’ Daily Walking for Travel and Leisure: Interaction Between Attitude Toward Walking and the Neighborhood Environment. Am J Health Promot 2016; 31:435-443. [DOI: 10.1177/0890117116669278] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: Studies on how the interaction of psychological and environmental characteristics influences walking are limited, and the results are inconsistent. Our aim is to examine how the attitude toward walking and neighborhood environments interacts to influence walking. Design: Cross-sectional phone and mail survey. Setting: Participants randomly sampled from 6 study sites including Los Angeles, Chicago, Baltimore, Minneapolis, Manhattan, and Bronx Counties in New York City, and Forsyth and Davidson Counties in North Carolina. Participants: The final sample consisted of 2621 persons from 2011 to 2012. Measures: Total minutes of walking for travel or leisure, attitude toward walking, and perceptions of the neighborhood environments were self-reported. Street Smart (SS) Walk Score (a measure of walkability derived from a variety of geographic data) was obtained for each residential location. Analysis: Linear regression models adjusting for age, gender, race/ethnicity, education, and income. Results: Attitude toward walking was positively associated with walking for both purposes. Walking for travel was significantly associated with SS Walk Score, whereas walking for leisure was not. The SS Walk Score and selected perceived environment characteristics were associated with walking in people with a very positive attitude toward walking but were not associated with walking in people with a less positive attitude. Conclusion: Attitudes toward walking and neighborhood environments interact to affect walking behavior.
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Affiliation(s)
- Yong Yang
- School of Public Health, University of Memphis, Memphis, TN, USA
| | - Ana V. Diez-Roux
- School of Public Health, Drexel University, Philadelphia, PA, USA
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Berchuck SI, Warren JL, Herring AH, Evenson KR, Moore KA, Ranchod YK, Diez-Roux AV. Spatially Modelling the Association Between Access to Recreational Facilities and Exercise: The 'Multi-Ethnic Study of Atherosclerosis'. J R Stat Soc Ser A Stat Soc 2016; 179:293-310. [PMID: 26877598 PMCID: PMC4751045 DOI: 10.1111/rssa.12119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Numerous studies have investigated the relationship between the built environment and physical activity. However these studies assume that these relationships are invariant over space. In this study, we introduce a novel method to analyze the association between access to recreational facilities and exercise allowing for spatial heterogeneity. In addition, this association is studied before and after controlling for crime, a variable that could explain spatial heterogeneity of associations. We use data from the Chicago site of the Multi-Ethnic Study of Atherosclerosis of 781 adults aged 46 years and over. A spatially varying coefficient Tobit regression model is implemented in the Bayesian setting to allow for the association of interest to vary over space. The relationship is shown to vary over Chicago, being positive in the south but negative or null in the north. Controlling for crime weakens the association in the south with little change observed in northern Chicago. The results of this study indicate that spatial heterogeneity in associations of environmental factors with health may vary over space and deserve further exploration.
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Affiliation(s)
- Samuel I. Berchuck
- University of North Carolina at Chapel Hill, Department of Biostatistics, Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Joshua L. Warren
- Yale University, Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
| | - Amy H. Herring
- University of North Carolina at Chapel Hill, Department of Biostatistics, Gillings School of Global Public Health, Chapel Hill, NC, USA. University of North Carolina at Chapel Hill, Carolina Population Center, Chapel Hill, NC, USA
| | - Kelly R. Evenson
- University of North Carolina at Chapel Hill, Department of Epidemiology, Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Kari A.B. Moore
- University of Michigan, Center for Social Epidemiology and Population Health, Ann Arbor, MI, USA
| | | | - Ana V. Diez-Roux
- Drexel University, School of Public Health, Philadelphia, PA, USA
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Ware EB, Smith JA, Mukherjee B, Lee S, Kardia SLR, Diez-Roux AV. Applying Novel Methods for Assessing Individual- and Neighborhood-Level Social and Psychosocial Environment Interactions with Genetic Factors in the Prediction of Depressive Symptoms in the Multi-Ethnic Study of Atherosclerosis. Behav Genet 2016; 46:89-99. [PMID: 26254610 PMCID: PMC4720563 DOI: 10.1007/s10519-015-9734-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 08/04/2015] [Indexed: 12/13/2022]
Abstract
Complex illnesses, like depression, are thought to arise from the interplay between psychosocial stressors and genetic predispositions. Approaches that take into account both personal and neighborhood factors and that consider gene regions as well as individual SNPs may be necessary to capture these interactions across race and ethnic groups. We used novel gene-region based analysis methods [Sequence Kernel Association Test (SKAT) and meta-analysis (MetaSKAT), gene-environment set association test (GESAT)], as well as traditional linear models to identify gene region and SNP × psychosocial factor interactions at the individual- and neighborhood-level, across multiple race/ethnicities. Multiple regions identified in SKAT analyses showed evidence of a significant gene-region association with averaged depressive symptom scores across race/ethnicity (MetaSKAT p values <0.001). One region × neighborhood-environment interaction was significantly associated with averaged depressive symptom score across race/ethnicity after multiple testing correction (chr 18:21454070-21494070, Fisher's combined p value = 0.001). The examination of gene regions jointly with environmental factors measured at multiple levels (individuals and their contexts) may shed light on the etiology of depressive illness across race/ethnicities.
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Affiliation(s)
- Erin B Ware
- Institute for Social Research, University of Michigan, #4614 SPH Tower, 1415 Washington Heights, Ann Arbor, MI, 48109, USA.
