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Zhu AL, Le AD, Li Y, Palaniappan LP, Srinivasan M, Shah NS, Wong SS, Valero-Elizondo J, Elfassy T, Yang E. Social Determinants of Cardiovascular Risk Factors Among Asian American Subgroups. J Am Heart Assoc 2024; 13:e032509. [PMID: 38567660 DOI: 10.1161/jaha.123.032509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 01/30/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Social determinants of health (SDOH) play a significant role in the development of cardiovascular risk factors. We investigated SDOH associations with cardiovascular risk factors among Asian American subgroups. METHODS AND RESULTS We utilized the National Health Interview Survey, a nationally representative survey of US adults, years 2013 to 2018. SDOH variables were categorized into economic stability, neighborhood and social cohesion, food security, education, and health care utilization. SDOH score was created by categorizing 27 SDOH variables as 0 (favorable) or 1 (unfavorable). Self-reported cardiovascular risk factors included diabetes, high cholesterol, high blood pressure, obesity, insufficient physical activity, suboptimal sleep, and nicotine exposure. Among 6395 Asian adults aged ≥18 years, 22.1% self-identified as Filipino, 21.6% as Asian Indian, 21.0% as Chinese, and 35.3% as other Asian. From multivariable-adjusted logistic regression models, each SD increment of SDOH score was associated with higher odds of diabetes among Chinese (odds ratio [OR], 1.45; 95% CI, 1.04-2.03) and Filipino (OR, 1.24; 95% CI, 1.02-1.51) adults; high blood pressure among Filipino adults (OR, 1.28; 95% CI, 1.03-1.60); insufficient physical activity among Asian Indian (OR, 1.42; 95% CI, 1.22-1.65), Chinese (OR, 1.58; 95% CI, 1.33-1.88), and Filipino (OR, 1.24; 95% CI, 1.06-1.46) adults; suboptimal sleep among Asian Indian adults (OR, 1.20; 95% CI, 1.01-1.42); and nicotine exposure among Chinese (OR, 1.56; 95% CI, 1.15-2.11) and Filipino (OR, 1.50; 95% CI, 1.14-1.97) adults. CONCLUSIONS Unfavorable SDOH are associated with higher odds of cardiovascular risk factors in Asian American subgroups. Culturally specific interventions addressing SDOH may help improve cardiovascular health among Asian Americans.
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Affiliation(s)
- Alicia L Zhu
- Stanford University Center for Asian Healthcare Research and Education Stanford CA
- College of Arts and Sciences, School of Global Public Health New York University New York NY
| | - Austin D Le
- Stanford University Center for Asian Healthcare Research and Education Stanford CA
- Environmental Health Sciences Division University of California, Berkeley, School of Public Health Berkeley CA
| | - Yuemeng Li
- Stanford University Center for Asian Healthcare Research and Education Stanford CA
- Nell Hodgson Woodruff School of Nursing Emory University Atlanta GA
| | - Latha P Palaniappan
- Stanford University Center for Asian Healthcare Research and Education Stanford CA
- Division of Primary Care and Population Health Stanford University School of Medicine Stanford CA
| | - Malathi Srinivasan
- Stanford University Center for Asian Healthcare Research and Education Stanford CA
- Division of Primary Care and Population Health Stanford University School of Medicine Stanford CA
| | - Nilay S Shah
- Departments of Medicine (Cardiology) and Preventive Medicine Northwestern University Feinberg School of Medicine Chicago IL
| | - Sally S Wong
- American Heart Association, Office of Science, Medicine, and Health Dallas TX
| | - Javier Valero-Elizondo
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center Houston TX
| | - Tali Elfassy
- Stanford University Center for Asian Healthcare Research and Education Stanford CA
- Department of Medicine, Division of Nephrology and Hypertension University of Miami Miller School of Medicine Miami FL
| | - Eugene Yang
- Stanford University Center for Asian Healthcare Research and Education Stanford CA
- Division of Cardiology University of Washington School of Medicine Seattle WA
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Javed Z, Valero-Elizondo J, Cainzos-Achirica M, Sharma G, Mossialos E, Parekh T, Hagan K, Hyder AA, Kash B, Nasir K. Race, Social Determinants of Health, and Risk of All-Cause and Cardiovascular Mortality in the United States. J Racial Ethn Health Disparities 2024; 11:853-864. [PMID: 37017921 DOI: 10.1007/s40615-023-01567-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 03/04/2023] [Accepted: 03/08/2023] [Indexed: 04/06/2023]
Abstract
OBJECTIVE To examine the independent and interdependent effects of race and social determinants of health (SDoH) and risk of all-cause and cardiovascular disease (CVD) mortality in the US. DATA SOURCE/STUDY DESIGN Secondary analysis of pooled data for 252,218 participants of the 2006-2018 National Health Interview Survey, linked to the National Death Index. METHODS Age-adjusted mortality rates (AAMR) were reported for non-Hispanic White (NHW) and non-Hispanic Black (NHB) individuals overall, and by quintiles of SDoH burden, with higher quintiles representing higher cumulative social disadvantage (SDoH-Qx). Survival analysis was used to examine the association between race, SDoH-Qx, and all-cause and CVD mortality. FINDINGS AAMRs for all-cause and CVD mortality were higher for NHB and considerably higher at higher levels of SDoH-Qx, however, with similar mortality rates at any given level of SDoH-Qx. In multivariable models, NHB experienced 20-25% higher mortality risk relative to NHW (aHR = 1.20-1.26); however, no association was observed after adjusting for SDoH. In contrast, higher SDoH burden was associated with up to nearly threefold increased risk of all-cause (aHR, Q5 vs Q1 = 2.81) and CVD mortality (aHR, Q5 vs Q1 = 2.90); the SDoH effect was observed similarly for NHB (aHR, Q5:all-cause mortality = 2.38; CVD mortality = 2.58) and NHW (aHR, Q5:all-cause mortality = 2.87; CVD mortality = 2.93) subgroups. SDoH burden mediated 40-60% of the association between NHB race and mortality. CONCLUSIONS These findings highlight the critical role of SDoH as upstream drivers of racial inequities in all-cause and CVD mortality. Population level interventions focused on addressing adverse SDoH experienced by NHB individuals may help mitigate persistent disparities in mortality in the US.
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Affiliation(s)
- Zulqarnain Javed
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA.
- Center for Health Data Science and Analytics, Houston Methodist, Houston, TX, 77030, USA.
- Houston Methodist Academic Institute, Houston, TX, 77030, USA.
- Houston Methodist Research Institute, 7550 Greenbriar Dr, Houston, TX, 77030, USA.
- Center for Cardiovascular Computational Health & Precision Medicine (C3-PH), Houston Methodist, Houston, TX, USA.
| | - Javier Valero-Elizondo
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Miguel Cainzos-Achirica
- Department of Cardiology, Hospital del Mar / Parc de Salut Mar, Barcelona, Spain
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Garima Sharma
- Division of Cardiology, Ciccarone Center for Prevention of Cardiovascular Disease, The Johns Hopkins, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Elias Mossialos
- Department of Health Policy, London School of Economics, London, UK
| | - Tarang Parekh
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
- Center for Health Data Science and Analytics, Houston Methodist, Houston, TX, 77030, USA
| | - Kobina Hagan
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
- Center for Health Data Science and Analytics, Houston Methodist, Houston, TX, 77030, USA
| | - Adnan A Hyder
- Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Bita Kash
- Center for Health and Nature, Houston Methodist, Houston, TX, USA
- Texas A&M University School of Public Health, College Station, TX, USA
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
- Center for Health Data Science and Analytics, Houston Methodist, Houston, TX, 77030, USA
- Houston Methodist Academic Institute, Houston, TX, 77030, USA
- Houston Methodist Research Institute, 7550 Greenbriar Dr, Houston, TX, 77030, USA
- Center for Cardiovascular Computational Health & Precision Medicine (C3-PH), Houston Methodist, Houston, TX, USA
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Patel KV, Budoff MJ, Valero-Elizondo J, Lahan S, Ali SS, Taha MB, Blaha MJ, Blankstein R, Shapiro MD, Pandey A, Arias L, Feldman T, Cury RC, Cainzos-Achirica M, Shah SH, Ziffer JA, Fialkow J, Nasir K. Coronary Atherosclerosis Across the Glycemic Spectrum Among Asymptomatic Adults: The Miami Heart Study at Baptist Health South Florida. Circ Cardiovasc Imaging 2023; 16:e015314. [PMID: 37772409 PMCID: PMC10695004 DOI: 10.1161/circimaging.123.015314] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 09/01/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND The contemporary burden and characteristics of coronary atherosclerosis, assessed using coronary computed tomography angiography (CCTA), is unknown among asymptomatic adults with diabetes and prediabetes in the United States. The pooled cohort equations and coronary artery calcium (CAC) score stratify atherosclerotic cardiovascular disease risk, but their association with CCTA findings across glycemic categories is not well established. METHODS Asymptomatic adults without atherosclerotic cardiovascular disease enrolled in the Miami Heart Study were included. Participants underwent CAC and CCTA testing and were classified into glycemic categories. Prevalence of coronary atherosclerosis (any plaque, noncalcified plaque, plaque with ≥1 high-risk feature, maximal stenosis ≥50%) assessed by CCTA was described across glycemic categories and further stratified by pooled cohort equations-estimated atherosclerotic cardiovascular disease risk and CAC score. Adjusted logistic regression was used to evaluate the associations between glycemic categories and coronary outcomes. RESULTS Among 2352 participants (49.5% women), the prevalence of euglycemia, prediabetes, and diabetes was 63%, 30%, and 7%, respectively. Coronary plaque was more commonly present across worsening glycemic categories (euglycemia, 43%; prediabetes, 58%; diabetes, 69%), and similar pattern was observed for other coronary outcomes. In adjusted analyses, compared with euglycemia, prediabetes and diabetes were each associated with higher odds of any coronary plaque (OR, 1.30 [95% CI, 1.05-1.60] and 1.75 [1.17-2.61], respectively), noncalcified plaque (OR, 1.47 [1.19-1.81] and 1.99 [1.38-2.87], respectively), and plaque with ≥1 high-risk feature (OR, 1.65 [1.14-2.39] and 2.53 [1.48-4.33], respectively). Diabetes was associated with stenosis ≥50% (OR, 3.01 [1.79-5.08]; reference=euglycemia). Among participants with diabetes and estimated atherosclerotic cardiovascular disease risk <5%, 46% had coronary plaque and 10% had stenosis ≥50%. Among participants with diabetes and CAC=0, 30% had coronary plaque and 3% had stenosis ≥50%. CONCLUSIONS Among asymptomatic adults, worse glycemic status is associated with higher prevalence and extent of coronary atherosclerosis, high-risk plaque, and stenosis. In diabetes, CAC was more closely associated with CCTA findings and informative in a larger population than the pooled cohort equations.
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Affiliation(s)
- Kershaw V Patel
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, TX (K.V.P., J.V.-E., S.L., M.B.T., K.N.)
| | - Matthew J Budoff
- Harbor-UCLA Medical Center, Torrance, CA (M.J.B.)
- David Geffen School of Medicine, University of California, Los Angeles (M.J.B.)
| | - Javier Valero-Elizondo
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, TX (K.V.P., J.V.-E., S.L., M.B.T., K.N.)
- Center for Outcomes Research, Houston Methodist (J.V.-E., K.N.)
| | - Shubham Lahan
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, TX (K.V.P., J.V.-E., S.L., M.B.T., K.N.)
| | - Shozab S Ali
- Miami Cardiac and Vascular Institute, Baptist Health South Florida (S.S.A., L.A., T.F., R.C.C., J.A.Z., J.F.)
- Herbert Wertheim College of Medicine, Florida International University, Miami (S.S.A., T.F., R.C.C.)
| | - Mohamad B Taha
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, TX (K.V.P., J.V.-E., S.L., M.B.T., K.N.)
| | - Michael J Blaha
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore (M.J.B., M.C.-A., K.N.)
| | - Ron Blankstein
- Brigham and Women's Hospital Heart and Vascular Center, and Harvard Medical School, Boston, MA (R.B.)
| | - Michael D Shapiro
- Center for Prevention of Cardiovascular Disease, Section on Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, NC (M.D.S.)
| | - Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (A.P.)
| | - Lara Arias
- Miami Cardiac and Vascular Institute, Baptist Health South Florida (S.S.A., L.A., T.F., R.C.C., J.A.Z., J.F.)
| | - Theodore Feldman
- Miami Cardiac and Vascular Institute, Baptist Health South Florida (S.S.A., L.A., T.F., R.C.C., J.A.Z., J.F.)
- Herbert Wertheim College of Medicine, Florida International University, Miami (S.S.A., T.F., R.C.C.)
| | - Ricardo C Cury
- Miami Cardiac and Vascular Institute, Baptist Health South Florida (S.S.A., L.A., T.F., R.C.C., J.A.Z., J.F.)
- Herbert Wertheim College of Medicine, Florida International University, Miami (S.S.A., T.F., R.C.C.)
| | - Miguel Cainzos-Achirica
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore (M.J.B., M.C.-A., K.N.)
- Department of Cardiology, Hospital del Mar and Hospital del Mar Research Institute, Barcelona, Spain (M.C.-A.)
| | - Svati H Shah
- Duke Clinical Research Institute, Durham, NC (S.H.S.)
| | - Jack A Ziffer
- Miami Cardiac and Vascular Institute, Baptist Health South Florida (S.S.A., L.A., T.F., R.C.C., J.A.Z., J.F.)
| | - Jonathan Fialkow
- Miami Cardiac and Vascular Institute, Baptist Health South Florida (S.S.A., L.A., T.F., R.C.C., J.A.Z., J.F.)
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, TX (K.V.P., J.V.-E., S.L., M.B.T., K.N.)
- Center for Outcomes Research, Houston Methodist (J.V.-E., K.N.)
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore (M.J.B., M.C.-A., K.N.)
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Hagan K, Javed Z, Cainzos-Achirica M, Hyder AA, Mossialos E, Yahya T, Acquah I, Valero-Elizondo J, Pan A, Nwana N, Taha M, Nasir K. Cumulative social disadvantage and health-related quality of life: national health interview survey 2013-2017. BMC Public Health 2023; 23:1710. [PMID: 37667245 PMCID: PMC10476290 DOI: 10.1186/s12889-023-16168-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 06/21/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND Evidence for the association between social determinants of health (SDoH) and health-related quality of life (HRQoL) is largely based on single SDoH measures, with limited evaluation of cumulative social disadvantage. We examined the association between cumulative social disadvantage and the Health and Activity Limitation Index (HALex). METHODS Using adult data from the National Health Interview Survey (2013-2017), we created a cumulative disadvantage index by aggregating 47 deprivations across 6 SDoH domains. Respondents were ranked using cumulative SDoH index quartiles (SDoH-Q1 to Q4), with higher quartile groups being more disadvantaged. We used two-part models for continuous HALex scores and logistic regression for poor HALex (< 20th percentile score) to examine HALex differences associated with cumulative disadvantage. Lower HALex scores implied poorer HRQoL performance. RESULTS The study sample included 156,182 respondents, representing 232.8 million adults in the United States (mean age 46 years; 51.7% women). The mean HALex score was 0.85 and 17.7% had poor HALex. Higher SDoH quartile groups had poorer HALex performance (lower scores and increased prevalence of poor HALex). A unit increase in SDoH index was associated with - 0.010 (95% CI [-0.011, -0.010]) difference in HALex score and 20% higher odds of poor HALex (odds ratio, OR = 1.20; 95% CI [1.19, 1.21]). Relative to SDoH-Q1, SDoH-Q4 was associated with HALex score difference of -0.086 (95% CI [-0.089, -0.083]) and OR = 5.32 (95% CI [4.97, 5.70]) for poor HALex. Despite a higher burden of cumulative social disadvantage, Hispanics had a weaker SDoH-HALex association than their non-Hispanic White counterparts. CONCLUSIONS Cumulative social disadvantage was associated with poorer HALex performance in an incremental fashion. Innovations to incorporate SDoH-screening tools into clinical decision systems must continue in order to accurately identify socially vulnerable groups in need of both clinical risk mitigation and social support. To maximize health returns, policies can be tailored through community partnerships to address systemic barriers that exist within distinct sociodemographic groups, as well as demographic differences in health perception and healthcare experience.
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Affiliation(s)
- Kobina Hagan
- Division of Health Equity and Health Disparities Research, Center for Outcomes Research, Houston Methodist, Houston, TX, USA
| | - Zulqarnain Javed
- Division of Health Equity and Health Disparities Research, Center for Outcomes Research, Houston Methodist, Houston, TX, USA
| | - Miguel Cainzos-Achirica
- Division of Health Equity and Health Disparities Research, Center for Outcomes Research, Houston Methodist, Houston, TX, USA
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, 6550 Fannin St Suite 1801, 77030, Houston, TX, USA
| | - Adnan A Hyder
- Center on Commercial Determinants of Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Elias Mossialos
- Department of Health Policy, London School of Economics and Political Sciences, London, UK
- Centre for Health Policy, Imperial College London, London, UK
| | - Tamer Yahya
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, 6550 Fannin St Suite 1801, 77030, Houston, TX, USA
| | - Isaac Acquah
- Division of Health Equity and Health Disparities Research, Center for Outcomes Research, Houston Methodist, Houston, TX, USA
| | - Javier Valero-Elizondo
- Division of Health Equity and Health Disparities Research, Center for Outcomes Research, Houston Methodist, Houston, TX, USA
| | - Alan Pan
- Division of Health Equity and Health Disparities Research, Center for Outcomes Research, Houston Methodist, Houston, TX, USA
| | - Nwabunie Nwana
- Division of Health Equity and Health Disparities Research, Center for Outcomes Research, Houston Methodist, Houston, TX, USA
| | - Mohamad Taha
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, 6550 Fannin St Suite 1801, 77030, Houston, TX, USA
| | - Khurram Nasir
- Division of Health Equity and Health Disparities Research, Center for Outcomes Research, Houston Methodist, Houston, TX, USA.
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, 6550 Fannin St Suite 1801, 77030, Houston, TX, USA.
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Walia HK, Khosla AA, Saxena A, Aneni E, Ali SS, Valero-Elizondo J, Cainzos-Achirica M, Feldman T, Fialkow J, Nasir K. Atherosclerotic plaque in individuals without known cardiovascular disease but with established obstructive sleep apnea and at high risk of obstructive sleep apnea. Am J Prev Cardiol 2023; 14:100497. [PMID: 37131984 PMCID: PMC10149201 DOI: 10.1016/j.ajpc.2023.100497] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 04/06/2023] [Accepted: 04/10/2023] [Indexed: 05/04/2023] Open
Abstract
Objectives In a large U.S. cohort free of CVD evaluated by coronary computed CT angiography, we aimed to assess the association between established / high risk of Obstructive Sleep Apnea (OSA) and coronary plaque. Background There are limited data available depicting the association between established / high risk of OSA and the presence of coronary plaque in a population-based sample free from CVD. Methods Cross-sectional data from 2359 participants enrolled in the Miami Heart Study (MiHeart) who underwent coronary CT angiography was used for this study. The Berlin questionnaire was used to stratify patients as having high or low risk of OSA. Multiple multivariable logistic regression analyses were conducted to investigate the association between the risk of developing OSA with the presence, volume, and composition of plaque. Results According to the Berlin questionnaire, 1559 participants were (66.1%) at low risk of OSA and 800 patients (33.9%) with established / high risk of OSA. Plaque characterization on CCTA revealed a greater incidence of any possible plaque composition in the established / high risk of OSA category (59.6% vs. 43.5%) compared to the low risk of OSA cohort. In logistic regression models, after adjusting for demographics and cardiovascular risk factors, a significant association could still be noted between established / high risk of OSA and any coronary plaque on CCTA (OR=1.31, CI 1.05, 1.63, p = 0.016). Subgroup analysis in the Hispanic population also portrayed a significant association between established / high risk of OSA and the presence of coronary plaque on CCTA (OR = 1.55 CI 1.13, 2.12, p = 0.007). Conclusion After accounting for CVD risk factors, individuals at established / high risk of OSA have a higher likelihood of the presence of coronary plaque. Future studies should focus on OSA presence or risk, OSA severity, and the longitudinal consequences of coronary atherosclerosis.
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Affiliation(s)
- Harneet K Walia
- Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, FL, USA
| | - Atulya Aman Khosla
- Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, FL, USA
| | - Anshul Saxena
- Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, FL, USA
| | - Ehimen Aneni
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Shozab S Ali
- Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, FL, USA
| | - Javier Valero-Elizondo
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Miguel Cainzos-Achirica
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Theodore Feldman
- Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, FL, USA
| | - Jonathan Fialkow
- Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, FL, USA
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
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Kwapong YA, Sharma G, Valero-Elizondo J, Achirica MC, Ali SS, Blaha MJ, Blankstein R, Shapiro MD, Arias L, Budoff MJ, Feldman T, Cury RC, Mehta L, Fialkow J, Nasir K. The association of sex-specific hormones with coronary artery plaque characteristics from Miami Heart (MiHeart) study. Am J Prev Cardiol 2023; 14:100479. [PMID: 36950675 PMCID: PMC10025130 DOI: 10.1016/j.ajpc.2023.100479] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 02/01/2023] [Accepted: 02/25/2023] [Indexed: 03/06/2023] Open
Abstract
Objective The association of sex-specific hormones with coronary computed tomography angiography(CCTA)-based plaque characteristics in women without cardiovascular disease is not well understood. We investigated the association of sex-specific hormones with coronary artery plaque characteristics in a contemporary multiracial cohort with no clinical coronary artery disease (CAD). Methods In this cross-sectional analysis, we utilized data from 2,325 individuals with no clinical CAD from the Miami Heart (MiHeart) study. Multivariable logistic regression models were used to investigate the association of sex hormones: sex hormone binding globulin (SHBG), dehydroepiandrosterone (DHEA), free and total testosterone, estradiol, with plaque characteristics among women and men. Results Of the 1,155 women, 34.2% had any plaque and 3.4% had any high-risk plaque features (HRP) while among men (n = 1170), 63.1% had any plaque and 10.4% had HRP. Among women, estradiol and SHBG were associated with lower odds of any plaque after adjusting for age and race-ethnicity (estradiol OR per SD increase: 0.87, 95%CI: 0.76-0.98; SHBG OR per SD increase: 0.82, 95%CI: 0.72-0.93) but the significance did not persist after adjustment of cardiovascular risk factors. High free testosterone was associated with higher odds of HRP (aOR:3.48, 95%CI:1.07-11.26) but null associations for the other sex hormones with HRP, in the context of limited sample size. Among men, there were no significant associations between sex-specific hormones and plaque or HRP. Conclusion Among young to middle-aged women with no clinical CAD, increasing estradiol and SHBG were associated with lower odds of any plaque and higher free testosterone was associated with HRP. Larger cohorts may be needed to validate this.
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Affiliation(s)
- Yaa A. Kwapong
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Garima Sharma
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Javier Valero-Elizondo
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
- Center for Outcomes Research, Houston Methodist, Houston, TX, USA
| | - Miguel Cainzos Achirica
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
- Center for Outcomes Research, Houston Methodist, Houston, TX, USA
| | - Shozab S. Ali
- Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, FL, USA
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Michael J. Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Ron Blankstein
- Brigham and Women's Hospital Heart and Vascular Center, and Harvard Medical School, Boston, MA, USA
| | - Michael D. Shapiro
- Center for Prevention of Cardiovascular Disease, Section on Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Lara Arias
- Center for Outcomes Research, Houston Methodist, Houston, TX, USA
| | - Matthew J. Budoff
- Division of Cardiology, Harbor UCLA Medical Center, Torrance, CA, USA
- The Lundquist Institute, Harbor UCLA, Medical Center, Torrance, CA, USA
| | - Theodore Feldman
- Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, FL, USA
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Ricardo C. Cury
- Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, FL, USA
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Laxmi Mehta
- Division of Cardiology, the Ohio State University School of Medicine, Columbus, OH, USA
| | - Jonathan Fialkow
- Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, FL, USA
| | - Khurram Nasir
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
- Center for Outcomes Research, Houston Methodist, Houston, TX, USA
- Corresponding author at: Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, 6550 Fannin St Suite 1801, Houston, TX 77030, USA.
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Khan N, Javed Z, Acquah I, Hagan K, Khan M, Valero-Elizondo J, Chang R, Javed U, Taha MB, Blaha MJ, Virani SS, Sharma G, Blankstein R, Gulati M, Mossialos E, Hyder AA, Achirica MC, Nasir K. Low educational attainment is associated with higher all-cause and cardiovascular mortality in the United States adult population. BMC Public Health 2023; 23:900. [PMID: 37193999 DOI: 10.1186/s12889-023-15621-y] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 04/06/2023] [Indexed: 05/18/2023] Open
Abstract
INTRODUCTION Educational attainment is an important social determinant of health (SDOH) for cardiovascular disease (CVD). However, the association between educational attainment and all-cause and CVD mortality has not been longitudinally evaluated on a population-level in the US, especially in individuals with atherosclerotic cardiovascular disease (ASCVD). In this nationally representative study, we assessed the association between educational attainment and the risk of all-cause and cardiovascular (CVD) mortality in the general adult population and in adults with ASCVD in the US. METHODS We used data from the 2006-2014 National Death Index-linked National Health Interview Survey for adults ≥ 18 years. We generated age-adjusted mortality rates (AAMR) by levels of educational attainment (< high school (HS), HS/General Education Development (GED), some college, and ≥ College) in the overall population and in adults with ASCVD. Cox proportional hazards models were used to examine the multivariable-adjusted associations between educational attainment and all-cause and CVD mortality. RESULTS The sample comprised 210,853 participants (mean age 46.3), representing ~ 189 million adults annually, of which 8% had ASCVD. Overall, 14.7%, 27%, 20.3%, and 38% of the population had educational attainment < HS, HS/GED, Some College, and ≥ College, respectively. During a median follow-up of 4.5 years, all-cause age-adjusted mortality rates were 400.6 vs. 208.6 and 1446.7 vs. 984.0 for the total and ASCVD populations for < HS vs ≥ College education, respectively. CVD age adjusted mortality rates were 82.1 vs. 38.7 and 456.4 vs 279.5 for the total and ASCVD populations for < HS vs ≥ College education, respectively. In models adjusting for demographics and SDOH, < HS (reference = ≥ College) was associated with 40-50% increased risk of mortality in the total population and 20-40% increased risk of mortality in the ASCVD population, for both all-cause and CVD mortality. Further adjustment for traditional risk factors attenuated the associations but remained statistically significant for < HS in the overall population. Similar trends were seen across sociodemographic subgroups including age, sex, race/ethnicity, income, and insurance status. CONCLUSIONS Lower educational attainment is independently associated with increased risk of all-cause and CVD mortality in both the total and ASCVD populations, with the highest risk observed for individuals with < HS education. Future efforts to understand persistent disparities in CVD and all-cause mortality should pay close attention to the role of education, and include educational attainment as an independent predictor in mortality risk prediction algorithms.
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Affiliation(s)
- Najah Khan
- Department of Internal Medicine, Houston Methodist Hospital, Houston, TX), USA
- Center for Cardiovascular Computational Health and Precision Medicine (C3-PH) , Houston Methodist, Houston, TX), USA
- Houston Methodist Academic Institute, Houston Methodist, Houston, TX), USA
| | - Zulqarnain Javed
- Center for Cardiovascular Computational Health and Precision Medicine (C3-PH) , Houston Methodist, Houston, TX), USA
- Houston Methodist Academic Institute, Houston Methodist, Houston, TX), USA
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, 6550 Fannin St Suite 1801, Houston, TX, 77030, USA
| | - Isaac Acquah
- Houston Methodist Academic Institute, Houston Methodist, Houston, TX), USA
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, MD, 21218, USA
| | - Kobina Hagan
- Houston Methodist Academic Institute, Houston Methodist, Houston, TX), USA
| | - Madiha Khan
- Department of Internal Medicine, Houston Methodist Hospital, Houston, TX), USA
| | | | - Ryan Chang
- Washington University in St. Louis, St. Louis, MO), USA
| | - Umair Javed
- National University of Medical Sciences, Rawalpindi, Pakistan
| | - Mohamad B Taha
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, 6550 Fannin St Suite 1801, Houston, TX, 77030, USA
| | - Michael J Blaha
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD), USA
| | - Salim S Virani
- Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX), USA
| | - Garima Sharma
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD), USA
| | - Ron Blankstein
- Cardiovascular Imaging Program, Department of Medicine and Radiology, Brigham and Women's Hospital, Boston, MA), USA
| | - Martha Gulati
- Department of Preventive Cardiology, Harbor-UCLA Medical Center, Los Angeles, CA, USA
| | - Elias Mossialos
- Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Adnan A Hyder
- Center On Commercial Determinants of Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Miguel Cainzos Achirica
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD), USA
- Department of Cardiology, Hospital del Mar / Parc de Salut Mar, Barcelona, Spain
| | - Khurram Nasir
- Center for Cardiovascular Computational Health and Precision Medicine (C3-PH) , Houston Methodist, Houston, TX), USA.
- Houston Methodist Academic Institute, Houston Methodist, Houston, TX), USA.
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, 6550 Fannin St Suite 1801, Houston, TX, 77030, USA.
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8
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Acquah I, Hagan K, Javed Z, Taha MB, Valero-Elizondo J, Nwana N, Yahya T, Sharma G, Gulati M, Hammoud A, Shapiro MD, Blankstein R, Blaha MJ, Cainzos-Achirica M, Nasir K. Social Determinants of Cardiovascular Risk, Subclinical Cardiovascular Disease, and Cardiovascular Events. J Am Heart Assoc 2023; 12:e025581. [PMID: 36926956 PMCID: PMC10111542 DOI: 10.1161/jaha.122.025581] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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] [Indexed: 03/18/2023]
Abstract
Background Although there is research on the impact of social determinants of health (SDOHs) on cardiovascular health, most existing evidence is based on individual SDOH components. We evaluated the impact of cumulative SDOH burden on cardiovascular risk factors, subclinical atherosclerosis, and incident cardiovascular disease events. Methods and Results We included 6479 participants from the MESA (Multi-Ethnic Study of Atherosclerosis). A weighted aggregate SDOH score representing the cumulative number of unfavorable SDOHs, identified from 14 components across 5 domains (economic stability, neighborhood and physical environment, community and social context, education, and health care system access) was calculated and divided into quartiles (quartile 4 being the least favorable). The impact of cumulative SDOH burden on cardiovascular risk factors (hypertension, diabetes, dyslipidemia, smoking, and obesity), systemic inflammation, subclinical atherosclerosis, and incident cardiovascular disease was evaluated. Increasing social disadvantage was associated with increased odds of all cardiovascular risk factors except dyslipidemia. Smoking was the risk factor most strongly associated with worse SDOH (odds ratio [OR], 2.67 for quartile 4 versus quartile 1 [95% CI, 2.13-3.34]). Participants within SDOH quartile 4 had 33% higher odds of increased high-sensitivity C-reactive protein (OR, 1.33 [95% CI, 1.11-1.60]) and 31% higher risk of all cardiovascular disease (hazard ratio, 1.31 [95% CI, 1.03-1.67]), yet no greater burden of subclinical atherosclerosis (OR, 1.01 [95% CI, 0.79-1.29]), when compared with those in quartile 1. Conclusions Increasing social disadvantage was associated with more prevalent cardiovascular risk factors, inflammation, and incident cardiovascular disease. These findings call for better identification of SDOHs in clinical practice and stronger measures to mitigate the higher SDOH burden among the socially disadvantaged to improve cardiovascular outcomes.
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Affiliation(s)
- Isaac Acquah
- Center for Outcomes Research Houston Methodist Houston TX
| | - Kobina Hagan
- Center for Outcomes Research Houston Methodist Houston TX
| | - Zulqarnain Javed
- Division of Health Disparities and Equity Research Center for Outcomes Research, Houston Methodist Houston TX
| | - Mohamad B Taha
- Division of Cardiovascular Prevention and Wellness Houston Methodist DeBakey Heart and Vascular Center Houston TX
| | | | - Nwabunie Nwana
- Center for Outcomes Research Houston Methodist Houston TX
| | - Tamer Yahya
- Division of Cardiovascular Prevention and Wellness Houston Methodist DeBakey Heart and Vascular Center Houston TX
| | - Garima Sharma
- Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins University School of Medicine Baltimore MD
| | - Martha Gulati
- Division of Cardiology University of Arizona (Phoenix) Phoenix AZ
| | | | - Michael D Shapiro
- Section of Cardiovascular Medicine Wake Forest School of Medicine Winston Salem NC
| | - Ron Blankstein
- Cardiovascular Imaging Program, Department of Medicine and Radiology Brigham and Women's Hospital Boston MA
| | - Michael J Blaha
- Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins University School of Medicine Baltimore MD
| | - Miguel Cainzos-Achirica
- Center for Outcomes Research Houston Methodist Houston TX
- Division of Cardiovascular Prevention and Wellness Houston Methodist DeBakey Heart and Vascular Center Houston TX
| | - Khurram Nasir
- Center for Outcomes Research Houston Methodist Houston TX
- Division of Cardiovascular Prevention and Wellness Houston Methodist DeBakey Heart and Vascular Center Houston TX
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Aneni EC, Osondu CU, Joseph J, Saeed G, Valero-Elizondo J, Veledar E, Nasir K. Habitual sleep duration and its relationship with cardiovascular health, healthcare costs, and resource utilization in a working population. Sleep Health 2023; 9:77-85. [PMID: 36371382 PMCID: PMC9991949 DOI: 10.1016/j.sleh.2022.10.001] [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: 03/14/2022] [Revised: 09/30/2022] [Accepted: 10/04/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Little is known about the relationship between habitual sleep duration, cardiovascular health (CVH) and their impact on healthcare costs and resource utilization. We describe the relationship between sleep duration and ideal CVH, and the associated burden of healthcare expenditure and utilization in a large South Florida employee population free from known cardiovascular disease. METHODS The study used data obtained from a 2014 voluntary Health Risk Assessment among 8629 adult employees of Baptist Health South Florida. Health expenditures and resource utilization information were obtained through medical claims data. Frequencies of the individual and cumulative CVH metrics across sleep duration were computed. Mean and marginal per-capita healthcare expenditures were estimated. RESULTS The mean age was 43 years, 57% were of Hispanic ethnicity. Persons with 6-8.9hours and ≥9 hours of sleep were significantly more likely to report optimal goals for diet, physical activity, body mass index, and blood pressure when compared to those who slept less than 6 hours. Compared to those who slept less than 6 hours, those sleeping 6-8.9hours and ≥9hours had approximately 2- (odds ratio 2.1, 95% confidence interval: 1.9-3.0) and 3-times (odds ratio 3.0, 95% confidence interval: 1.6-5.6) higher odds of optimal CVH. Both groups with 6 or more hours of sleep had lower total per-capita expenditure (approximately $2000 and $2700 respectively), lower odds of visiting an emergency room, or being hospitalized compared to those who slept < 6 hours. CONCLUSION Sleeping 6 or more hours was associated with better CVH, lower healthcare expenditures, and reduced healthcare resource utilization.