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
| | - Jennifer A Smith
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Bhramar Mukherjee
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Seunggeun Lee
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Sharon L R Kardia
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Ana V Diez-Roux
- Department of Epidemiology and Biostatistics, School of Public Health, Drexel University, Philadelphia, PA, USA
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Ogilvie RP, Everson-Rose SA, Longstreth WT, Rodriguez CJ, Diez-Roux AV, Lutsey PL. Psychosocial Factors and Risk of Incident Heart Failure: The Multi-Ethnic Study of Atherosclerosis. Circ Heart Fail 2015; 9:e002243. [PMID: 26699386 DOI: 10.1161/circheartfailure.115.002243] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 03/07/2013] [Indexed: 12/18/2022]
Abstract
BACKGROUND Heart failure (HF) is a major source of morbidity and mortality in the United States. Psychosocial factors have frequently been studied as risk factors for coronary heart disease but not for HF. METHODS AND RESULTS We examined the relationship between psychological status and incident HF among 6782 individuals from the Multi-Ethnic Study of Atherosclerosis (MESA). Anger, anxiety, chronic stress, depressive symptoms, and hostility were measured using validated scales, and physician reviewers adjudicated incident HF events. Cox proportional hazards models were used to adjust for relevant demographic, behavioral, and physiological covariates. Interactions by age, race, sex, and self-reported health were examined in exploratory analyses. During a mean follow-up of 9.3 years, 242 participants developed incident HF. There was no association between psychosocial factors and HF hazard ratios (95% confidence interval) for the highest versus lowest quartile: anger=1.14 (0.81-1.60), anxiety=0.74 (0.51-1.07), chronic stress=1.25 (0.90-1.72), depressive symptoms=1.19 (0.76-1.85), and hostility=0.95 (0.62-1.42). In exploratory analysis, among the participants reporting fair/poor health at baseline, those reporting high versus low levels of anxiety, chronic stress, and depressive symptoms had 2-fold higher risk of incident HF, but there was no association for those with good/very good/excellent self-reported health. CONCLUSIONS Overall, these psychosocial factors were not significantly associated with incident HF. However, for participants reporting poor health at baseline, there was evidence that anxiety, chronic stress, and depressive symptoms were associated with increased risk of HF. Future research with greater statistical power is necessary to replicate these findings and seek explanations.
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Affiliation(s)
- Rachel P Ogilvie
- From the Division of Epidemiology and Community Health, School of Public Health (R.P.O., P.L.L.) and Department of Medicine and Program in Health Disparities Research, University of Minnesota Medical School (S.A.E.-R.), Minneapolis; Departments of Neurology and Epidemiology, University of Washington, Seattle (W.T.L.); Section of Cardiology, Department of Medicine and Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC (C.J.R.); and Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, PA (A.V.D.-R.).
| | - Susan A Everson-Rose
- From the Division of Epidemiology and Community Health, School of Public Health (R.P.O., P.L.L.) and Department of Medicine and Program in Health Disparities Research, University of Minnesota Medical School (S.A.E.-R.), Minneapolis; Departments of Neurology and Epidemiology, University of Washington, Seattle (W.T.L.); Section of Cardiology, Department of Medicine and Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC (C.J.R.); and Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, PA (A.V.D.-R.)
| | - W T Longstreth
- From the Division of Epidemiology and Community Health, School of Public Health (R.P.O., P.L.L.) and Department of Medicine and Program in Health Disparities Research, University of Minnesota Medical School (S.A.E.-R.), Minneapolis; Departments of Neurology and Epidemiology, University of Washington, Seattle (W.T.L.); Section of Cardiology, Department of Medicine and Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC (C.J.R.); and Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, PA (A.V.D.-R.)
| | - Carlos J Rodriguez
- From the Division of Epidemiology and Community Health, School of Public Health (R.P.O., P.L.L.) and Department of Medicine and Program in Health Disparities Research, University of Minnesota Medical School (S.A.E.-R.), Minneapolis; Departments of Neurology and Epidemiology, University of Washington, Seattle (W.T.L.); Section of Cardiology, Department of Medicine and Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC (C.J.R.); and Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, PA (A.V.D.-R.)
| | - Ana V Diez-Roux
- From the Division of Epidemiology and Community Health, School of Public Health (R.P.O., P.L.L.) and Department of Medicine and Program in Health Disparities Research, University of Minnesota Medical School (S.A.E.-R.), Minneapolis; Departments of Neurology and Epidemiology, University of Washington, Seattle (W.T.L.); Section of Cardiology, Department of Medicine and Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC (C.J.R.); and Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, PA (A.V.D.-R.)
| | - Pamela L Lutsey
- From the Division of Epidemiology and Community Health, School of Public Health (R.P.O., P.L.L.) and Department of Medicine and Program in Health Disparities Research, University of Minnesota Medical School (S.A.E.-R.), Minneapolis; Departments of Neurology and Epidemiology, University of Washington, Seattle (W.T.L.); Section of Cardiology, Department of Medicine and Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC (C.J.R.); and Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, PA (A.V.D.-R.)