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Affiliation(s)
- Ehimen C Aneni
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA.
| | | | - Jeffrin Joseph
- Mosaic Life Care at St Joseph, St. Joseph, Missouri, USA
| | - Guljana Saeed
- Section of Pulmonary and Critical Care and Sleep Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Emir Veledar
- Baptist Health South Florida, Miami, Florida, USA
| | - Khurram Nasir
- Houston Methodist Hospital, Houston, Texas, USA; Center for Outcomes Research and Evaluation, Yale University & Yale New Haven Health System, New Haven, Connecticut, USA
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Valero-Elizondo J, Javed Z, Khera R, Tano ME, Dudum R, Acquah I, Hyder AA, Andrieni J, Sharma G, Blaha MJ, Virani SS, Blankstein R, Cainzos-Achirica M, Nasir K. Unfavorable social determinants of health are associated with higher burden of financial toxicity among patients with atherosclerotic cardiovascular disease in the US: findings from the National Health Interview Survey. Arch Public Health 2022; 80:248. [PMID: 36474300 PMCID: PMC9727868 DOI: 10.1186/s13690-022-00987-z] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 10/10/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Atherosclerotic cardiovascular disease (ASCVD) is a major cause of financial toxicity, defined as excess financial strain from healthcare, in the US. Identifying factors that put patients at greatest risk can help inform more targeted and cost-effective interventions. Specific social determinants of health (SDOH) such as income are associated with a higher risk of experiencing financial toxicity from healthcare, however, the associations between more comprehensive measures of cumulative social disadvantage and financial toxicity from healthcare are poorly understood. METHODS Using the National Health Interview Survey (2013-17), we assessed patients with self-reported ASCVD. We identified 34 discrete SDOH items, across 6 domains: economic stability, education, food poverty, neighborhood conditions, social context, and health systems. To capture the cumulative effect of SDOH, an aggregate score was computed as their sum, and divided into quartiles, the highest (quartile 4) containing the most unfavorable scores. Financial toxicity included presence of: difficulty paying medical bills, and/or delayed/foregone care due to cost, and/or cost-related medication non-adherence. RESULTS Approximately 37% of study participants reported experiencing financial toxicity from healthcare, with a prevalence of 15% among those in SDOH Q1 vs 68% in SDOH Q4. In fully-adjusted regression analyses, individuals in the 2nd, 3rd and 4th quartiles of the aggregate SDOH score had 1.90 (95% CI 1.60, 2.26), 3.66 (95% CI 3.11, 4.35), and 8.18 (95% CI 6.83, 9.79) higher odds of reporting any financial toxicity from healthcare, when compared with participants in the 1st quartile. The associations were consistent in age-stratified analyses, and were also present in analyses restricted to non-economic SDOH domains and to 7 upstream SDOH features. CONCLUSIONS An unfavorable SDOH profile was strongly and independently associated with subjective financial toxicity from healthcare. This analysis provides further evidence to support policies and interventions aimed at screening for prevalent financial toxicity and for high financial toxicity risk among socially vulnerable groups.
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Affiliation(s)
- Javier Valero-Elizondo
- Department of Cardiology, Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart & Vascular Center, 7550 Greenbriar Drive, Houston, TX, 77030, USA.
- Center for Outcomes Research, Houston Methodist, 7550 Greenbriar Drive, Houston, TX, 77030, USA.
| | - Zulqarnain Javed
- Department of Cardiology, Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart & Vascular Center, 7550 Greenbriar Drive, Houston, TX, 77030, USA
- Center for Outcomes Research, Houston Methodist, 7550 Greenbriar Drive, Houston, TX, 77030, USA
| | - Rohan Khera
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA
| | - Mauricio E Tano
- Center for Outcomes Research, Houston Methodist, 7550 Greenbriar Drive, Houston, TX, 77030, USA
| | - Ramzi Dudum
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA, USA
| | - Isaac Acquah
- Center for Outcomes Research, Houston Methodist, 7550 Greenbriar Drive, Houston, TX, 77030, USA
| | - Adnan A Hyder
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Julia Andrieni
- Population Health and Primary Care, Houston Methodist Hospital, Houston, TX, USA
| | - Garima Sharma
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael J Blaha
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- The Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA
| | - Salim S Virani
- Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
- Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations in Quality, Effectiveness, and Safety, Houston, TX, USA
- Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, TX, USA
- Department of Medicine, Section of Cardiovascular Research, Baylor College of Medicine, Houston, TX, USA
| | - Ron Blankstein
- Cardiovascular Imaging Program, Cardiovascular Division and Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Miguel Cainzos-Achirica
- Department of Cardiology, Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart & Vascular Center, 7550 Greenbriar Drive, Houston, TX, 77030, USA
- Center for Outcomes Research, Houston Methodist, 7550 Greenbriar Drive, Houston, TX, 77030, USA
| | - Khurram Nasir
- Department of Cardiology, Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart & Vascular Center, 7550 Greenbriar Drive, Houston, TX, 77030, USA
- Center for Outcomes Research, Houston Methodist, 7550 Greenbriar Drive, Houston, TX, 77030, USA
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11
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Javed Z, Valero-Elizondo J, Khan SU, Taha MB, Maqsood MH, Mossialos E, Sharma G, Hyder AA, Cainzos-Achirica M, Nasir K. Cumulative Social Disadvantage and All-Cause Mortality in the United States: Findings from a National Study. Popul Health Manag 2022; 25:789-797. [PMID: 36473192 DOI: 10.1089/pop.2022.0184] [Citation(s) in RCA: 4] [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] [Indexed: 12/12/2022] Open
Abstract
The extent to which cumulative social disadvantage-defined as aggregate social risk resulting from multiple co-occurring adverse social determinants of health (SDOH)-affects the risk of all-cause mortality, independent of demographic and clinical risk factors, is not well understood. The objective of this study was to examine the association between cumulative social disadvantage, measured using a comprehensive 47-factor SDOH framework, and mortality in a nationally representative sample of adults in the United States. The authors conducted secondary analysis of pooled data for 63,540 adult participants of the 2013-2015 National Death Index-linked National Health Interview Survey. Age-adjusted mortality rates (AAMRs) were reported by quintiles of aggregate SDOH burden, with higher quintiles denoting greater social disadvantage. Cox proportional hazards models were used to examine the association between cumulative social disadvantage and risk of all-cause mortality. AAMR increased significantly with greater SDOH burden, ranging from 631 per 100,000 person-years (PYs) for participants in SDOH-Q1 to 1490 per 100,000 PYs for those in SDOH-Q5. In regression models adjusted for demographics, being in SDOH-Q5 was associated with 2.5-fold higher risk of mortality, relative to Q1 (adjusted hazard ratio [aHR] = 2.57 [95% confidence interval, CI = 1.94-3.41]); the observed association persisted after adjusting for comorbidities, with over 2-fold increased risk of mortality for SDOH-Q5 versus Q1 (aHR = 2.02 [95% CI = 1.52-2.67]). These findings indicate that cumulative social disadvantage is associated with increased risk of all-cause mortality, independent of demographic and clinical factors. Population level interventions focused on improving individuals' social, economic, and environmental conditions may help reduce the burden of mortality and mitigate persistent disparities.
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Affiliation(s)
- Zulqarnain Javed
- Division of Health Equity and Disparities Research, Center for Outcomes Research, Houston Methodist, Houston, Texas, USA.,Houston Methodist Academic Institute, Houston Methodist Hospital, Houston, Texas, USA
| | - Javier Valero-Elizondo
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA.,Center for Cardiovascular Computational Health and Precision Medicine (C3-PH), Houston Methodist, Houston, Texas, USA
| | - Safi U Khan
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Mohamad B Taha
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | | | - Elias Mossialos
- Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Garima Sharma
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Adnan A Hyder
- Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, USA
| | - Miguel Cainzos-Achirica
- Division of Health Equity and Disparities Research, Center for Outcomes Research, Houston Methodist, Houston, Texas, USA.,Houston Methodist Academic Institute, Houston Methodist Hospital, Houston, Texas, USA.,Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Khurram Nasir
- Division of Health Equity and Disparities Research, Center for Outcomes Research, Houston Methodist, Houston, Texas, USA.,Houston Methodist Academic Institute, Houston Methodist Hospital, Houston, Texas, USA.,Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA.,Center for Cardiovascular Computational Health and Precision Medicine (C3-PH), Houston Methodist, Houston, Texas, USA
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Verma H, Javed Z, Hong JC, Mahajan S, Mszar R, Grandhi GR, Desai NR, Virani SS, Javed U, Valero-Elizondo J, Nasir K. The Impact of the Affordable Care Act on Disparities in Utilization of Cardiovascular Preventive Services by Socioeconomic Status. Popul Health Manag 2022; 25:669-676. [PMID: 36067118 DOI: 10.1089/pop.2021.0337] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Disparities in cardiovascular outcomes are persistent in our society. The objective was to track the trends before and after the passage of the Affordable Care Act in socioeconomic status (SES) disparities in utilization of cardiovascular disease (CVD) preventive services among nonelderly adults aged 18-64 years. This study used the National Health Interview Survey (2011-2017) to compare utilization of blood pressure, cholesterol, glycemic screening, and diet and smoking cessation advice over time between groups stratified by SES and race using difference-in-difference analysis. This study also measured the differences over time in specific vulnerable population subgroups (Hispanic, low-income and uninsured vs. White, middle-high-income, and insured). The study population included 176,961 surveyed individuals (mean age 40 [±13] years; 51% female; 67.7% non-Hispanic White) between 2011 and 2017, translating to 194.8 million nonelderly US adults per year. Most individuals were from high-income SES (40.0%), followed by middle-income (28.1%), low-income (13.6%), and lowest income SES (18.3%). The proportion of CVD preventive services increased over all SES categories through the study period. The biggest relative changes were seen among low-income individuals. The difference in blood pressure checks, cholesterol checks, and smoking cessation advise between high- and lowest income groups showed a statistically significant decrease at 5.2%, 4.8%, and 11.2%, respectively, between 2011 and 2017. The findings demonstrate a trend in reduction of CVD preventive care disparities between SES groups. However, a gap still exists, and this study highlights the need for continuous improvement to eliminate SES disparities.
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Affiliation(s)
- Hannah Verma
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Zulqarnain Javed
- Center for Outcomes Research, Houston Methodist Research Institute, Houston, Texas, USA
| | - Jonathan C Hong
- Division of Cardiac Surgery, Northwestern University, Chicago, Illinois, USA
| | - Shiwani Mahajan
- Center for Outcomes Research and Evaluation, Yale New Haven Health, New Haven, Connecticut, USA
| | - Reed Mszar
- Center for Outcomes Research and Evaluation, Yale New Haven Health, New Haven, Connecticut, USA
| | - Gowtham R Grandhi
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, Maryland, USA
| | - Nihar R Desai
- Center for Outcomes Research and Evaluation, Yale New Haven Health, New Haven, Connecticut, USA.,Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Salim S Virani
- Department of Medicine, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA.,Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Umair Javed
- Department of Biological Sciences, National University of Medical Sciences, Rawalpindi, Pakistan
| | - Javier Valero-Elizondo
- Center for Outcomes Research, Houston Methodist Research Institute, Houston, Texas, USA.,Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Khurram Nasir
- Center for Outcomes Research, Houston Methodist Research Institute, Houston, Texas, USA.,Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
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13
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Khan SU, Nguyen RT, Javed Z, Singh M, Valero-Elizondo J, Cainzos-Achirica M, Nasir K. Socioeconomic status, cardiovascular risk profile, and premature coronary heart disease. Am J Prev Cardiol 2022; 11:100368. [PMID: 35928553 PMCID: PMC9344344 DOI: 10.1016/j.ajpc.2022.100368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 07/17/2022] [Accepted: 07/23/2022] [Indexed: 11/24/2022] Open
Abstract
Background The combined influence of traditional cardiovascular risk factors and socioeconomic status (SES) on premature CHD (<65 years) remains understudied. Methods We used the National Health Interview Survey (NHIS) database (2012-2018) to examine the association of sociodemographic (income, education, insurance status) and cardiovascular risk profile (CRF: ranging from optimal (0–1 risk CV factor) to poor (≥4 risk CV factors)) with CHD in young (18- 44 years) and middle-aged (45–64 years) adults. Results Among the 168,969 included adults (young: 46.6%), the prevalence of CHD was 3%, translating to 6.4 million young and middle-aged adults. Adults with low family income, lesser education and no insurance were more likely to have CHD. While majority of young adults (65%) had optimal CRF profile and only 4% had poor CRF profile, 26% of middle-aged adults carried poor CRF profile. When examined by income status, education, and insurance status, odds of CHD were increased with worsening CRF profile. In multivariate regressions, low income participants who had a poor CRF (reference: optimal CRF) had higher odds of CHD in both young (aOR: 9.12 [95% CI, 6.16–13.50]) and middle-aged adults (aOR: 8.22 [95% CI, 6.12–11.05]). Within participants with a high school education or lower, those with a poor CRF profile (reference: optimal CRF) had increased odds of CHD in young (aOR: 10.35 [95% CI, 6.66–16.11]) and middle-aged adults (aOR: 10.40 [95% CI, 7.91–13.66]). In the uninsured, those with a poor CRF profile (reference: optimal CRF) had an 8-9 fold increased odds of CHD in young (aOR: 7.65 [95% CI, 4.26–13.73]) and middle-aged adults (aOR: 9.34 [95% CI, 5.90–14.79]). Conclusions In this national survey, individuals with poor CRF profile had higher odds of premature CHD than those with optimal profile, and burden of CHD increased with worsening of CRF profile.
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Ali HJR, Valero-Elizondo J, Wang SY, Cainzos-Achirica M, Bhimaraj A, Khan SU, Khan MS, Mossialos E, Khera R, Nasir K. Subjective Financial Hardship from Medical Bills Among Patients with Heart Failure in the United States: The 2014-2018 Medical Expenditure Panel Survey. J Card Fail 2022; 28:1424-1433. [PMID: 35839928 DOI: 10.1016/j.cardfail.2022.06.009] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 06/04/2022] [Accepted: 06/07/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Heart failure (HF) poses a substantial economic burden to the United States (US) healthcare system. In contrast, little is known about the financial challenges faced by patients with HF. In this study, we examined the scope and sociodemographic predictors of subjective financial hardship from medical bills in patients with HF. METHODS In the Medical Expenditure Panel Survey (MEPS; years 2014-2018), a US nationally representative database, we identified all patients who reported having HF. Any subjective financial hardship from medical bills was assessed based on patients reporting either themselves or their families 1) having difficulties paying medical bills in the past 12 months, 2) paid bills late, or 3) unable to pay bills at all. Logistic regression was used to evaluate independent predictors of financial hardship among patients with HF. All analyses took into consideration the survey's complex design. RESULTS A total of 116,563 MEPS participants were included in the analysis, of whom 858 (0.7%) had a diagnosis of HF, representing 1.8 million (95% CI 1.6 to 2.0) patients annually. Overall, 33% (95% CI 29% to 38%) reported any financial hardship from medical bills with 13.2% not being able to pay bills at all. Age ≤65 years and lower educational attainment were independently associated with higher odds of subjective financial hardship from medical bills. CONCLUSION Subjective financial hardship is a prevalent issue among patients with HF in the US, particularly those who are younger and have lower educational attainment. There is a need for policies that reduce out-of-pocket costs in the care of HF, an enhanced identification of this phenomenon in the clinical setting, and approaches to help minimize financial toxicity in patients with HF while ensuring optimal quality of care.