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Jones MR, Diez-Roux AV, O’Neill MS, Guallar E, Sharrett AR, Post W, Kaufman JD, Navas-Acien A. Ambient air pollution and racial/ethnic differences in carotid intima-media thickness in the Multi-Ethnic Study of Atherosclerosis (MESA). J Epidemiol Community Health 2015; 69:1191-8. [PMID: 26142402 PMCID: PMC4763882 DOI: 10.1136/jech-2015-205588] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 06/17/2015] [Indexed: 11/03/2022]
Abstract
BACKGROUND In the USA, ethnic disparities in atherosclerosis persist after accounting for known risk factors. Ambient air pollution is associated with increased levels of atherosclerosis and differs in the USA by race/ethnicity. We estimated the influence of ambient air pollution exposure to ethnic differences in common carotid intima-media thickness (IMT). METHODS We cross-sectionally studied 6347 Caucasian-American, African-American, Hispanic and Chinese adults across 6 US cities in 2000-2002. Annual ambient air pollution concentrations (fine particulate matter [PM2.5] and oxides of nitrogen [NOX]) were estimated at each participant's residence. IMT was assessed by ultrasound. RESULTS The mean IMT was 19.4 and 37.6 μm smaller for Hispanic women and men, 53.6 and 7.1 μm smaller for Chinese women and men, and 23.4 and 38.7 μm higher for African-American women and men compared with Caucasian-American women and men. After adjustment for PM2.5, the differences in IMT remained similar for Hispanic and African-American participants but was even more negative for Chinese participants (mean IMT difference of -58.4 μm for women and -15.7 μm for men) compared with Caucasian-American participants. The IMT difference in Chinese participants compared with Caucasian-American participants related to their higher PM2.5 exposures was 4.8 μm (95% CI 0.2 to 10.8) for women and 8.6 μm (95% CI 3.4 to 15.3) for men. NOX was not related to ethnic differences in IMT. CONCLUSIONS The smaller carotid IMT levels in Chinese participants were even smaller after accounting for higher PM2.5 concentrations in Chinese participants compared with Caucasian-American participants. Air pollution was not related to IMT differences in African-American and Hispanic participants compared with Caucasian-American participants.
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Affiliation(s)
- Miranda R Jones
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ana V Diez-Roux
- University of Michigan School of Public Health, Ann Arbor, Michigan, USA
- Drexel University School of Public Health, Philadelphia, Pennsylvania, USA
| | - Marie S O’Neill
- University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Eliseo Guallar
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - A Richey Sharrett
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Wendy Post
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Joel D Kaufman
- University of Washington School of Public Health, Seattle, Washington, USA
| | - Ana Navas-Acien
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Landsbergis PA, Diez-Roux AV, Fujishiro K, Baron S, Kaufman JD, Meyer JD, Koutsouras G, Shimbo D, Shrager S, Stukovsky KH, Szklo M. Job Strain, Occupational Category, Systolic Blood Pressure, and Hypertension Prevalence: The Multi-Ethnic Study of Atherosclerosis. J Occup Environ Med 2015; 57:1178-84. [PMID: 26539765 PMCID: PMC4636023 DOI: 10.1097/jom.0000000000000533] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To assess associations of occupational categories and job characteristics with prevalent hypertension. METHODS We analyzed 2517 Multi-Ethnic Study of Atherosclerosis participants, working 20+ hours per week, in 2002 to 2004. RESULTS Higher job decision latitude was associated with a lower prevalence of hypertension, prevalence ratio = 0.78 (95% confidence interval 0.66 to 0.91) for the top versus bottom quartile of job decision latitude. Associations, however, differed by occupation: decision latitude was associated with a higher prevalence of hypertension in health care support occupations (interaction P = 0.02). Occupation modified associations of sex with hypertension: a higher prevalence of hypertension in women (vs men) was observed in health care support and in blue-collar occupations (interaction P = 0.03). CONCLUSIONS Lower job decision latitude is associated with hypertension prevalence in many occupations. Further research is needed to determine reasons for differential impact of decision latitude and sex on hypertension across occupations.
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Affiliation(s)
- Paul A Landsbergis
- Department of Environmental and Occupational Health Sciences (Dr Landsbergis, Mr Koutsouras), State University of New York Downstate School of Public Health, Brooklyn; School of Public Health (Dr Diez-Roux), Drexel University, Philadelphia, Pennsylvania; Division of Surveillance, Hazard Evaluations, and Field Studies (Dr Fujishiro), National Institute for Occupational Safety and Health, Cincinnati, Ohio; Barry Commoner Center for Health and the Environment (Dr Baron), Queens College, New York; Department of Environmental and Occupational Health Sciences (Dr Kaufman), University of Washington, Seattle; Department of Preventive Medicine (Dr Meyer), Mount Sinai School of Medicine; Department of Medicine (Dr Shimbo), Columbia University, New York; Department of Biostatistics (Ms Shrager), University of Washington, Seattle; and Department of Epidemiology (Dr Szklo), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Sims M, Diez-Roux AV, Gebreab SY, Brenner A, Dubbert P, Wyatt S, Bruce M, Hickson D, Payne T, Taylor H. Perceived discrimination is associated with health behaviours among African-Americans in the Jackson Heart Study. J Epidemiol Community Health 2015; 70:187-94. [PMID: 26417003 DOI: 10.1136/jech-2015-206390] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Accepted: 09/11/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND Using Jackson Heart Study data, we examined associations of multiple measures of perceived discrimination with health behaviours among African-Americans (AA). METHODS The cross-sectional associations of everyday, lifetime and burden of discrimination with odds of smoking and mean differences in physical activity, dietary fat and sleep were examined among 4925 participants aged 35-84 years after adjustment for age and socioeconomic status (SES). RESULTS Men reported slightly higher levels of everyday and lifetime discrimination than women and similar levels of burden of discrimination as women. After adjustment for age and SES, everyday discrimination was associated with more smoking and a greater percentage of dietary fat in men and women (OR for smoking: 1.13, 95% CI 1.00 to 1.28 and 1.19, 95% CI 1.05 to 1.34; mean difference in dietary fat: 0.37, p<0.05 and 0.43, p<0.01, in men and women, respectively). Everyday and lifetime discrimination were associated with fewer hours of sleep in men and women (mean difference for everyday discrimination: -0.08, p<0.05 and -0.18, p<0.001, respectively; and mean difference for lifetime discrimination: -0.08, p<0.05 and -0.24, p<0.001, respectively). Burden of discrimination was associated with more smoking and fewer hours of sleep in women only. CONCLUSIONS Higher levels of perceived discrimination were associated with select health behaviours among men and women. Health behaviours offer a potential mechanism through which perceived discrimination affects health in AA.
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Affiliation(s)
- Mario Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Ana V Diez-Roux
- School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Samson Y Gebreab
- Metabolic, Cardiovascular and Inflammatory Disease Genomics Branch, National Human Genome Research Institute (NHGRI), Bethesda, Maryland, USA
| | - Allison Brenner
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Patricia Dubbert
- Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, North Little Rock, Arkansas, USA
| | - Sharon Wyatt
- School of Nursing, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Marino Bruce
- Department of Sociology and Criminology, Jackson State University, Jackson, Mississippi, USA
| | - DeMarc Hickson
- Center for Research, Evaluation and Environmental & Policy Change, My Brother's Keeper, Inc, Jackson, Mississippi, USA
| | - Tom Payne
- Department of Otolaryngology & Communicative Sciences, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Herman Taylor
- Cardiovascular Research Institute, Morehouse School of Medicine, Atlanta, Georgia, USA
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Unger E, Diez-Roux AV, Lloyd-Jones DM, Mujahid MS, Nettleton JA, Bertoni A, Badon SE, Ning H, Allen NB. Association of neighborhood characteristics with cardiovascular health in the multi-ethnic study of atherosclerosis. Circ Cardiovasc Qual Outcomes 2015; 7:524-31. [PMID: 25006187 DOI: 10.1161/circoutcomes.113.000698] [Citation(s) in RCA: 121] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The concept of cardiovascular health (CVH) was introduced as a global measure of one's burden of cardiovsacular risk factors. Previous studies established the relationship between neighborhood characteristics and individual cardiovascular risk factors. However, the relationship between neighborhood environment and overall CVH remains unknown. METHODS AND RESULTS We analyzed data from the Multi-Ethnic Study of Atherosclerosis baseline examination (2000–2002). Mean age was 61.6 years, and 52% were women. Ideal, intermediate, and poor categories of cholesterol, body mass index, diet, physical activity, fasting glucose, blood pressure, and smoking were defined according to the American Heart Association 2020 Strategic Goals, assigned an individual score, and summed to create an overall score. CVH scores were categorized into ideal (11–14 points), intermediate (9–10), and poor (0–8). Neighborhood exposures included favorable food store and physical activity resources densities (by 1-mile buffer), reported healthy food availability,walking/physical activity environment, safety, and social cohesion (by census tract). Multinomial logistic regression was used to determine the association of each characteristic with ideal and intermediate CVH, adjusted for demographics and neighborhood socioeconomic status. Over 20% of Multi-Ethnic Study of Atherosclerosis participants had an ideal CVH score at baseline. In fully adjusted models, favorable food stores (odds ratio=1.22; 1.06–1.40), physical activity resources(odds ratio=1.19; 1.08–1.31), walking/physical activity environment (odds ratio=1.20; 1.05–1.37), and neighborhood socioeconomic status (odds ratio=1.22; 1.11–1.33) were associated with higher odds of having an ideal CVH score. CONCLUSIONS Neighborhood environment including favorable food stores, physical activity resources, walking/physical activity environment, and neighborhood socioeconomic status are associated with ideal CVH. Further research is needed to investigate the longitudinal associations between neighborhood environment and CVH.
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Nethery RC, Warren JL, Herring AH, Moore KAB, Evenson KR, Diez-Roux AV. A common spatial factor analysis model for measured neighborhood-level characteristics: The Multi-Ethnic Study of Atherosclerosis. Health Place 2015; 36:35-46. [PMID: 26372887 DOI: 10.1016/j.healthplace.2015.08.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 06/11/2015] [Accepted: 08/26/2015] [Indexed: 11/19/2022]
Abstract
The purpose of this study was to reduce the dimensionality of a set of neighborhood-level variables collected on participants in the Multi-Ethnic Study of Atherosclerosis (MESA) while appropriately accounting for the spatial structure of the data. A common spatial factor analysis model in the Bayesian setting was utilized in order to properly characterize dependencies in the data. Results suggest that use of the spatial factor model can result in more precise estimation of factor scores, improved insight into the spatial patterns in the data, and the ability to more accurately assess associations between the neighborhood environment and health outcomes.
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Affiliation(s)
- Rachel C Nethery
- University of North Carolina at Chapel Hill, Department of Biostatistics, Gillings School of Global Public Health, Hall, CB # 7420, Chapel USA.
| | - Joshua L Warren
- Yale University, Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
| | - Amy H Herring
- University of North Carolina at Chapel Hill, Department of Biostatistics, Gillings School of Global Public Health, Hall, CB # 7420, Chapel USA
| | - Kari A B Moore
- Drexel University, Department of Epidemiology and Biostatistics, Philadelphia, PA, USA
| | - Kelly R Evenson
- University of North Carolina at Chapel Hill, Department of Epidemiology, Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Ana V Diez-Roux
- Drexel University, School of Public Health, Philadelphia, PA, USA
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Moffitt R, Schoeni RF, Brown C, Chase-Lansdale PL, Couper MP, Diez-Roux AV, Hurst E, Seltzer JA. Assessing the need for a new nationally representative household panel survey in the United States. ACTA ACUST UNITED AC 2015; 40:1-26. [PMID: 26688609 DOI: 10.3233/jem-150411] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We introduce this special issue on the critical matter of whether the existing household panel surveys in the U.S. are adequate to address the important emerging social science and policy questions of the next few decades. We summarize the conference papers which address this issue in different domains. The papers detail many new and important emerging research questions but also identify key limitations in existing panels in addressing those questions. To address these limitations, we consider the advantages and disadvantages of initiating a new, general-purpose omnibus household panel in the U.S. We also discuss the particular benefits of starting new panels that have specific targeted domains such as child development, population health and health care. We also develop a list of valuable enhancements to existing panels which could address many of their limitations.