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Affiliation(s)
- Hyeon-Ju Ryoo Ali
- Department of Cardiology, Houston Methodist Hospital, Houston, TX, USA.
| | - Javier Valero-Elizondo
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA; Center for Outcomes Research, Houston Methodist, Houston, TX, USA
| | - Stephen Y Wang
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Miguel Cainzos-Achirica
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA; Center for Outcomes Research, Houston Methodist, Houston, TX, USA
| | - Arvind Bhimaraj
- Department of Cardiology, Houston Methodist Hospital, Houston, TX, USA
| | - Safi U Khan
- Department of Cardiology, Houston Methodist Hospital, Houston, TX, USA
| | | | - Elias Mossialos
- London School of Economics and Political Science, London, UK
| | - Rohan Khera
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA; Center for Outcomes Research, Houston Methodist, Houston, TX, USA.
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Wang SY, Valero-Elizondo J, Cainzos-Achirica M, Desai NR, Nasir K, Khera R. Measures of Financial Hardship From Health Care Expenses Among Families With a Member With Atherosclerotic Cardiovascular Disease in the US. JAMA Health Forum 2022; 3:e221962. [PMID: 35977226 PMCID: PMC9308060 DOI: 10.1001/jamahealthforum.2022.1962] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 05/15/2022] [Indexed: 12/03/2022] Open
Abstract
Importance Patients with atherosclerotic cardiovascular disease (ASCVD) face substantial financial burden from health care costs as assessed by many disparate measures. However, evaluation of the concordance of existing measures and the prevalence of financial burden based on these measures is lacking. Objective To compare subjectively reported and objectively measured financial burden from health care in families of patients with ASCVD. Design Setting and Participants This cross-sectional study used data from the Medical Expenditure Panel Survey, a nationally representative survey of individuals and families in the US, and included all families with 1 or more members with ASCVD from 2014 to 2018. Analyses were conducted from October 2021 to April 2022. Main Outcomes and Measures Using accepted definitions, objective financial hardship represented annual out-of-pocket medical expenses exceeding 20% of annual postsubsistence income, and subjective financial hardship represented self-reported problems paying medical bills or paying them over time. Prevalence of financial hardship was identified based on individual definitions and their concordance was assessed. Factors associated with each type of financial hardship were examined using risk-adjusted survey logistic regression. Multivariable logistic regression was used to model the odds of subjective financial hardship vs objective financial hardship across subgroups. The association between measures of financial hardship and self-reported deferral of care was also assessed. Results Among 10 975 families of patients with ASCVD, representing 22.5 million families nationally (mean [SD] age of index individual, 66 [24] years; estimated 54% men]), 37% experienced either objective or subjective financial hardship. This group included 11% (95% CI, 10%-11%) with objective financial hardship, 21% (95% CI, 20%-22%) with subjective financial hardship, and 5% (95% CI, 5%-6%) with both objective and subjective financial hardship. Mean age was 70 (95% CI, 68-71) years vs 61 (95% CI, 60-62) years for index patients in families reporting objective financial hardship only vs subjective financial hardship only, with no difference in sex (50% [95% CI, 46%-54%] of men vs 49% [95% CI, 47%-52%] of women). In risk-adjusted analyses, among families of patients with ASCVD, patient age of 65 years or older was associated with lower odds of subjective financial hardship than objective financial hardship (odds ratio [OR], 0.39; 95% CI, 0.20-0.76), whereas higher income (OR, 6.08; 95% CI, 3.93-9.42 for an income of >100%-200% of the federal poverty level [FPL] vs ≤100% of the FPL and OR, 20.46; 95% CI, 11.45-36.56 for >200% of FPL vs ≤100% of FPL), public insurance (OR, 6.60; 95% CI, 4.20-10.37), and being uninsured (OR, 5.36; 95% CI, 2.61-10.98) were associated with higher odds of subjective financial hardship than objective financial hardship. Subjective financial hardship alone was associated with significantly higher adjusted odds of self-reporting deferred or forgone care compared with objective financial hardship alone (OR, 2.69; 95% CI, 1.79-4.06). Conclusions and Relevance In this cross-sectional study of US adults, 2 in 5 families of patients with ASCVD experienced health care-related financial hardship, but a focus on objective or subjective measures alone would have captured only half the burden and not identified those deferring health care. The findings suggest that a comprehensive framework that evaluates both objective and subjective measures is essential to monitor financial consequences of health care.
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Affiliation(s)
- Stephen Y. Wang
- Department of Internal Medicine, Yale New Haven Hospital, New Haven, Connecticut
| | - Javier Valero-Elizondo
- Center for Outcomes Research, Houston Methodist, Houston, Texas
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, DeBakey Heart & Vascular Center, Houston Methodist, Houston, Texas
| | - Miguel Cainzos-Achirica
- Center for Outcomes Research, Houston Methodist, Houston, Texas
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, DeBakey Heart & Vascular Center, Houston Methodist, Houston, Texas
| | - Nihar R. Desai
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
| | - Khurram Nasir
- Center for Outcomes Research, Houston Methodist, Houston, Texas
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, DeBakey Heart & Vascular Center, Houston Methodist, Houston, Texas
| | - Rohan Khera
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
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Walia H, Saxena A, Ali S, Valero-Elizondo J, Cainzos-Achirica M, Feldman T, Nasir K, Fialkow J. 0704 Association of high-risk obstructive sleep apnea with inflammatory markers in asymptomatic young and middle-aged adults in Miami Heart (MiHeart) Study at Baptist Health South Florida. Sleep 2022. [DOI: 10.1093/sleep/zsac079.700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Obstructive Sleep Apnea (OSA) is associated with elevated inflammatory markers in those with cardiovascular disease (CVD). In contrast, there are limited data to support this association in asymptomatic individuals. The Miami Heart Study measured high sensitivity C-reactive protein (hs-CRP), Interleukin 6 (IL-6) and TNF- Alpha in a cohort of asymptomatic individuals from the general population. We hypothesized that there will be significant association of high OSA risk with inflammatory markers in Miami Heart Study cohort free of CVD.
Methods
We analyzed data for 2359 clinical CVD-free participants from the Miami Heart Study, age 40-65 years (May 2015-Sept 2018). High OSA risk included those with an OSA diagnosis and/or those with high risk using the Berlin questionnaire. Poisson regression analyses were utilized to examine the associations between high OSA risk (reference: low risk) and hs-CRP, IL-6 and TNF alpha levels (continuous), in univariate and multivariate models (adjusting for age, sex, race/ethnicity [model 2], and BMI, diabetes, hypertension, high cholesterol and smoking [model 3]).
Results
800 (34%) participants were categorized as high OSA risk. Those with high OSA risk tended to be Hispanic, male, and with a higher CVD risk factor burden, especially obesity (64% vs 17%, p < 0.005) when compared to those with low OSA risk. Patients with high OSA risk had higher median values of hs-CRP (2.1 vs 1.0), IL-6 (2.0 vs 1.4), and TNF-alpha (1.2 vs 1.1) when compared to those with low OSA risk (all p < 0.001). When adjusting for age, sex, and race/ethnicity, the mean difference between patients with high and low OSA risk in hs-CRP was 1.86 (95% CI 1.69, 2.02), and 0.85 (95% CI 0.71, 0.99) in IL6. When further adjusting for CVD risk factors, these differences were attenuated, but statistically significant (hs-CRP [0.32, 95% CI 0.16, 0.48]; IL6 [0.37, 95% CI 0.21, 0.53]). In adjusted analyses, TNF-alpha was not statistically different between OSA risk populations.
Conclusion
Individuals at high risk for OSA had significant higher levels of hs-CRP and IL6, signaling to potential role of OSA in mediating the increased inflammatory markers in asymptomatic CVD risk free individuals.
Support (If Any)
Baptist Health South Florida
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Satish P, Vela E, Bilal U, Cleries M, Kanaya AM, Kandula N, Virani SS, Islam N, Valero-Elizondo J, Yahya T, Comin-Colet J, Nasir K, Mauri J, Cainzos-Achirica M. Burden of cardiovascular risk factors and disease in five Asian groups in Catalonia: a disaggregated, population-based analysis of 121 000 first-generation Asian immigrants. Eur J Prev Cardiol 2022; 29:916-924. [PMID: 33969397 PMCID: PMC9793716 DOI: 10.1093/eurjpc/zwab074] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [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: 02/26/2021] [Revised: 04/07/2021] [Accepted: 04/18/2021] [Indexed: 12/30/2022]
Abstract
AIMS To evaluate the burden of cardiovascular risk factors and disease (CVD) among five Asian groups living in Catalonia (Spain): Indian, Pakistani, Bangladeshi, Filipino, and Chinese. METHODS AND RESULTS Retrospective cohort study using the Catalan Health Surveillance System database including 42 488 Pakistanis, 40 745 Chinese, 21 705 Indians, 9544 Filipinos, and 6907 Bangladeshis; and 5.3 million native individuals ('locals'). We estimated the age-adjusted prevalence (as of 31 December 2019) and incidence (during 2019) of diabetes, hypertension, hyperlipidaemia, obesity, tobacco use, coronary heart disease (CHD), cerebrovascular disease, atrial fibrillation, and heart failure (HF). Bangladeshis had the highest prevalence of diabetes (17.4% men, 22.6% women) followed by Pakistanis. Bangladeshis also had the highest prevalence of hyperlipidaemia (23.6% men, 18.3% women), hypertension among women (24%), and incident tobacco use among men. Pakistani women had the highest prevalence of obesity (28%). For CHD, Bangladeshi men had the highest prevalence (7.3%), followed by Pakistanis (6.3%); and Pakistanis had the highest prevalence among women (3.2%). For HF, the prevalence in Pakistani and Bangladeshi women was more than twice that of locals. Indians had the lowest prevalence of diabetes across South Asians, and of CHD across South Asian men, while the prevalence of CHD among Indian women was twice that of local women (2.6% vs. 1.3%). Filipinos had the highest prevalence of hypertension among men (21.8%). Chinese men and women had the lowest prevalence of risk factors and CVD. CONCLUSIONS In Catalonia, preventive interventions adapted to the risk profile of different Asian immigrant groups are needed, particularly for Bangladeshis and Pakistanis.
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Affiliation(s)
- Priyanka Satish
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, 6565 Fannin St Brown Bldg. B5-019, Houston, TX 77030, USA
| | - Emili Vela
- Healthcare Information and Knowledge Unit, Catalan Health Service, Travessera de les Corts, 131-159 - Pavelló Ave Maria; 08028 Barcelona, Spain,Pla Director de Malalties de l’Aparell Circulatori (PDMAC), Health Department of the Government of Catalonia, Travessera de les Corts, 131-159 - Pavelló Ave Maria; 08028 Barcelona, Spain
| | - Usama Bilal
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Nesbitt Hall, 3215 Market St, Philadelphia, PA 19104, USA
| | - Montse Cleries
- Healthcare Information and Knowledge Unit, Catalan Health Service, Travessera de les Corts, 131-159 - Pavelló Ave Maria; 08028 Barcelona, Spain,Pla Director de Malalties de l’Aparell Circulatori (PDMAC), Health Department of the Government of Catalonia, Travessera de les Corts, 131-159 - Pavelló Ave Maria; 08028 Barcelona, Spain
| | - Alka M. Kanaya
- Department of Medicine, University of California, San Francisco (CA), 505 Parnassus Ave, San Francisco, CA 94143, USA
| | - Namratha Kandula
- Feinberg School of Medicine, Northwestern University, Chicago(IL), 303 E Chicago Ave, Chicago, IL 60611, USA
| | - Salim S. Virani
- Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center and Section of Cardiology, Department of Medicine, Baylor College of Medicine, 2002 Holcombe Blvd, Houston, TX 77030, USA
| | - Nadia Islam
- Department of Population Health, NYU Langone Health, 550 1st Avenue, New York, NY 10016, USA
| | - Javier Valero-Elizondo
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, 6565 Fannin St Brown Bldg. B5-019, Houston, TX 77030, USA,Center for Outcomes Research, Houston Methodist, 6670 Bertner Ave, Houston, TX 77030, USA
| | - Tamer Yahya
- Center for Outcomes Research, Houston Methodist, 6670 Bertner Ave, Houston, TX 77030, USA
| | - Josep Comin-Colet
- Pla Director de Malalties de l’Aparell Circulatori (PDMAC), Health Department of the Government of Catalonia, Travessera de les Corts, 131-159 - Pavelló Ave Maria; 08028 Barcelona, Spain,Department of Cardiology, Bellvitge University Hospital, Carrer de la Feixa Llarga, s/n, 08907, L’Hospitalet de Llobregat, Barcelona, Spain,Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Gran Via de les Corts Catalanes, 585, 08007 Barcelona, Spain
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, 6565 Fannin St Brown Bldg. B5-019, Houston, TX 77030, USA,Center for Outcomes Research, Houston Methodist, 6670 Bertner Ave, Houston, TX 77030, USA
| | - Josepa Mauri
- Pla Director de Malalties de l’Aparell Circulatori (PDMAC), Health Department of the Government of Catalonia, Travessera de les Corts, 131-159 - Pavelló Ave Maria; 08028 Barcelona, Spain,Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Carretera de Canyet, s/n, 08916 Badalona, Barcelona, Spain
| | - Miguel Cainzos-Achirica
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, 6565 Fannin St Brown Bldg. B5-019, Houston, TX 77030, USA,Center for Outcomes Research, Houston Methodist, 6670 Bertner Ave, Houston, TX 77030, USA,Corresponding author. Tel: +1 443 413 6350,
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Nasir K, Cainzos-Achirica M, Valero-Elizondo J, Ali SS, Havistin R, Lakshman S, Blaha MJ, Blankstein R, Shapiro MD, Arias L, Saxena A, Feldman T, Budoff MJ, Ziffer JA, Fialkow J, Cury RC. Coronary Atherosclerosis in an Asymptomatic U.S. Population. JACC: Cardiovascular Imaging 2022; 15:1604-1618. [DOI: 10.1016/j.jcmg.2022.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/04/2022] [Accepted: 02/09/2022] [Indexed: 12/13/2022]
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Nguyen RT, Khan SU, Valero-Elizondo J, Cainzos-Achirica M, Nasir K. Association of Income Status with Stroke in Non-Elderly Adults in the United States, 2012-2018. Curr Probl Cardiol 2022:101235. [DOI: 10.1016/j.cpcardiol.2022.101235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 04/24/2022] [Indexed: 11/24/2022]
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Caraballo C, Mahajan S, Valero-Elizondo J, Massey D, Lu Y, Roy B, Riley C, Annapureddy AR, Murugiah K, Elumn J, Nasir K, Nunez-Smith M, Forman HP, Jackson CL, Herrin J, Krumholz HM. Evaluation of Temporal Trends in Racial and Ethnic Disparities in Sleep Duration Among US Adults, 2004-2018. JAMA Netw Open 2022; 5:e226385. [PMID: 35389500 PMCID: PMC8990329 DOI: 10.1001/jamanetworkopen.2022.6385] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
IMPORTANCE Historically marginalized racial and ethnic groups are generally more likely to experience sleep deficiencies. It is unclear how these sleep duration disparities have changed during recent years. OBJECTIVE To evaluate 15-year trends in racial and ethnic differences in self-reported sleep duration among adults in the US. DESIGN, SETTING, AND PARTICIPANTS This serial cross-sectional study used US population-based National Health Interview Survey data collected from 2004 to 2018. A total of 429 195 noninstitutionalized adults were included in the analysis, which was performed from July 26, 2021, to February 10, 2022. EXPOSURES Self-reported race, ethnicity, household income, and sex. MAIN OUTCOMES AND MEASURES Temporal trends and racial and ethnic differences in short (<7 hours in 24 hours) and long (>9 hours in 24 hours) sleep duration and racial and ethnic differences in the association between sleep duration and age. RESULTS The study sample consisted of 429 195 individuals (median [IQR] age, 46 [31-60] years; 51.7% women), of whom 5.1% identified as Asian, 11.8% identified as Black, 14.7% identified as Hispanic or Latino, and 68.5% identified as White. In 2004, the adjusted estimated prevalence of short and long sleep duration were 31.4% and 2.5%, respectively, among Asian individuals; 35.3% and 6.4%, respectively, among Black individuals; 27.0% and 4.6%, respectively, among Hispanic or Latino individuals; and 27.8% and 3.5%, respectively, among White individuals. During the study period, there was a significant increase in short sleep prevalence among Black (6.39 [95% CI, 3.32-9.46] percentage points), Hispanic or Latino (6.61 [95% CI, 4.03-9.20] percentage points), and White (3.22 [95% CI, 2.06-4.38] percentage points) individuals (P < .001 for each), whereas prevalence of long sleep changed significantly only among Hispanic or Latino individuals (-1.42 [95% CI, -2.52 to -0.32] percentage points; P = .01). In 2018, compared with White individuals, short sleep prevalence among Black and Hispanic or Latino individuals was higher by 10.68 (95% CI, 8.12-13.24; P < .001) and 2.44 (95% CI, 0.23-4.65; P = .03) percentage points, respectively, and long sleep prevalence was higher only among Black individuals (1.44 [95% CI, 0.39-2.48] percentage points; P = .007). The short sleep disparities were greatest among women and among those with middle or high household income. In addition, across age groups, Black individuals had a higher short and long sleep duration prevalence compared with White individuals of the same age. CONCLUSIONS AND RELEVANCE The findings of this cross-sectional study suggest that from 2004 to 2018, the prevalence of short and long sleep duration was persistently higher among Black individuals in the US. The disparities in short sleep duration appear to be highest among women, individuals who had middle or high income, and young or middle-aged adults, which may be associated with health disparities.
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Affiliation(s)
- César Caraballo
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Shiwani Mahajan
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Javier Valero-Elizondo
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
- Center for Outcomes Research, Houston Methodist Research Institute, Houston, Texas
| | - Daisy Massey
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
| | - Yuan Lu
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Brita Roy
- Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Carley Riley
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Division of Critical Care Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Amarnath R. Annapureddy
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Karthik Murugiah
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Johanna Elumn
- SEICHE Center for Health and Justice, Section of General Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
- Center for Outcomes Research, Houston Methodist Research Institute, Houston, Texas
| | - Marcella Nunez-Smith
- Equity Research and Innovation Center, Section of General Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Howard P. Forman
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - Chandra L. Jackson
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, North Carolina
- Intramural Program, National Institute on Minority Health and Health Disparities, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - Jeph Herrin
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Harlan M. Krumholz
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
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Acquah I, Hagan K, Valero-Elizondo J, Javed Z, Butt SA, Mahajan S, Taha MB, Hyder AA, Mossialos E, Cainzos-Achirica M, Nasir K. Delayed medical care due to transportation barriers among adults with atherosclerotic cardiovascular disease. Am Heart J 2022; 245:60-69. [PMID: 34902312 DOI: 10.1016/j.ahj.2021.11.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 11/06/2021] [Accepted: 11/19/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND In patients with atherosclerotic cardiovascular disease (ASCVD), barriers related to transportation may impair access to care, with potential implications for prognosis. Although few studies have explored transportation barriers among patients with ASCVD, the correlates of delayed care due to transportation barriers have not been examined in this population. We aimed to examine this in U.S. patients with ASCVD using nationally representative data. METHODS Using data from the 2009-2018 National Health Interview Survey, we estimated the self-reported prevalence of delayed medical care due to transportation barriers among adults with ASCVD, overall and by sociodemographic characteristics. Logistic regression was used to examine the association between various sociodemographic characteristics and delayed care due to transportation barriers. RESULTS Among adults with ASCVD, 4.5% (95% CI; 4.2, 4.8) or ∼876,000 annually reported delayed care due to transportation barriers. Income (low-income: odds ratio [OR] 4.43, 95% CI [3.04, 6.46]; lowest-income: OR 6.35, 95% CI [4.36, 9.23]) and Medicaid insurance (OR 4.53; 95% CI [3.27, 6.29]) were strongly associated with delayed care due to transportation barriers. Additionally, younger individuals, women, non-Hispanic Black adults, and those from the U.S. South or Midwest, had higher odds of reporting delayed care due to transportation barriers. CONCLUSIONS Approximately 5% of adults with ASCVD experience delayed care due to transportation barriers. Vulnerable groups include young adults, women, low-income people, and those with public/no insurance. Future studies should analyze the feasibility and potential benefits of interventions such as use of telehealth, mobile clinics, and provision of transportation among patients with ASCVD in the U.S.
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Affiliation(s)
- Isaac Acquah
- Center for Outcomes Research, Houston Methodist, Houston, TX
| | - Kobina Hagan
- Center for Outcomes Research, Houston Methodist, Houston, TX
| | - Javier Valero-Elizondo
- Center for Outcomes Research, Houston Methodist, Houston, TX; Division for Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX
| | | | - Sara Ayaz Butt
- Center for Outcomes Research, Houston Methodist, Houston, TX
| | - Shiwani Mahajan
- The Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT; Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Mohamad Badie Taha
- Department of Medicine, University of Florida College of Medicine, Gainesville, FL
| | - Adnan A Hyder
- Center on Commercial Determinants of Health, Milken Institute School of Public Health, The George Washington University, Washington, DC
| | - Elias Mossialos
- Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Miguel Cainzos-Achirica
- Center for Outcomes Research, Houston Methodist, Houston, TX; Division for Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX
| | - Khurram Nasir
- Center for Outcomes Research, Houston Methodist, Houston, TX; Division for Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX.
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Taha MB, Valero-Elizondo J, Yahya T, Caraballo C, Khera R, Patel KV, Ali HJR, Sharma G, Mossialos E, Cainzos-Achirica M, Nasir K. Cost-Related Medication Nonadherence in Adults With Diabetes in the United States: The National Health Interview Survey 2013-2018. Diabetes Care 2022; 45:594-603. [PMID: 35015860 DOI: 10.2337/dc21-1757] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 12/09/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Health-related expenditures resulting from diabetes are rising in the U.S. Medication nonadherence is associated with worse health outcomes among adults with diabetes. We sought to examine the extent of reported cost-related medication nonadherence (CRN) in individuals with diabetes in the U.S. RESEARCH DESIGN AND METHODS We studied adults age ≥18 years with self-reported diabetes from the National Health Interview Survey (NHIS) (2013-2018), a U.S. nationally representative survey. Adults reporting skipping doses, taking less medication, or delaying filling a prescription to save money in the past year were considered to have experienced CRN. The weighted prevalence of CRN was estimated overall and by age subgroups (<65 and ≥65 years). Logistic regression was used to identify sociodemographic characteristics independently associated with CRN. RESULTS Of the 20,326 NHIS participants with diabetes, 17.6% (weighted 2.3 million) of those age <65 years reported CRN, compared with 6.9% (weighted 0.7 million) among those age ≥65 years. Financial hardship from medical bills, lack of insurance, low income, high comorbidity burden, and female sex were independently associated with CRN across age groups. Lack of insurance, duration of diabetes, current smoking, hypertension, and hypercholesterolemia were associated with higher odds of reporting CRN among the nonelderly but not among the elderly. Among the elderly, insulin use significantly increased the odds of reporting CRN (odds ratio 1.51; 95% CI 1.18, 1.92). CONCLUSIONS In the U.S., one in six nonelderly and one in 14 elderly adults with diabetes reported CRN. Removing financial barriers to accessing medications may improve medication adherence among these patients, with the potential to improve their outcomes.
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Affiliation(s)
- Mohamad B Taha
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX
| | - Javier Valero-Elizondo
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX.,Center for Outcomes Research, Houston Methodist, Houston, TX
| | - Tamer Yahya
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX
| | - César Caraballo
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT
| | - Rohan Khera
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT.,Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Kershaw V Patel
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX
| | - Hyeon Ju R Ali
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX
| | - Garima Sharma
- Division of Cardiology, Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine and Hospital, Baltimore, MD
| | - Elias Mossialos
- Department of Health Policy, London School of Economics and Political Sciences, London, U.K
| | - Miguel Cainzos-Achirica
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX.,Center for Outcomes Research, Houston Methodist, Houston, TX
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX.,Center for Outcomes Research, Houston Methodist, Houston, TX
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Nguyen RT, Khan S, Acquah I, Javed Z, Valero-Elizondo J, Taha MB, Virani SS, Blaha M, Hanif B, Blankstein R, Sharma G, Cainzos-Achirica M, Nasir K. ASSOCIATION OF CARDIOVASCULAR RISK PROFILE WITH ALL-CAUSE AND CARDIOVASCULAR MORTALITY IN NON-ELDERLY US ADULTS, 2006-2014. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)02489-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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24
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Yahya T, Acquah I, Taha MB, Valero-Elizondo J, Al-Mallah MH, Chamsi-Pasha MA, Zoghbi WA, Soliman A, Faza N, Cainzos-Achirica M, Nasir K. Cardiovascular risk profile of Middle Eastern immigrants living in the United States-the National Health Interview Survey. Am J Prev Cardiol 2022; 9:100312. [PMID: 35024678 PMCID: PMC8732795 DOI: 10.1016/j.ajpc.2021.100312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 12/17/2021] [Accepted: 12/22/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Middle Eastern (ME) immigrants are one of the fastest-growing groups in the US. Although ME countries have a high burden of atherosclerotic cardiovascular disease (ASCVD), the cardiovascular health status among ME immigrants in the US has not been studied in detail. This study aims to characterize the cardiovascular health status (CVD risk factors and ASCVD burden) among ME immigrants in the US. METHODS We used 2012-2018 data from the National Health Interview Survey, a US nationally representative survey. ME origin, CVD risk factors, and ASCVD status were self-reported. We compared these to US-born non-Hispanic white (NHW) individuals in the US. RESULTS Among 139,778 adults included, 886 (representing 1.3 million individuals, mean age 46.8) were of ME origin, and 138,892 were US-born NHWs (representing 150 million US adults, mean age 49.3). ME participants were more likely to have higher education, lower income and be uninsured. The age-adjusted prevalence of hypertension (22.4% vs 27.4%) and obesity (21.4% vs 31.4%) were significantly lower in ME vs NHW participants, respectively. There were no significant differences between the groups in the age-adjusted prevalence of ASCVD, diabetes, hyperlipidemia, and smoking. Only insufficient physical activity was higher among ME individuals. ME immigrants living in the US for 10 years or more reported higher age-adjusted prevalence of hypertension, hyperlipidemia, and ASCVD. CONCLUSIONS ME immigrants in the US have lower odds of hypertension and obesity, and of having a suboptimal CRF profile compared to US-born NHWs. Further studies are needed to determine whether these findings are related to lower risk, selection of a healthier ME subgroup in NHIS, or possible under-detection of cardiovascular risk factors in ME immigrants living in the US.
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Affiliation(s)
- Tamer Yahya
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, 6550 Fannin St Suite 1801, Houston TX 77030, USA
| | - Isaac Acquah
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, 6550 Fannin St Suite 1801, Houston TX 77030, USA
- Center for Outcomes Research, Houston Methodist, Houston TX, USA
| | - Mohamad B Taha
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, 6550 Fannin St Suite 1801, Houston TX 77030, USA
| | | | - Mouaz H. Al-Mallah
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, 6550 Fannin St Suite 1801, Houston TX 77030, USA
| | - Mohammed A. Chamsi-Pasha
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, 6550 Fannin St Suite 1801, Houston TX 77030, USA
| | - William A. Zoghbi
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, 6550 Fannin St Suite 1801, Houston TX 77030, USA
| | - Ahmed Soliman
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, 6550 Fannin St Suite 1801, Houston TX 77030, USA
| | - Nadeen Faza
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, 6550 Fannin St Suite 1801, Houston TX 77030, USA
| | - Miguel Cainzos-Achirica
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, 6550 Fannin St Suite 1801, Houston TX 77030, USA
- Center for Outcomes Research, Houston Methodist, Houston TX, USA
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, 6550 Fannin St Suite 1801, Houston TX 77030, USA
- Center for Outcomes Research, Houston Methodist, Houston TX, USA
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25
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Chang R, Javed Z, Taha M, Yahya T, Valero-Elizondo J, Brandt EJ, Cainzos-Achirica M, Mahajan S, Ali HJ, Nasir K. Food insecurity and cardiovascular disease: Current trends and future directions. Am J Prev Cardiol 2022; 9:100303. [PMID: 34988538 PMCID: PMC8702994 DOI: 10.1016/j.ajpc.2021.100303] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/20/2021] [Accepted: 12/07/2021] [Indexed: 11/24/2022] Open
Abstract
Food insecurity (FI) - a state of limited access to nutritionally adequate food - is notably more prominent among patients with cardiovascular disease (CVD) than the general population. Current research suggests that FI increases the risk of cardiovascular morbidity and mortality through various behavioral and biological pathways. Importantly, FI is more prevalent among low-income households and disproportionately affects households with children, particularly those led by single mothers. These disparities necessitate solutions specifically geared towards helping these high-risk subgroups, who also experience increased risk of CVD associated with FI. Further, individuals with CVD may experience increased risk of FI due to the financial burden imposed by CVD care. While participation in federal aid programs like the Supplemental Nutrition Assistance Program and the Special Supplemental Nutrition Program for Women, Infants, and Children has been associated with cardiovascular health benefits, residual FI and lower dietary quality among many families suggest a need for better outreach and expanded public assistance programs. Healthcare systems and community organizations can play a vital role in screening individuals for FI and connecting them with food and educational resources. While further research is needed to evaluate sociodemographic differences in the FI-CVD relationship, interventions at the policy, health system, and community levels can help address both the burden of FI and its impacts on cardiovascular health.
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Affiliation(s)
- Ryan Chang
- Washington University in St. Louis, St. Louis, MO, USA
- Division of Health Equity and Disparities Research, Center for Outcomes Research, Houston Methodist, Houston, TX, USA
| | - Zulqarnain Javed
- Division of Health Equity and Disparities Research, Center for Outcomes Research, Houston Methodist, Houston, TX, USA
| | - Mohamad Taha
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Tamer Yahya
- Division of Health Equity and Disparities Research, Center for Outcomes Research, Houston Methodist, Houston, TX, USA
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Javier Valero-Elizondo
- Division of Health Equity and Disparities Research, Center for Outcomes Research, Houston Methodist, Houston, TX, USA
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
- Center for Cardiovascular Computational Health & Precision Medicine (C3-PH), USA
| | - Eric J. Brandt
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Miguel Cainzos-Achirica
- Division of Health Equity and Disparities Research, Center for Outcomes Research, Houston Methodist, Houston, TX, USA
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
- Center for Cardiovascular Computational Health & Precision Medicine (C3-PH), USA
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Shiwani Mahajan
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Hyeon-Ju Ali
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Khurram Nasir
- Division of Health Equity and Disparities Research, Center for Outcomes Research, Houston Methodist, Houston, TX, USA
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
- Center for Cardiovascular Computational Health & Precision Medicine (C3-PH), USA
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Johns Hopkins Medicine, Baltimore, MD, USA
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26
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Butt S, Tano M, Valero-Elizondo J, Javed Z, Hagan K, Acquah I, Mossialos E, Nikoloski Z, Achirica MC, Nasir K. MULTIDIMENSIONAL POVERTY AS A SOCIAL DETERMINANT OF HEALTH FOR ATHEROSCLEROTIC CARDIOVASCULAR DISEASE IN THE UNITED STATES. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)02423-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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27
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Nasir K, Acquah I, Dey AK, Agrawal T, Hassan SZ, Glassner K, Abraham B, Quigley EM, Blankstein R, Virani SS, Blaha MJ, Valero-Elizondo J, Cainzos-Achirica M, Mehta NN. Inflammatory bowel disease and atherosclerotic cardiovascular disease in U.S. adults—A population-level analysis in the national health interview survey. Am J Prev Cardiol 2022; 9:100316. [PMID: 35112094 PMCID: PMC8790599 DOI: 10.1016/j.ajpc.2022.100316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 12/31/2021] [Accepted: 01/15/2022] [Indexed: 11/04/2022] Open
Abstract
Objectives To evaluate the association between inflammatory bowel disease (IBD) and atherosclerotic cardiovascular disease (ASCVD) and whether this association is modified by age or sex. Methods We conducted a cross-sectional analysis using data from the 2015–2016 National Health Interview Survey (NHIS). The exposure of interest was self-reported IBD. The outcome of interest was prevalent ASCVD, which included a history of angina, myocardial infarction or stroke. We used survey-specific descriptive statistics to obtain weighted national estimates for IBD and ASCVD prevalence. Logistic regression models were used to assess the association between IBD and ASCVD, progressively adjusting for demographics and traditional risk factors. Effect modification by age and sex was evaluated. Results Among participants with IBD, the age-adjusted prevalence of ASCVD was 12.0% compared to 6.9% among those without IBD (p < 0.001). In multivariable regression analyses IBD was associated with increased odds of having ASCVD, even after adjustment for demographics and traditional risk factors (odds ratio 1.58, 95% CI 1.17–2.13). We found statistically significant interaction by age (p < 0.001) whereby those in the younger age strata had the strongest association (fully adjusted odds ratio among 18- to 44-year-olds 3.35, 95% CI 1.75, 6.40) while the association was null in those ≥65 years. Effect modification by sex was not observed. Conclusion Our analysis confirms an independent association between IBD and ASCVD in the U.S., particularly among young adults. Further studies are needed to fully establish a causal relationship between IBD and ASCVD, characterize the mechanisms underlying these associations, and identify tailored opportunities for ASCVD prevention in young and middle-aged adults with IBD.