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Affiliation(s)
- Robert Moffitt
- Department of Economics, Johns Hopkins University, Baltimore, MD, USA
| | - Robert F Schoeni
- Institute for Social Research, Department of Economics, and School of Public Policy, University of Michigan, Ann Arbor, MI, USA
| | - Charles Brown
- Department of Economics and Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | | | - Mick P Couper
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Ana V Diez-Roux
- School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Erik Hurst
- Booth School of Business, University of Chicago, Chicago, IL, USA
| | - Judith A Seltzer
- Department of Sociology, University of California at Los Angeles, Los Angeles, CA, USA
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Hajat A, Moore K, Do DP, Stein Merkin S, Punjabi NM, Sáñchez BN, Seeman T, Diez-Roux AV. Examining the cross-sectional and longitudinal association between diurnal cortisol and neighborhood characteristics: Evidence from the multi-ethnic study of atherosclerosis. Health Place 2015; 34:199-206. [PMID: 26073509 DOI: 10.1016/j.healthplace.2015.05.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 05/26/2015] [Accepted: 05/28/2015] [Indexed: 11/26/2022]
Abstract
We examined cross-sectional and longitudinal associations between neighborhood socioeconomic status, social cohesion and safety and features of the diurnal cortisol curve including: area under the curve (AUC), wake-to-bed slope, wake-up, cortisol awakening response (CAR, wake-up to 30 min post-awakening), early decline (30 min to 2 h post-awakening) and late decline (2 h post-awakening to bed time). In cross-sectional analyses, higher neighborhood poverty was associated with a flatter early decline and a flatter wake-to-bed slope. Higher social cohesion and safety were associated with higher wake-up cortisol, steeper early decline and steeper wake-to-bed slope. Over 5 years, wake-up cortisol increased, CAR, early decline, late decline and wake-to-bed slope became flatter and AUC became larger. Higher poverty was associated with less pronounced increases in wake-up and AUC, while higher social cohesion was associated with greater increases in wake-up and AUC. Adverse neighborhood environments were cross-sectionally associated with flatter cortisol profiles, but associations with changes in cortisol were weak and not in the expected direction.
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Affiliation(s)
- Anjum Hajat
- University of Washington, School of Public Health, Department of Epidemiology, 4225 Roosevelt Way NE, Suite 303, Seattle, WA 98105, USA.
| | - Kari Moore
- Drexel University, School of Public Health, Department of Epidemiology and Biostatistics, Nesbitt Hall, 3215 Market Street, Philadelphia, PA 19104, USA.
| | - D Phuong Do
- University of Wisconsin Milwaukee, Zilber School of Public Health, Department of Epidemiology and Public Health Policy and Administration, 1240 N, 10th Street, Milwaukee, WA 53201, USA.
| | - Sharon Stein Merkin
- University of California Los Angeles, David Geffen School of Medicine, Department of Medicine, Division of Geriatrics, 10945 Le Conte Avenue, Suite 2339, Los Angeles, CA 90095, USA.
| | - Naresh M Punjabi
- Johns Hopkins University, Division of Pulmonary and Critical Care Medicine, 5501 Hopkins Bayview Circle, Room 4B.36, Baltimore, MD 21224, USA
| | - Brisa Ney Sáñchez
- University of Michigan, School of Public Health, Department of Biostatistics, 1415 Washington Heights, M4124 SPH II, Ann Arbor, MI 48109, USA.
| | - Teresa Seeman
- University of California Los Angeles, David Geffen School of Medicine, Department of Medicine, Division of Geriatrics, 10945 Le Conte Avenue, Suite 2339, Los Angeles, CA 90095, USA.
| | - Ana V Diez-Roux
- Drexel University, School of Public Health, Department of Epidemiology and Biostatistics, Nesbitt Hall, 3215 Market Street, Philadelphia, PA 19104, USA.
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Gebreab SY, Davis SK, Symanzik J, Mensah GA, Gibbons GH, Diez-Roux AV. Geographic variations in cardiovascular health in the United States: contributions of state- and individual-level factors. J Am Heart Assoc 2015; 4:e001673. [PMID: 26019131 PMCID: PMC4599527 DOI: 10.1161/jaha.114.001673] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Improving cardiovascular health (CVH) of all Americans by 2020 is a strategic goal of the American Heart Association. Understanding the sources of variation and identifying contextual factors associated with poor CVH may suggest important avenues for prevention. Methods and Results Cross-sectional data from the Behavioral Risk Factor Surveillance System for the year 2011 were linked to state-level coronary heart disease and stroke mortality data from the National Vital Statistics System and to state-level measures of median household income, income inequality, taxes on soda drinks and cigarettes, and food and physical activity environments from various administrative sources. Poor CVH was defined according to the American Heart Association definition using 7 self-reported CVH metrics (current smoking, physical inactivity, obesity, poor diet, hypertension, diabetes, and high cholesterol). Linked micromap plots and multilevel logistic models were used to examine state variation in poor CVH and to investigate the contributions of individual- and state-level factors to this variation. We found significant state-level variation in the prevalence of poor CVH (median odds ratio 1.32, P<0.001). Higher rates of poor CVH and cardiovascular disease mortality were clustered in the southern states. Minority and low socioeconomic groups were strongly associated with poor CVH and explained 51% of the state-level variation in poor CVH; state-level factors explained an additional 28%. State-level median household income (odds ratio 0.89; 95% CI 0.84–0.94), taxes on soda drinks (odds ratio 0.94; 95% CI 0.89–0.99), farmers markets (odds ratio 0.91; 95% CI 0.85–0.98), and convenience stores (odds ratio 1.09; 95% CI 1.01–1.17) were predictive of poor CVH even after accounting for individual-level factors. Conclusions There is significant state-level variation in poor CVH that is partly explained by individual- and state-level factors. Additional longitudinal research is warranted to examine the influence of state-level policies and food and physical activity environments on poor CVH.
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Affiliation(s)
- Samson Y Gebreab
- Metabolic, Cardiovascular and Inflammatory Disease Genomics Branch, National Human Genome Research Institute (NHGRI), NIH, Bethesda, MD (S.Y.G., S.K.D., G.H.G.)
| | - Sharon K Davis
- Metabolic, Cardiovascular and Inflammatory Disease Genomics Branch, National Human Genome Research Institute (NHGRI), NIH, Bethesda, MD (S.Y.G., S.K.D., G.H.G.)
| | - Jürgen Symanzik
- Department of Statistics, Utah State University, Logan, UT (S.)
| | - George A Mensah
- National Heart, Lung, and Blood Institute (NHLBI), NIH, Bethesda, MD (G.A.M.)
| | - Gary H Gibbons
- Metabolic, Cardiovascular and Inflammatory Disease Genomics Branch, National Human Genome Research Institute (NHGRI), NIH, Bethesda, MD (S.Y.G., S.K.D., G.H.G.)
| | - Ana V Diez-Roux
- Michigan Center for Integrative Approaches to Health Disparities (CIAHD), University of Michigan, Ann Arbor, MI (A.V.D.R.) School of Public Health, Drexel University, Philadelphia, PA (A.V.D.R.)
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Yang Y, Auchincloss AH, Rodriguez DA, Brown DG, Riolo R, Diez-Roux AV. Modeling spatial segregation and travel cost influences on utilitarian walking: Towards policy intervention. Comput Environ Urban Syst 2015; 51:59-69. [PMID: 25733776 PMCID: PMC4342617 DOI: 10.1016/j.compenvurbsys.2015.01.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We develop an agent-based model of utilitarian walking and use the model to explore spatial and socioeconomic factors affecting adult utilitarian walking and how travel costs as well as various educational interventions aimed at changing attitudes can alter the prevalence of walking and income differentials in walking. The model is validated against US national data. We contrast realistic and extreme parameter values in our model and test effects of changing these parameters across various segregation and pricing scenarios while allowing for interactions between travel choice and place and for behavioral feedbacks. Results suggest that in addition to income differences in the perceived cost of time, the concentration of mixed land use (differential density of residences and businesses) are important determinants of income differences in walking (high income walk less), whereas safety from crime and income segregation on their own do not have large influences on income differences in walking. We also show the difficulty in altering walking behaviors for higher income groups who are insensitive to price and how adding to the cost of driving could increase the income differential in walking particularly in the context of segregation by income and land use. We show that strategies to decrease positive attitudes towards driving can interact synergistically with shifting cost structures to favor walking in increasing the percent of walking trips. Agent-based models, with their ability to capture dynamic processes and incorporate empirical data, are powerful tools to explore the influence on health behavior from multiple factors and test policy interventions.
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Affiliation(s)
- Yong Yang
- School of Public Health, University of Memphis, Memphis, TN, USA
| | - Amy H. Auchincloss
- Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, Pa, USA
| | - Daniel A. Rodriguez
- Department of City and Regional Planning, University of North Carolina, Chapel Hill, NC, USA
| | - Daniel G. Brown
- School of Natural Resources & Environment, University of Michigan, Ann Arbor, MI, USA
| | - Rick Riolo
- Center for the Study of Complex Systems, University of Michigan, Ann Arbor, MI, USA
| | - Ana V. Diez-Roux
- School of Public Health, Drexel University, Philadelphia, PA, USA
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Park SK, Adar SD, O'Neill MS, Auchincloss AH, Szpiro A, Bertoni AG, Navas-Acien A, Kaufman JD, Diez-Roux AV. Long-term exposure to air pollution and type 2 diabetes mellitus in a multiethnic cohort. Am J Epidemiol 2015; 181:327-36. [PMID: 25693777 DOI: 10.1093/aje/kwu280] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Although air pollution has been suggested as a possible risk factor for type 2 diabetes mellitus (DM), results from existing epidemiologic studies have been inconsistent. We investigated the associations of prevalence and incidence of DM with long-term exposure to air pollution as estimated using annual average concentrations of particulate matter with an aerodynamic diameter of 2.5 μm or less (PM₂.₅) and nitrogen oxides at baseline (2000) in the Multi-Ethnic Study of Atherosclerosis. All participants were aged 45-84 years at baseline and were recruited from 6 US sites. There were 5,839 participants included in the study of prevalent DM and 5,135 participants without DM at baseline in whom we studied incident DM. After adjustment for potential confounders, we found significant associations of prevalent DM with PM₂.₅ (odds ratio (OR) = 1.09, 95% confidence interval (CI): 1.00, 1.17) and nitrogen oxides (OR = 1.18, 95% CI: 1.01, 1.38) per each interquartile-range increase (2.43 µg/m(3) and 47.1 ppb, respectively). Larger but nonsignificant associations were observed after further adjustment for study site (for PM₂.₅, OR = 1.16, 95% CI: 0.94, 1.42; for nitrogen oxides, OR = 1.29, 95% CI: 0.94, 1.76). No air pollution measures were significantly associated with incident DM over the course of the 9-year follow-up period. Results were partly consistent with a link between long-term exposure to air pollution and the risk of type 2 DM. Additional studies with a longer follow-up time and a greater range of air pollution exposures, including high levels, are warranted to evaluate the hypothesized association.