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Khan SU, Acquah I, Javed Z, Valero-Elizondo J, Yahya T, Blankstein R, Virani SS, Blaha MJ, Hyder AA, Dubey P, Vahidy FS, Cainzos-Achirica M, Nasir K. Social Determinants of Health Among Non-Elderly Adults With Stroke in the United States. Mayo Clin Proc 2022; 97:238-249. [PMID: 35120692 DOI: 10.1016/j.mayocp.2021.08.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/31/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To examine the association of social determinants of health (SDOH) on prevalence of stroke in non-elderly adults (<65 years of age). METHODS We used the National Health Interview Survey (2013-2017) database. The study population was stratified into younger (<45 years of age) and middle age (45 to 64 years of age) adults. For each individual, an SDOH aggregate score was calculated representing the cumulative number of individual unfavorable SDOH (present vs absent), identified from 39 subcomponents across five domains (economic stability, neighborhood, community and social context, food, education, and health care system access) and divided into quartiles (quartile 1, most favorable; quartile 4, most unfavorable). Multivariable models tested the association between SDOH score quartiles and stroke. RESULTS The age-adjusted prevalence of stroke was 1.4% in the study population (n=123,631; 58.2% (n=71,956) in patients <45 years of age). Young adults reported approximately 20% of all strokes. Participants with stroke had unfavorable responses to 36 of 39 SDOH; nearly half (48%) of all strokes were reported by participants in the highest SDOH score quartile. A stepwise increase in age-adjusted stroke prevalence was observed across increasing quartiles of SDOH (first, 0.6%; second, 0.9%; third, 1.4%; and fourth, 2.9%). After accounting for demographics and cardiovascular disease risk factors, participants in the fourth vs first quartile had higher odds of stroke (odds ratio, 2.78; 95% CI, 2.25 to 3.45). CONCLUSION Nearly half of all non-elderly individuals with stroke have an unfavorable SDOH profile. Standardized assessment of SDOH risk burden may inform targeted strategies to mitigate disparities in stroke burden and outcomes in this population.
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Affiliation(s)
- Safi U Khan
- Department of Cardiovascular Medicine, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX
| | - Isaac Acquah
- Center for Outcomes Research, Houston Methodist, Houston, TX; Division of Health Equity & Disparities Research, Center for Outcomes Research, Houston Methodist, Houston TX, USA
| | - Zulqarnain Javed
- Division of Health Equity & Disparities Research, Center for Outcomes Research, Houston Methodist, Houston TX, USA
| | - Javier Valero-Elizondo
- Center for Outcomes Research, Houston Methodist, Houston, TX; Division of Health Equity & Disparities Research, Center for Outcomes Research, Houston Methodist, Houston TX, USA
| | - Tamer Yahya
- Center for Outcomes Research, Houston Methodist, Houston, TX; Division of Health Equity & Disparities Research, Center for Outcomes Research, Houston Methodist, Houston TX, USA
| | - Ron Blankstein
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA
| | - Salim S Virani
- Michael E. DeBakey Veterans Affair Medical Center & Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Michael J Blaha
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University, Baltimore, MD
| | - Adnan A Hyder
- Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Prachi Dubey
- Department of Radiology, Houston Methodist Hospital & Houston Methodist Research Institute, Houston, TX
| | | | - Miguel Cainzos-Achirica
- Center for Outcomes Research, Houston Methodist, Houston, TX; Division of Cardiovascular Prevention and Wellness, Department of Cardiovascular Medicine, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Department of Cardiovascular Medicine, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX; Division of Health Equity & Disparities Research, Center for Outcomes Research, Houston Methodist, Houston TX, USA; Center for Cardiovascular Computational Health & Precision Medicine (C3-PH), Houston Methodist, Houston, TX, USA.
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29
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Javed Z, Valero-Elizondo J, Maqsood MH, Mahajan S, Taha MB, Patel KV, Sharma G, Hagan K, Blaha MJ, Blankstein R, Mossialos E, Virani SS, Cainzos-Achirica M, Nasir K. Social determinants of health and obesity: Findings from a national study of US adults. Obesity (Silver Spring) 2022; 30:491-502. [PMID: 35088551 DOI: 10.1002/oby.23336] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 10/06/2021] [Accepted: 10/16/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE This study examined the association between social determinants of health (SDOH) burden and overweight/obesity in a nationally representative sample of adults in the United States. METHODS Data for 161,795 adults aged ≥18 years from the 2013 to 2017 National Health Interview Survey were used. A total of 38 SDOH were aggregated to create a cumulative SDOH score, which was divided into quartiles (Q1-Q4) to denote levels of SDOH burden. Prevalence of overweight and obesity was examined across SDOH quartiles in the total population and by age, sex, and race/ethnicity. Multinomial logistic regression models were used to analyze the association between SDOH quartiles and overweight/obesity, adjusting for relevant covariates. RESULTS There was a graded increase in obesity prevalence with increasing SDOH burden. At nearly each quartile, overweight and obesity rates were higher for middle-aged and non-Hispanic Black adults compared with their counterparts; additional differences were observed by sex. In fully adjusted models, SDOH-Q4 was associated with 15%, 50%, and 70% higher relative prevalence of overweight, obesity class 1 and 2, and obesity class 3, respectively, relative to SDOH-Q1. CONCLUSIONS Cumulative social disadvantage, denoted by higher SDOH burden, was associated with increased odds of obesity, independent of clinical and demographic factors.
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Affiliation(s)
- Zulqarnain Javed
- Division of Health Equity & Disparities Research, Center for Outcomes Research, Houston Methodist, Houston, Texas, USA
| | - Javier Valero-Elizondo
- Division of Health Equity & Disparities Research, Center for Outcomes Research, Houston Methodist, Houston, Texas, USA
- Division of Cardiovascular Prevention and Wellness, DeBakey Heart and Vascular Center, Houston Methodist, Houston, Texas, USA
- Center for Cardiovascular Computational Health & Precision Medicine (C3-PH), Houston Methodist, Houston, Texas, USA
| | | | - Shiwani Mahajan
- Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Mohamad B Taha
- Division of Cardiovascular Prevention and Wellness, DeBakey Heart and Vascular Center, Houston Methodist, Houston, Texas, USA
| | - Kershaw V Patel
- Division of Cardiovascular Prevention and Wellness, DeBakey Heart and Vascular Center, Houston Methodist, Houston, Texas, USA
| | - Garima Sharma
- Division of Cardiology, Ciccarone Center for Prevention of Cardiovascular Disease, The Johns Hopkins University School of Medicine, The John Hopkins University, Baltimore, Maryland, USA
| | - Kobina Hagan
- Division of Health Equity & Disparities Research, Center for Outcomes Research, Houston Methodist, Houston, Texas, USA
| | - Michael J Blaha
- Division of Cardiology, Ciccarone Center for Prevention of Cardiovascular Disease, The Johns Hopkins University School of Medicine, The John Hopkins University, Baltimore, Maryland, USA
| | - Ron Blankstein
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Harvard University, Boston, Massachusetts, USA
| | - Elias Mossialos
- Department of Health Policy, London School of Economics, London, UK
| | - Salim S Virani
- Health Policy, Quality & Informatics Program, Health Services Research & Development Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
- Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas, USA
- Section of Cardiology, Health Services Research and Development, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
| | - Miguel Cainzos-Achirica
- Division of Health Equity & Disparities Research, Center for Outcomes Research, Houston Methodist, Houston, Texas, USA
- Division of Cardiovascular Prevention and Wellness, DeBakey Heart and Vascular Center, Houston Methodist, Houston, Texas, USA
- Center for Cardiovascular Computational Health & Precision Medicine (C3-PH), Houston Methodist, Houston, Texas, USA
| | - Khurram Nasir
- Division of Health Equity & Disparities Research, Center for Outcomes Research, Houston Methodist, Houston, Texas, USA
- Division of Cardiovascular Prevention and Wellness, DeBakey Heart and Vascular Center, Houston Methodist, Houston, Texas, USA
- Center for Cardiovascular Computational Health & Precision Medicine (C3-PH), Houston Methodist, Houston, Texas, USA
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30
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Javed Z, Haisum Maqsood M, Yahya T, Amin Z, Acquah I, Valero-Elizondo J, Andrieni J, Dubey P, Jackson RK, Daffin MA, Cainzos-Achirica M, Hyder AA, Nasir K. Race, Racism, and Cardiovascular Health: Applying a Social Determinants of Health Framework to Racial/Ethnic Disparities in Cardiovascular Disease. Circ Cardiovasc Qual Outcomes 2022; 15:e007917. [PMID: 35041484 DOI: 10.1161/circoutcomes.121.007917] [Citation(s) in RCA: 87] [Impact Index Per Article: 43.5] [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] [Indexed: 11/16/2022]
Abstract
Health care in the United States has seen many great innovations and successes in the past decades. However, to this day, the color of a person's skin determines-to a considerable degree-his/her prospects of wellness; risk of disease, and death; and the quality of care received. Disparities in cardiovascular disease (CVD)-the leading cause of morbidity and mortality globally-are one of the starkest reminders of social injustices, and racial inequities, which continue to plague our society. People of color-including Black, Hispanic, American Indian, Asian, and others-experience varying degrees of social disadvantage that puts these groups at increased risk of CVD and poor disease outcomes, including mortality. Racial/ethnic disparities in CVD, while documented extensively, have not been examined from a broad, upstream, social determinants of health lens. In this review, we apply a comprehensive social determinants of health framework to better understand how structural racism increases individual and cumulative social determinants of health burden for historically underserved racial and ethnic groups, and increases their risk of CVD. We analyze the link between race, racism, and CVD, including major pathways and structural barriers to cardiovascular health, using 5 distinct social determinants of health domains: economic stability; neighborhood and physical environment; education; community and social context; and healthcare system. We conclude with a set of research and policy recommendations to inform future work in the field, and move a step closer to health equity.
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Affiliation(s)
- Zulqarnain Javed
- Division of Health Equity & Disparities Research, Center for Outcomes Research, Houston Methodist, TX (Z.J., M.C.-A., K.N.)
| | | | - Tamer Yahya
- Center for Outcomes Research, Houston Methodist, TX (T.Y., I.A., J.V.-E., M.C.-A., K.N.)
| | | | - Isaac Acquah
- Center for Outcomes Research, Houston Methodist, TX (T.Y., I.A., J.V.-E., M.C.-A., K.N.)
| | - Javier Valero-Elizondo
- Center for Outcomes Research, Houston Methodist, TX (T.Y., I.A., J.V.-E., M.C.-A., K.N.).,Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, TX (J.V.-E., M.C.-A., K.N.).,Center for Cardiovascular Computational Health & Precision Medicine (C3-PH), Houston Methodist, TX (J.V.-E., M.C.-A., K.N.)
| | - Julia Andrieni
- Population Health and Primary Care (J.A.), Houston Methodist Hospital, TX
| | - Prachi Dubey
- Houston Methodist Hospital, Houston Methodist Research Institute, TX (P.D.)
| | - Ryane K Jackson
- Office of Community Benefits (R.K.J.), Houston Methodist Hospital, TX
| | - Mary A Daffin
- Barrett Daffin Frappier Turner & Engel, L.L.P., Houston, TX (M.A.D.)
| | - Miguel Cainzos-Achirica
- Division of Health Equity & Disparities Research, Center for Outcomes Research, Houston Methodist, TX (Z.J., M.C.-A., K.N.).,Center for Outcomes Research, Houston Methodist, TX (T.Y., I.A., J.V.-E., M.C.-A., K.N.).,Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, TX (J.V.-E., M.C.-A., K.N.).,Center for Cardiovascular Computational Health & Precision Medicine (C3-PH), Houston Methodist, TX (J.V.-E., M.C.-A., K.N.)
| | - Adnan A Hyder
- Milken Institute School of Public Health, George Washington University, DC (A.A.H.)
| | - Khurram Nasir
- Division of Health Equity & Disparities Research, Center for Outcomes Research, Houston Methodist, TX (Z.J., M.C.-A., K.N.).,Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, TX (J.V.-E., M.C.-A., K.N.).,Center for Cardiovascular Computational Health & Precision Medicine (C3-PH), Houston Methodist, TX (J.V.-E., M.C.-A., K.N.)
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Okunrintemi V, Valero-Elizondo J, Stone NJ, Blankstein R, Blaha MJ, Gulati M, Virani SS, Zoghbi WA, Michos ED, Nasir K. Shared decision making and patient reported outcomes among adults with atherosclerotic cardiovascular disease, medical expenditure panel survey 2006-2015. Am J Prev Cardiol 2021; 8:100281. [PMID: 34877558 PMCID: PMC8627957 DOI: 10.1016/j.ajpc.2021.100281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 10/04/2021] [Accepted: 10/08/2021] [Indexed: 12/02/2022] Open
Abstract
Question: Whether there is an association between shared decision making (SDM) and patient reported outcomes among individuals with atherosclerotic cardiovascular disease (ASCVD). Findings: In this retrospective cohort study among individuals with ASCVD, compared with poor SDM, optimal SDM was associated with increased utilization of guideline therapy for secondary prevention of ASCVD, lower frequency of ED visits, improved perception of health and healthcare related quality of life, without any significant influence on healthcare expenditure. Meaning: The results from this study could provide useful evidence for expanding the use of SDM in patient-centered care among individuals with ASCVD.
Importance Shared decision-making (SDM), one of the pillars of patient centered care is strongly encouraged and has been incorporated into the management of atherosclerotic cardiovascular disease (ASCVD) but the expansion of its use has been limited Objective To determine the association of SDM on patient-reported health status, measures of quality of care, healthcare resource utilization, and healthcare spending among US adults with ASCVD Method This is a retrospective cohort study in an ambulatory setting, utilizing the Medical Expenditure Panel Survey (MEPS) 2006–2015. Analysis completed in December 2020. Participants included were adults 18 years and over with a diagnosis of ASCVD. We used the average weighted response to self-administered questionnaire evaluating shared-decision-making process as the exposure variable in the regression model. Outcome measures included inpatient hospitalizations, Emergency Department (ED) visits, statin and aspirin use, self-perception of health, and healthcare expenditure Results When compared with individuals reporting poor SDM, those with optimal SDM were more likely to report statin and aspirin use [statin use, Odds Ratio (OR) 1.26 (95% CI, 1.09–1.46)], [aspirin use, 1.25 (1.07–1.45)], more likely to have a positive perception of their health and healthcare related quality of life, and were less likely to visit the ED [OR for ≥ 2 ED visits: 0.81 (0.67–0.99)]. There was no difference between groups in annual total or out of pocket healthcare expenditure Conclusion This study suggests that effective SDM is associated with better utilization of healthcare resources and patient reported health outcomes. We hope these results could provide useful evidence for expanding the use of SDM in patient-centered care among individuals with ASCVD
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Affiliation(s)
| | | | - Neil J Stone
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ron Blankstein
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA
| | - Michael J Blaha
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Martha Gulati
- Division of Cardiology, University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Salim S Virani
- Michael E. DeBakey VA Medical Center & Section of Cardiovascular Research, Baylor College of Medicine, Houston, TX, USA
| | | | - Erin D Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Khurram Nasir
- Houston Methodist DeBakey Heart and Vascular Center, TX, USA
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Kherallah R, Al Rifai M, Kamat I, Krittanawong C, Mahtta D, Lee MT, Liu J, Nasir K, Valero-Elizondo J, Patel J, Al-Mallah MH, Petersen LA, Virani SS. Prevalence and predictors of cost-related medication nonadherence in individuals with cardiovascular disease: Results from the Behavioral Risk Factor Surveillance System (BRFSS) survey. Prev Med 2021; 153:106715. [PMID: 34242664 PMCID: PMC9125503 DOI: 10.1016/j.ypmed.2021.106715] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 02/18/2021] [Revised: 05/23/2021] [Accepted: 07/03/2021] [Indexed: 11/17/2022]
Abstract
Medication nonadherence is highly prevalent among patients with chronic cardiovascular disease. Poor adherence has been associated with increased morbidity and mortality. Medication cost is a major driver for medication nonadherence. Utilizing data from the 2016 to 2018 Behavioral Risk Factor Surveillance System (BRFSS) survey, we estimated the prevalence of cost-related medication nonadherence (CRMNA) among the overall population and among individuals who reported a history of diabetes, atherosclerotic cardiovascular disease (ASCVD), or hypertension. We then performed multivariable logistic regression to analyze sociodemographic factors associated with CRMNA. Our study population consisted of 142,577 individuals of whom 24% were older than 65 years, 47% were men, 66% were White, 17% Black, 35% had hypertension, 13% had diabetes mellitus, and 10% had ASCVD. CRMNA was reported in 10% of the overall population, 12% among those with hypertension, 17% among those with diabetes, and 17% among those with ASCVD. Age below 65 years, female gender, unemployment, lower income, lower educational attainment, having at least 1 comorbidity, and living in a state that did not expand Medicaid were independently associated with CRMNA. The prevalence of CRMNA increased with greater number of these high-risk sociodemographic factors. We conclude that the prevalence of CRMNA is 10% among U.S. adults overall and is higher among those with common chronic diseases. Risk factors associated with CRMNA should be addressed in order to improve adherence rates and health outcomes among high-risk individuals.
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Affiliation(s)
- Riyad Kherallah
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States of America
| | - Mahmoud Al Rifai
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, United States of America
| | - Ishan Kamat
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States of America
| | - Chayakrit Krittanawong
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, United States of America
| | - Dhruv Mahtta
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, United States of America
| | - Michelle T Lee
- Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations in Quality, Effectiveness, and Safety, Houston, TX, United States of America
| | - Jing Liu
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, United States of America
| | - Khurram Nasir
- Center for Outcomes Research, Houston Methodist Research Institute, Houston, TX, United States of America
| | - Javier Valero-Elizondo
- Center for Outcomes Research, Houston Methodist Research Institute, Houston, TX, United States of America
| | - Jaideep Patel
- Heart Center, Division of Cardiology, Virginia Commonwealth University Medical Center, Richmond, VA, United States of America
| | - Mouaz H Al-Mallah
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, United States of America
| | - Laura A Petersen
- Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations in Quality, Effectiveness, and Safety, Houston, TX, United States of America; Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, United States of America
| | - Salim S Virani
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, United States of America; Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations in Quality, Effectiveness, and Safety, Houston, TX, United States of America; Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States of America; Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, United States of America.