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Laposky AD, Van Cauter E, Diez-Roux AV. Reducing health disparities: the role of sleep deficiency and sleep disorders. Sleep Med 2015; 18:3-6. [PMID: 26431756 DOI: 10.1016/j.sleep.2015.01.007] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Revised: 12/22/2014] [Accepted: 01/14/2015] [Indexed: 12/31/2022]
Abstract
Decrements in sleep health, including insufficient sleep duration, irregular timing of sleep, poor sleep quality, and sleep/circadian disorders, are widespread in modern society and are associated with an array of disease risks and outcomes, including those contributing to health disparities (eg, cardiovascular disease, obesity and diabetes, psychiatric illness, and cancer). Recent findings have uncovered racial/ethnic and socioeconomic position differences in sleep health; however, the contribution of sleep deficiency to health disparities remains largely unexplored, and understanding the underlying causes of disparities in sleep health is only beginning to emerge. In 2011, the National Heart, Lung, and Blood Institute (NHLBI) convened a workshop, bringing together sleep and health disparities investigators, to identify research gaps and opportunities to advance sleep and health disparities science. This article provides a brief background and rationale for the workshop, and it disseminates the research recommendations and priorities resulting from the working group discussions.
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Affiliation(s)
- Aaron D Laposky
- National Heart, Lung and Blood Institute, National Institutes of Health, 6701 Rockledge Drive, Suite 10042, Bethesda, MD 20892-7952, USA.
| | - Eve Van Cauter
- Department of Medicine, University of Chicago, 5841 South Maryland Ave, MC 6092, Chicago, IL 60637, USA
| | - Ana V Diez-Roux
- School of Public Health, Drexel University, 3215 Market St., Philadelphia, PA 19104, USA
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Adar SD, Kaufman JD, Diez-Roux AV, Hoffman EA, D'Souza J, Stukovsky KH, Rich SS, Rotter JI, Guo X, Raffel LJ, Sampson PD, Oron AP, Raghunathan T, Barr RG. Air pollution and percent emphysema identified by computed tomography in the Multi-Ethnic study of Atherosclerosis. Environ Health Perspect 2015; 123:144-51. [PMID: 25302408 PMCID: PMC4314244 DOI: 10.1289/ehp.1307951] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 10/09/2014] [Indexed: 05/27/2023]
Abstract
BACKGROUND Air pollution is linked to low lung function and to respiratory events, yet little is known of associations with lung structure. OBJECTIVES We examined associations of particulate matter (PM2.5, PM10) and nitrogen oxides (NOx) with percent emphysema-like lung on computed tomography (CT). METHODS The Multi-Ethnic Study of Atherosclerosis (MESA) recruited participants (45-84 years of age) in six U.S. states. Percent emphysema was defined as lung regions < -910 Hounsfield Units on cardiac CT scans acquired following a highly standardized protocol. Spirometry was also conducted on a subset. Individual-level 1- and 20-year average air pollution exposures were estimated using spatiotemporal models that included cohort-specific measurements. Multivariable regression was conducted to adjust for traditional risk factors and study location. RESULTS Among 6,515 participants, we found evidence of an association between percent emphysema and long-term pollution concentrations in an analysis leveraging between-city exposure contrasts. Higher concentrations of PM2.5 (5 μg/m3) and NOx (25 ppb) over the previous year were associated with 0.6 (95% CI: 0.1, 1.2%) and 0.5 (95% CI: 0.1, 0.9%) higher average percent emphysema, respectively. However, after adjustment for study site the associations were -0.6% (95% CI: -1.5, 0.3%) for PM2.5 and -0.5% (95% CI: -1.1, 0.02%) for NOx. Lower lung function measures (FEV1 and FVC) were associated with higher PM2.5 and NOx levels in 3,791 participants before and after adjustment for study site, though most associations were not statistically significant. CONCLUSIONS Associations between ambient air pollution and percentage of emphysema-like lung were inconclusive in this cross-sectional study, thus longitudinal analyses may better clarify these associations with percent emphysema.
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Affiliation(s)
- Sara D Adar
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
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Ko YA, Mukherjee B, Smith JA, Park SK, Kardia SLR, Allison MA, Vokonas PS, Chen J, Diez-Roux AV. Testing departure from additivity in Tukey's model using shrinkage: application to a longitudinal setting. Stat Med 2014; 33:5177-91. [PMID: 25112650 DOI: 10.1002/sim.6281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 06/10/2014] [Accepted: 07/10/2014] [Indexed: 01/12/2023]
Abstract
While there has been extensive research developing gene-environment interaction (GEI) methods in case-control studies, little attention has been given to sparse and efficient modeling of GEI in longitudinal studies. In a two-way table for GEI with rows and columns as categorical variables, a conventional saturated interaction model involves estimation of a specific parameter for each cell, with constraints ensuring identifiability. The estimates are unbiased but are potentially inefficient because the number of parameters to be estimated can grow quickly with increasing categories of row/column factors. On the other hand, Tukey's one-degree-of-freedom model for non-additivity treats the interaction term as a scaled product of row and column main effects. Because of the parsimonious form of interaction, the interaction estimate leads to enhanced efficiency, and the corresponding test could lead to increased power. Unfortunately, Tukey's model gives biased estimates and low power if the model is misspecified. When screening multiple GEIs where each genetic and environmental marker may exhibit a distinct interaction pattern, a robust estimator for interaction is important for GEI detection. We propose a shrinkage estimator for interaction effects that combines estimates from both Tukey's and saturated interaction models and use the corresponding Wald test for testing interaction in a longitudinal setting. The proposed estimator is robust to misspecification of interaction structure. We illustrate the proposed methods using two longitudinal studies-the Normative Aging Study and the Multi-ethnic Study of Atherosclerosis.