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Singh R, Javed Z, Yahya T, Valero-Elizondo J, Acquah I, Hyder AA, Maqsood MH, Amin Z, Al-Kindi S, Cainzos-Achirica M, Nasir K. Community and Social Context: An Important Social Determinant of Cardiovascular Disease. Methodist Debakey Cardiovasc J 2021; 17:15-27. [PMID: 34824678 PMCID: PMC8588761 DOI: 10.14797/mdcvj.846] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 04/05/2021] [Accepted: 08/18/2021] [Indexed: 12/21/2022] Open
Abstract
Disease prevention frameworks and clinical practice guidelines in the United States (US) have traditionally ignored upstream social determinants of health (SDOH), which are critical for reducing disparities in cardiovascular disease (CVD)-the leading cause of death in the US. Existing evidence demonstrates a protective effect of social support, social cohesion, and community engagement on overall health and wellbeing. Increasing community and social support is a major objective of the Healthy People 2030 initiative, with special provisions for vulnerable populations. However, to date, existing evidence of the association between community and social context (CSC)-an integral SDOH domain-and CVD has not been reviewed extensively. In particular, the individual and cumulative impact of CSC on CVD risk and the pathways linking CSC to cardiovascular outcomes are not well understood. In this review, we critically appraise current knowledge of the association between CSC and CVD, describe potential pathways linking CSC to CVD, and identify opportunities for evidence-based policy and practice interventions to improve CVD outcomes.
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Affiliation(s)
- Rahul Singh
- Department of Cardiology, University of Minnesota, Minnesota, US
| | - Zulqarnain Javed
- Division of Health Equity & Disparities Research, Center for Outcomes Research, Houston Methodist, Houston, Texas, US
| | - Tamer Yahya
- Center for Outcomes Research, Houston Methodist, Houston, Texas, US
| | - Javier Valero-Elizondo
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA.,Center for Cardiovascular Computational Health & Precision Medicine (C3-PH), Houston Methodist, Houston, Texas, US
| | - Isaac Acquah
- Center for Outcomes Research, Houston Methodist, Houston, Texas, US
| | | | | | - Zahir Amin
- University of Houston, Houston, Texas, US
| | - Sadeer Al-Kindi
- Case Western Reserve University School of Medicine, Cleveland, Ohio, US
| | - Miguel Cainzos-Achirica
- Center for Outcomes Research, Houston Methodist, Houston, Texas, US.,Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA.,Center for Cardiovascular Computational Health & Precision Medicine (C3-PH), Houston Methodist, Houston, Texas, US
| | - Khurram Nasir
- Center for Outcomes Research, Houston Methodist, Houston, Texas, US.,Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA.,Center for Cardiovascular Computational Health & Precision Medicine (C3-PH), Houston Methodist, Houston, Texas, US
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Satish P, Sadaf MI, Valero-Elizondo J, Grandhi GR, Yahya T, Zawahir H, Javed Z, Mszar R, Hanif B, Kalra A, Virani S, Cainzos-Achirica M, Nasir K. Heterogeneity in cardio-metabolic risk factors and atherosclerotic cardiovascular disease among Asian groups in the United States. Am J Prev Cardiol 2021; 7:100219. [PMID: 34611645 PMCID: PMC8387290 DOI: 10.1016/j.ajpc.2021.100219] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/27/2021] [Accepted: 06/13/2021] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE The Asian American population in the U.S. comprises various, ethnically diverse subgroups. Traditionally, this population has been studied as a single, aggregated group, potentially masking differences in risk among subgroups. Analyses using disaggregated data can help better characterize the health needs of different Asian subpopulations and inform targeted, effective public health interventions. We assessed the prevalence of cardiovascular disease (CVD) risk factors and atherosclerotic CVD (ASCVD) and their associations with socioeconomic factors among Chinese, Asian Indian, Filipino and Other Asian subjects, compared with non-Hispanic White (NHW) subjects in the U.S. METHODS : Cross-sectional study using data from 298,286 adults from the National Health Interview Survey (NHIS) from 2007 to 2018. We utilized chi-squared tests to compare characteristics across subgroups. Weighted proportions and unadjusted and adjusted logistic regression models were utilized to examine the associations between Asian subgroups, self-reported CVD risk factors and self-reported ASCVD, as well as between socioeconomic factors within each Asian subgroup. RESULTS : Asian Indian subjects had the highest prevalence of diabetes (12.5%), while Filipino subjects had the highest prevalence of hyperlipidemia (27.7%), hypertension (29.8%) and obesity (19.8%). Despite this, the prevalence of self-reported ASCVD was lower in all Asian groups compared with NHWs. Chinese subjects had the lowest odds of having each of the CVD risk factors assessed. CONCLUSION : We found considerable heterogeneity in the distribution of risk factors as well as ASCVD among Asian subgroups in the US. Compared with health system or community-based reports, the prevalence of risk factors and ASCVD may be underestimated in some Asian NHIS subgroups. There is an urgent need for efforts to improve recruitment of Asian participants of heterogeneous socioeconomic backgrounds in national surveys, as well as to perform a thorough assessment of risk factors and disease in this population, not relying solely on self-report.
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Affiliation(s)
- Priyanka Satish
- Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, United States
| | - Murrium I. Sadaf
- Yale New Haven Medical Center (Waterbury) Internal Medicine Residency Program, Waterbury, CT, United States
| | - Javier Valero-Elizondo
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, United States
- Center for Outcomes Research, Houston Methodist Research Institute, Houston, TX, United States
| | - Gowtham R. Grandhi
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, MD, United States
| | - Tamer Yahya
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, United States
| | - Hassan Zawahir
- Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, United States
| | - Zulqarnain Javed
- Center for Outcomes Research, Houston Methodist Research Institute, Houston, TX, United States
| | - Reed Mszar
- Yale/YNHH Center for Outcomes Research and Evaluation, New Haven, CT, United States
| | - Bashir Hanif
- Dean, Faculty of Cardiology, College of Physicians and Surgeons Pakistan (CPSP), Pakistan
| | - Ankur Kalra
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, OH, United States
| | - Salim Virani
- Section of Cardiovascular Research, Baylor College of Medicine and the Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States
| | - Miguel Cainzos-Achirica
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, United States
- Center for Outcomes Research, Houston Methodist Research Institute, Houston, TX, United States
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, United States
- Center for Outcomes Research, Houston Methodist Research Institute, Houston, TX, United States
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Mahajan S, Caraballo C, Lu Y, Valero-Elizondo J, Massey D, Annapureddy AR, Roy B, Riley C, Murugiah K, Onuma O, Nunez-Smith M, Forman HP, Nasir K, Herrin J, Krumholz HM. Trends in Differences in Health Status and Health Care Access and Affordability by Race and Ethnicity in the United States, 1999-2018. JAMA 2021; 326:637-648. [PMID: 34402830 PMCID: PMC8371573 DOI: 10.1001/jama.2021.9907] [Citation(s) in RCA: 90] [Impact Index Per Article: 30.0] [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] [Received: 10/29/2020] [Accepted: 06/01/2021] [Indexed: 12/17/2022]
Abstract
IMPORTANCE The elimination of racial and ethnic differences in health status and health care access is a US goal, but it is unclear whether the country has made progress over the last 2 decades. OBJECTIVE To determine 20-year trends in the racial and ethnic differences in self-reported measures of health status and health care access and affordability among adults in the US. DESIGN, SETTING, AND PARTICIPANTS Serial cross-sectional study of National Health Interview Survey data, 1999-2018, that included 596 355 adults. EXPOSURES Self-reported race, ethnicity, and income level. MAIN OUTCOMES AND MEASURES Rates and racial and ethnic differences in self-reported health status and health care access and affordability. RESULTS The study included 596 355 adults (mean [SE] age, 46.2 [0.07] years, 51.8% [SE, 0.10] women), of whom 4.7% were Asian, 11.8% were Black, 13.8% were Latino/Hispanic, and 69.7% were White. The estimated percentages of people with low income were 28.2%, 46.1%, 51.5%, and 23.9% among Asian, Black, Latino/Hispanic, and White individuals, respectively. Black individuals with low income had the highest estimated prevalence of poor or fair health status (29.1% [95% CI, 26.5%-31.7%] in 1999 and 24.9% [95% CI, 21.8%-28.3%] in 2018), while White individuals with middle and high income had the lowest (6.4% [95% CI, 5.9%-6.8%] in 1999 and 6.3% [95% CI, 5.8%-6.7%] in 2018). Black individuals had a significantly higher estimated prevalence of poor or fair health status than White individuals in 1999, regardless of income strata (P < .001 for the overall and low-income groups; P = .03 for middle and high-income group). From 1999 to 2018, racial and ethnic gaps in poor or fair health status did not change significantly, with or without income stratification, except for a significant decrease in the difference between White and Black individuals with low income (-6.7 percentage points [95% CI, -11.3 to -2.0]; P = .005); the difference in 2018 was no longer statistically significant (P = .13). Black and White individuals had the highest levels of self-reported functional limitations, which increased significantly among all groups over time. There were significant reductions in the racial and ethnic differences in some self-reported measures of health care access, but not affordability, with and without income stratification. CONCLUSIONS AND RELEVANCE In a serial cross-sectional survey study of US adults from 1999 to 2018, racial and ethnic differences in self-reported health status, access, and affordability improved in some subgroups, but largely persisted.
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Affiliation(s)
- Shiwani Mahajan
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - César Caraballo
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Yuan Lu
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Javier Valero-Elizondo
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
- Center for Outcomes Research, Houston Methodist Research Institute, Houston, Texas
| | - Daisy Massey
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
| | - Amarnath R. Annapureddy
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Brita Roy
- Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Carley Riley
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Division of Critical Care Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Karthik Murugiah
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Oyere Onuma
- Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Marcella Nunez-Smith
- Equity Research and Innovation Center, Section of General Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Howard P. Forman
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
- Center for Outcomes Research, Houston Methodist Research Institute, Houston, Texas
| | - Jeph Herrin
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Harlan M. Krumholz
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
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Mahajan S, Grandhi GR, Valero-Elizondo J, Mszar R, Khera R, Acquah I, Yahya T, Virani SS, Blankstein R, Blaha MJ, Cainzos-Achirica M, Nasir K. Scope and Social Determinants of Food Insecurity Among Adults With Atherosclerotic Cardiovascular Disease in the United States. J Am Heart Assoc 2021; 10:e020028. [PMID: 34387089 PMCID: PMC8475063 DOI: 10.1161/jaha.120.020028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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 Atherosclerotic cardiovascular disease (ASCVD) results in high out‐of‐pocket healthcare expenditures predisposing to food insecurity. However, the burden and determinants of food insecurity in this population are unknown. Methods and Results Using 2013 to 2018 National Health Interview Survey data, we evaluated the prevalence and sociodemographic determinants of food insecurity among adults with ASCVD in the United States. ASCVD was defined as self‐reported diagnosis of coronary heart disease or stroke. Food security was measured using the 10‐item US Adult Food Security Survey Module. Of the 190 113 study participants aged 18 years or older, 18 442 (adjusted prevalence 8.2%) had ASCVD, representing ≈20 million US adults annually. Among adults with ASCVD, 2968 or 14.6% (weighted ≈2.9 million US adults annually) reported food insecurity compared with 9.1% among those without ASCVD (P<0.001). Individuals with ASCVD who were younger (odds ratio [OR], 4.0 [95% CI, 2.8–5.8]), women (OR, 1.2 [1.0–1.3]), non‐Hispanic Black (OR, 2.3 [1.9–2.8]), or Hispanic (OR, 1.6 [1.2–2.0]), had private (OR, 1.8 [1.4–2.3]) or no insurance (OR, 2.3 [1.7–3.1]), were divorced/widowed/separated (OR, 1.2 [1.0–1.4]), and had low family income (OR, 4.7 [4.0–5.6]) were more likely to be food insecure. Among those with ASCVD and 6 of these high‐risk characteristics, 53.7% reported food insecurity and they had 36‐times (OR, 36.2 [22.6–57.9]) higher odds of being food insecure compared with those with ≤1 high‐risk characteristic. Conclusion About 1 in 7 US adults with ASCVD experience food insecurity, with more than 1 in 2 adults reporting food insecurity among the most vulnerable sociodemographic subgroups. There is an urgent need to address the barriers related to food security in this population.
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Affiliation(s)
- Shiwani Mahajan
- Center for Outcomes Research and Evaluation Yale New Haven Hospital New Haven CT.,Section of Cardiovascular Medicine Yale School of Medicine New Haven CT
| | | | - Javier Valero-Elizondo
- Division of Cardiovascular Prevention and Wellness Houston Methodist DeBakey Heart and Vascular Center Houston TX.,Center for Outcomes Research Houston Methodist Research Institute Houston TX
| | - Reed Mszar
- Center for Outcomes Research and Evaluation Yale New Haven Hospital New Haven CT.,Section of Cardiovascular Medicine Yale School of Medicine New Haven CT
| | - Rohan Khera
- Center for Outcomes Research and Evaluation Yale New Haven Hospital New Haven CT.,Section of Cardiovascular Medicine Yale School of Medicine New Haven CT
| | - Isaac Acquah
- Center for Outcomes Research Houston Methodist Research Institute Houston TX
| | - Tamer Yahya
- Division of Cardiovascular Prevention and Wellness Houston Methodist DeBakey Heart and Vascular Center Houston TX
| | - Salim S Virani
- Michael E. DeBakey Veterans Affairs Medical Center & Section of Cardiology Baylor College of Medicine Houston TX
| | - Ron Blankstein
- Cardiovascular Imaging Program Cardiovascular Division and Department of Radiology Brigham and Women's Hospital Boston MA
| | - Michael J Blaha
- The Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease Baltimore MD
| | - Miguel Cainzos-Achirica
- Division of Cardiovascular Prevention and Wellness Houston Methodist DeBakey Heart and Vascular Center Houston TX.,Center for Outcomes Research Houston Methodist Research Institute Houston TX
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness Houston Methodist DeBakey Heart and Vascular Center Houston TX.,Center for Outcomes Research Houston Methodist Research Institute Houston TX
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Acquah I, Valero-Elizondo J, Javed Z, Ibrahim HN, Patel KV, Ryoo Ali HJ, Menser T, Khera R, Cainzos-Achirica M, Nasir K. Financial Hardship Among Nonelderly Adults With CKD in the United States. Am J Kidney Dis 2021; 78:658-668. [PMID: 34144103 DOI: 10.1053/j.ajkd.2021.04.011] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 04/10/2021] [Indexed: 12/31/2022]
Abstract
RATIONALE & OBJECTIVE The burden of financial hardship among individuals with chronic kidney disease (CKD) has not been extensively studied. Therefore, we describe the scope and determinants of financial hardship among a nationally representative sample of adults with CKD. STUDY DESIGN Cross-sectional. SETTING & PARTICIPANTS Nonelderly adults with CKD from the 2014-2018 National Health Interview Survey. EXPOSURE Sociodemographic and clinical characteristics. OUTCOME Financial hardship based on medical bills and consequences of financial hardship (high financial distress, food insecurity, cost-related medication nonadherence, delayed/forgone care due to cost). Financial hardship was categorized into 3 levels: no financial hardship, financial hardship but able to pay bills, and unable to pay bills at all. Financial hardship was then modeled in 2 different ways: (1) any financial hardship (regardless of ability to pay) versus no financial hardship and (2) inability to pay bills versus no financial hardship and financial hardship but able to pay bills. ANALYTICAL APPROACH Nationally representative estimates of financial hardship from medical bills were computed. Multivariable logistic regression models were used to examine the associations of sociodemographic and clinical factors with the outcomes of financial hardship based on medical bills. RESULTS A total 1,425 individuals, representing approximately 2.1 million Americans, reported a diagnosis of CKD within the past year, of whom 46.9% (95% CI, 43.7%-50.2%) reported experiencing financial hardship from medical bills; 20.9% (95% CI, 18.5%-23.6%) reported inability to pay medical bills at all. Lack of insurance was the strongest determinant of financial hardship in this population (odds ratio, 4.06 [95% CI, 2.18-7.56]). LIMITATIONS Self-reported nature of CKD diagnosis. CONCLUSIONS Approximately half the nonelderly US population with CKD experiences financial hardship from medical bills that is associated strongly with lack of insurance. Evidence-based clinical and policy interventions are needed to address these hardships.