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Affiliation(s)
- Yi-An Ko
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, 48109, U.S.A
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Franco M, Bilal U, Diez-Roux AV. Preventing non-communicable diseases through structural changes in urban environments. J Epidemiol Community Health 2014; 69:509-11. [DOI: 10.1136/jech-2014-203865] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 10/25/2014] [Indexed: 11/04/2022]
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Jones MR, Diez-Roux AV, Hajat A, Kershaw KN, O'Neill MS, Guallar E, Post WS, Kaufman JD, Navas-Acien A. Race/ethnicity, residential segregation, and exposure to ambient air pollution: the Multi-Ethnic Study of Atherosclerosis (MESA). Am J Public Health 2014; 104:2130-7. [PMID: 25211756 DOI: 10.2105/ajph.2014.302135] [Citation(s) in RCA: 108] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We described the associations of ambient air pollution exposure with race/ethnicity and racial residential segregation. METHODS We studied 5921 White, Black, Hispanic, and Chinese adults across 6 US cities between 2000 and 2002. Household-level fine particulate matter (PM2.5) and nitrogen oxides (NOX) were estimated for 2000. Neighborhood racial composition and residential segregation were estimated using US census tract data for 2000. RESULTS Participants in neighborhoods with more than 60% Hispanic populations were exposed to 8% higher PM2.5 and 31% higher NOX concentrations compared with those in neighborhoods with less than 25% Hispanic populations. Participants in neighborhoods with more than 60% White populations were exposed to 5% lower PM2.5 and 18% lower NOX concentrations compared with those in neighborhoods with less than 25% of the population identifying as White. Neighborhoods with Whites underrepresented or with Hispanics overrepresented were exposed to higher PM2.5 and NOX concentrations. No differences were observed for other racial/ethnic groups. CONCLUSIONS Living in majority White neighborhoods was associated with lower air pollution exposures, and living in majority Hispanic neighborhoods was associated with higher air pollution exposures. This new information highlighted the importance of measuring neighborhood-level segregation in the environmental justice literature.
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Affiliation(s)
- Miranda R Jones
- Miranda R. Jones and Eliseo Guallar are with the Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD. Wendy S. Post is with the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD. Ana Navas-Acien is with the Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health. Ana V. Diez-Roux and Marie S. O'Neill are with the Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor. Anjum Hajat and Joel D. Kaufman are with the Department of Environmental and Occupational Health Sciences, University of Washington School of Public Health, Seattle. Kiarri N. Kershaw is with the Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
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Hiatt RA, Porco TC, Liu F, Balke K, Balmain A, Barlow J, Braithwaite D, Diez-Roux AV, Kushi LH, Moasser MM, Werb Z, Windham GC, Rehkopf DH. A multilevel model of postmenopausal breast cancer incidence. Cancer Epidemiol Biomarkers Prev 2014; 23:2078-92. [PMID: 25017248 DOI: 10.1158/1055-9965.epi-14-0403] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Breast cancer has a complex etiology that includes genetic, biologic, behavioral, environmental, and social factors. Etiologic factors are frequently studied in isolation with adjustment for confounding, mediating, and moderating effects of other factors. A complex systems model approach may present a more comprehensive picture of the multifactorial etiology of breast cancer. METHODS We took a transdisciplinary approach with experts from relevant fields to develop a conceptual model of the etiology of postmenopausal breast cancer. The model incorporated evidence of both the strength of association and the quality of the evidence. We operationalized this conceptual model through a mathematical simulation model with a subset of variables, namely, age, race/ethnicity, age at menarche, age at first birth, age at menopause, obesity, alcohol consumption, income, tobacco use, use of hormone therapy (HT), and BRCA1/2 genotype. RESULTS In simulating incidence for California in 2000, the separate impact of individual variables was modest, but reduction in HT, increase in the age at menarche, and to a lesser extent reduction in excess BMI >30 kg/m(2) were more substantial. CONCLUSIONS Complex systems models can yield new insights on the etiologic factors involved in postmenopausal breast cancer. Modification of factors at a population level may only modestly affect risk estimates, while still having an important impact on the absolute number of women affected. IMPACT This novel effort highlighted the complexity of breast cancer etiology, revealed areas of challenge in the methodology of developing complex systems models, and suggested additional areas for further study.
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Affiliation(s)
- Robert A Hiatt
- Department of Epidemiology and Biostatistics, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California.
| | - Travis C Porco
- Department of Epidemiology and Biostatistics, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California. Francis I. Proctor Foundation, University of California San Francisco, San Francisco, California
| | - Fengchen Liu
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, California
| | - Kaya Balke
- Department of Epidemiology and Biostatistics, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
| | - Allan Balmain
- Department of Biochemistry and Biophysics, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
| | | | - Dejana Braithwaite
- Department of Epidemiology and Biostatistics, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
| | - Ana V Diez-Roux
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan
| | | | - Mark M Moasser
- Department of Medicine, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
| | - Zena Werb
- Department of Anatomy, Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
| | - Gayle C Windham
- Division of Environmental and Occupational Disease Control, California Department of Public Health, Richmond, California
| | - David H Rehkopf
- Department of Medicine, Stanford University, Stanford, California
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