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Affiliation(s)
- Isaac Acquah
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas; Center for Outcomes Research, Houston Methodist Hospital, Houston, Texas
| | - Javier Valero-Elizondo
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas; Center for Outcomes Research, Houston Methodist Hospital, Houston, Texas
| | - Zulqarnain Javed
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas; Center for Outcomes Research, Houston Methodist Hospital, Houston, Texas
| | - Hassan N Ibrahim
- Division of Renal Disease and Hypertension, Department of Medicine, Houston Methodist Hospital, Houston, Texas
| | - Kershaw V Patel
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
| | - Hyeon-Ju Ryoo Ali
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
| | - Terri Menser
- Center for Outcomes Research, Houston Methodist Hospital, Houston, Texas
| | - Rohan Khera
- Yale University School of Medicine, New Haven, Connecticut
| | - Miguel Cainzos-Achirica
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas; Center for Outcomes Research, Houston Methodist Hospital, Houston, Texas
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas; Center for Outcomes Research, Houston Methodist Hospital, Houston, Texas.
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Valero-Elizondo J, Chouairi F, Khera R, Grandhi GR, Saxena A, Warraich HJ, Virani SS, Desai NR, Sasangohar F, Krumholz HM, Esnaola NF, Nasir K. Atherosclerotic Cardiovascular Disease, Cancer, and Financial Toxicity Among Adults in the United States. JACC CardioOncol 2021; 3:236-246. [PMID: 34396329 PMCID: PMC8352280 DOI: 10.1016/j.jaccao.2021.02.006] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 02/12/2021] [Indexed: 12/30/2022]
Abstract
Background Financial toxicity (FT) is a well-established side-effect of the high costs associated with cancer care. In recent years, studies have suggested that a significant proportion of those with atherosclerotic cardiovascular disease (ASCVD) experience FT and its consequences. Objectives This study aimed to compare FT for individuals with neither ASCVD nor cancer, ASCVD only, cancer only, and both ASCVD and cancer. Methods From the National Health Interview Survey, we identified adults with self-reported ASCVD and/or cancer between 2013 and 2018, stratifying results by nonelderly (age <65 years) and elderly (age ≥65 years). We defined FT if any of the following were present: any difficulty paying medical bills, high financial distress, cost-related medication nonadherence, food insecurity, and/or foregone/delayed care due to cost. Results The prevalence of FT was higher among those with ASCVD when compared with cancer (54% vs. 41%; p < 0.001). When studying the individual components of FT, in adjusted analyses, those with ASCVD had higher odds of any difficulty paying medical bills (odds ratio [OR]: 1.22; 95% confidence interval [CI]: 1.09 to 1.36), inability to pay bills (OR: 1.25; 95% CI: 1.04 to 1.50), cost-related medication nonadherence (OR: 1.28; 95% CI: 1.08 to 1.51), food insecurity (OR: 1.39; 95% CI: 1.17 to 1.64), and foregone/delayed care due to cost (OR: 1.17; 95% CI: 1.01 to 1.36). The presence of ≥3 of these factors was significantly higher among those with ASCVD and those with both ASCVD and cancer when compared with those with cancer (23% vs. 30% vs. 13%, respectively; p < 0.001). These results remained similar in the elderly population. Conclusions Our study highlights that FT is greater among patients with ASCVD compared with those with cancer, with the highest burden among those with both conditions.
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Affiliation(s)
- Javier Valero-Elizondo
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA.,Center for Outcomes Research, Houston Methodist, Houston, Texas, USA
| | - Fouad Chouairi
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Rohan Khera
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut, USA.,Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Gowtham R Grandhi
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, Maryland, USA
| | - Anshul Saxena
- Center for Healthcare Advancement and Outcomes, Baptist Health South Florida, Miami, Florida, USA
| | - Haider J Warraich
- Department of Medicine, Cardiology Section, VA Boston Healthcare System, Boston, Massachusetts, USA.,Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Salim S Virani
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA.,Section of Cardiovascular Research, Baylor College of Medicine, Houston, Texas, USA
| | - Nihar R Desai
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut, USA.,Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Farzan Sasangohar
- Center for Outcomes Research, Houston Methodist, Houston, Texas, USA.,Department of Industrial and Systems Engineering, Texas A&M College of Engineering, Texas A&M University, College Station, Texas, USA
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut, USA.,Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA.,Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, USA
| | - Nestor F Esnaola
- Cancer Center, Houston Methodist Research Institute, Houston, Texas, USA.,Department of Surgical Oncology, Fox Chase Cancer Center-Temple Health, Philadelphia, Pennsylvania, USA
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA.,Center for Outcomes Research, Houston Methodist, Houston, Texas, USA
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Wang SY, Valero-Elizondo J, Ali HJ, Pandey A, Cainzos-Achirica M, Krumholz HM, Nasir K, Khera R. Out-of-Pocket Annual Health Expenditures and Financial Toxicity From Healthcare Costs in Patients With Heart Failure in the United States. J Am Heart Assoc 2021; 10:e022164. [PMID: 33998273 PMCID: PMC8483501 DOI: 10.1161/jaha.121.022164] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background Heart failure (HF) poses a major public health burden in the United States. We examined the burden of out‐of‐pocket healthcare costs on patients with HF and their families. Methods and Results In the Medical Expenditure Panel Survey, we identified all families with ≥1 adult member with HF during 2014 to 2018. Total out‐of‐pocket healthcare expenditures included yearly care‐specific costs and insurance premiums. We evaluated 2 outcomes of financial toxicity: (1) high financial burden—total out‐of‐pocket healthcare expense to postsubsistence income ratio of >20%, and (2) catastrophic financial burden with the ratio of >40%—a bankrupting expense defined by the World Health Organization. There were 788 families in the Medical Expenditure Panel Survey with a member with HF representing 0.54% (95% CI, 0.48%–0.60%) of all families nationally. The overall mean annual out‐of‐pocket healthcare expenses were $4423 (95% CI, $3908–$4939), with medications and health insurance premiums representing the largest categories of cost. Overall, 14% (95% CI, 11%–18%) of families experienced a high burden and 5% (95% CI, 3%–6%) experienced a catastrophic burden. Among the two‐fifths of families considered low income, 24% (95% CI, 18%–30%) experienced a high financial burden, whereas 10% (95% CI, 6%–14%) experienced a catastrophic burden. Low‐income families had 4‐fold greater risk‐adjusted odds of high financial burden (odds ratio [OR] , 3.9; 95% CI, 2.3–6.6), and 14‐fold greater risk‐adjusted odds of catastrophic financial burden (OR, 14.2; 95% CI, 5.1–39.5) compared with middle/high‐income families. Conclusions Patients with HF and their families experience large out‐of‐pocket healthcare expenses. A large proportion encounter financial toxicity, with a disproportionate effect on low‐income families.
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Affiliation(s)
- Stephen Y Wang
- Department of Internal Medicine Yale-New Haven Hospital New Haven CT
| | | | - Hyeon-Ju Ali
- Department of Cardiology Houston Methodist Houston TX
| | - Ambarish Pandey
- Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX
| | | | - Harlan M Krumholz
- Section of Cardiovascular Medicine Department of Internal Medicine Yale School of Medicine New Haven CT.,Center for Outcomes Research and Evaluation Yale-New Haven Hospital New Haven CT
| | - Khurram Nasir
- Department of Cardiology Houston Methodist Houston TX
| | - Rohan Khera
- Section of Cardiovascular Medicine Department of Internal Medicine Yale School of Medicine New Haven CT.,Center for Outcomes Research and Evaluation Yale-New Haven Hospital New Haven CT
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Hagan KK, Javed Z, Cainzos-Achirica M, Sostman D, Vahidy FS, Valero-Elizondo J, Acquah I, Yahya T, Kash B, Andrieni JD, Dubey P, Hyder AA, Nasir K. Social Determinants of Adherence to COVID-19 Risk Mitigation Measures Among Adults With Cardiovascular Disease. Circ Cardiovasc Qual Outcomes 2021; 14:e008118. [PMID: 33955228 PMCID: PMC8204764 DOI: 10.1161/circoutcomes.121.008118] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Supplemental Digital Content is available in the text. Social determinants of health (SDOH) may limit the practice of coronavirus disease 2019 (COVID-19) risk mitigation guidelines with health implications for individuals with underlying cardiovascular disease (CVD). Population-based evidence of the association between SDOH and practicing such mitigation strategies in adults with CVD is lacking. We used the National Opinion Research Center’s COVID-19 Household Impact Survey conducted between April and June 2020 to evaluate sociodemographic disparities in adherence to COVID-19 risk mitigation measures in a sample of respondents with underlying CVD representing 18 geographic areas of the United States.
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Affiliation(s)
- Kobina K Hagan
- Center for Outcomes Research, Houston Methodist, Houston, TX (K.K.H., Z.J., M.C.-A., F.S.V., I.A., B.K., K.N.)
| | - Zulqarnain Javed
- Center for Outcomes Research, Houston Methodist, Houston, TX (K.K.H., Z.J., M.C.-A., F.S.V., I.A., B.K., K.N.)
| | - Miguel Cainzos-Achirica
- Center for Outcomes Research, Houston Methodist, Houston, TX (K.K.H., Z.J., M.C.-A., F.S.V., I.A., B.K., K.N.).,Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist De-Bakey Heart and Vascular Center, TX (M.C.-A., J.V.-E., T.Y, K.N.)
| | - Dirk Sostman
- Academic Institute, Houston Methodist, Houston, TX (D.S.).,Research Institute, Houston Methodist, Houston, TX (D.S.).,Department of Radiology, Weill Cornell Medicine, New York, NY (D.S.).,Weill Cornell Medicine, New York, NY (D.S., B.K.)
| | - Farhaan S Vahidy
- Center for Outcomes Research, Houston Methodist, Houston, TX (K.K.H., Z.J., M.C.-A., F.S.V., I.A., B.K., K.N.).,Neurological Institute, Houston Methodist, Houston, TX (F.S.V.)
| | - Javier Valero-Elizondo
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist De-Bakey Heart and Vascular Center, TX (M.C.-A., J.V.-E., T.Y, K.N.)
| | - Isaac Acquah
- Center for Outcomes Research, Houston Methodist, Houston, TX (K.K.H., Z.J., M.C.-A., F.S.V., I.A., B.K., K.N.)
| | - Tamer Yahya
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist De-Bakey Heart and Vascular Center, TX (M.C.-A., J.V.-E., T.Y, K.N.)
| | - Bita Kash
- Center for Outcomes Research, Houston Methodist, Houston, TX (K.K.H., Z.J., M.C.-A., F.S.V., I.A., B.K., K.N.).,Weill Cornell Medicine, New York, NY (D.S., B.K.).,Texas A&M University School of Public Health, College Station, TX (B.K.)
| | - Julia D Andrieni
- Department of Medicine, Houston Methodist, Houston, TX (J.D.A).,Department of Medicine, Weill Cornell Medicine, New York, NY (J.D.A.)
| | - Prachi Dubey
- Department of Radiology (P.D.), Houston Methodist Hospital, TX
| | - Adnan A Hyder
- Center on Commercial Determinants of Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, (A.A.H.)
| | - Khurram Nasir
- Center for Outcomes Research, Houston Methodist, Houston, TX (K.K.H., Z.J., M.C.-A., F.S.V., I.A., B.K., K.N.).,Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist De-Bakey Heart and Vascular Center, TX (M.C.-A., J.V.-E., T.Y, K.N.).,Department of Cardiology, DeBakey Heart and Vascular Center (K.N.), Houston Methodist Hospital, TX
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Acquah I, Valero-Elizondo J, Javed Z, Hagan K, Yahya T, Khan S, Cainzos-Achirica M, Nasir K. DETERMINANTS OF TRANSPORTATION BARRIERS AMONG ADULTS WITH ATHEROSCLEROTIC CARDIOVASCULAR DISEASE. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02992-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hagan K, Javed Z, Valero-Elizondo J, Khan S, Yahya T, Acquah I, Vahidy FS, Awar M, Dubey P, Kash B, Sostman DH, Cainzos-Achirica M, Nasir K. SOCIAL DETERMINANTS OF HEALTH DISPARITIES FOR COVID-19 MITIGATION MEASURES AMONG ADULTS WITH CARDIOVASCULAR DISEASE IN UNITED STATES. J Am Coll Cardiol 2021. [PMCID: PMC8100826 DOI: 10.1016/s0735-1097(21)01350-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Grandhi GR, Mozafarian M, Mszar R, Acquah I, Valero-Elizondo J, Cainzos-Achirica M, Omer SB, Ibrahim HN, Nasir K. Influenza Vaccination Among Adults With CKD in the United States: Regional, Demographic, and Socioeconomic Differences. Kidney Med 2021; 3:454-456. [PMID: 34136792 PMCID: PMC8178475 DOI: 10.1016/j.xkme.2020.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- Gowtham R Grandhi
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, MD
| | | | - Reed Mszar
- Center for Outcomes Research and Evaluation, Yale New Haven Health, New Haven, CT
| | - Isaac Acquah
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX.,Center for Outcomes Research, The Houston Methodist Research Institute, Houston, TX
| | - Javier Valero-Elizondo
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX.,Center for Outcomes Research, The Houston Methodist Research Institute, Houston, TX
| | - Miguel Cainzos-Achirica
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX.,Center for Outcomes Research, The Houston Methodist Research Institute, Houston, TX
| | - Saad B Omer
- Yale Institute of Global Health, New Haven, CT.,Yale School of Nursing, New Haven, CT.,Department of Internal Medicine (Infectious Diseases), Yale School of Public Health, New Haven, CT.,Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT
| | - Hassan N Ibrahim
- Division of Renal Diseases and Hypertension, Department of Medicine, Houston Methodist Hospital, Houston, TX
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX.,Center for Outcomes Research, The Houston Methodist Research Institute, Houston, TX.,Division of Cardiology, Yale University, New Haven, CT
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Mszar R, Mahajan S, Valero-Elizondo J, Grandhi GR, Caraballo C, Gopal DJ, Nemiroff RL, Soffer DE, Cainzos-Achirica M, Sharma G, Nasir K. Disparities in cholesterol screening among a nationally representative sample of pregnant women in the United States. Eur J Prev Cardiol 2020; 29:e11-e13. [PMID: 33624106 DOI: 10.1093/eurjpc/zwaa100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/17/2020] [Accepted: 09/29/2020] [Indexed: 11/14/2022]
Affiliation(s)
- Reed Mszar
- Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College Street, New Haven, CT 06510, USA.,Center for Outcomes Research and Evaluation, Yale New Haven Health, 1 Church Street, Suite 200, New Haven, CT 06510, USA
| | - Shiwani Mahajan
- Center for Outcomes Research and Evaluation, Yale New Haven Health, 1 Church Street, Suite 200, New Haven, CT 06510, USA.,Section of Cardiovascular Medicine, Yale School of Medicine, 333 Cedar Street, New Haven, CT 06520, USA
| | - Javier Valero-Elizondo
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, 6550 Fannin Street, Suite 1801, Houston, TX 77030, USA.,Center for Outcomes Research, Houston Methodist Research Institute, Houston, TX, USA
| | - Gowtham R Grandhi
- Department of Medicine, MedStar Union Memorial Hospital, 201 E University Pkwy, Baltimore, MD 21218, USA
| | - César Caraballo
- Center for Outcomes Research and Evaluation, Yale New Haven Health, 1 Church Street, Suite 200, New Haven, CT 06510, USA.,Section of Cardiovascular Medicine, Yale School of Medicine, 333 Cedar Street, New Haven, CT 06520, USA
| | - Dipika J Gopal
- Division of Cardiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Richard L Nemiroff
- Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Daniel E Soffer
- Division of Cardiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Miguel Cainzos-Achirica
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, 6550 Fannin Street, Suite 1801, Houston, TX 77030, USA.,Center for Outcomes Research, Houston Methodist Research Institute, Houston, TX, USA
| | - Garima Sharma
- Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, 6550 Fannin Street, Suite 1801, Houston, TX 77030, USA.,Center for Outcomes Research, Houston Methodist Research Institute, Houston, TX, USA
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Caraballo C, Massey D, Mahajan S, Lu Y, Annapureddy AR, Roy B, Riley C, Murugiah K, Valero-Elizondo J, Onuma O, Nunez-Smith M, Forman HP, Nasir K, Herrin J, Krumholz HM. Racial and Ethnic Disparities in Access to Health Care Among Adults in the United States: A 20-Year National Health Interview Survey Analysis, 1999-2018. medRxiv 2020:2020.10.30.20223420. [PMID: 33173905 PMCID: PMC7654899 DOI: 10.1101/2020.10.30.20223420] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
IMPORTANCE Racial and ethnic disparities plague the US health care system despite efforts to eliminate them. To understand what has been achieved amid these efforts, a comprehensive study from the population perspective is needed. OBJECTIVES To determine trends in rates and racial/ethnic disparities of key access to care measures among adults in the US in the last two decades. DESIGN Cross-sectional. SETTING Data from the National Health Interview Survey, 1999-2018. PARTICIPANTS Individuals >18 years old. EXPOSURE Race and ethnicity: non-Hispanic Black, non-Hispanic Asian, non-Hispanic White, Hispanic. MAIN OUTCOME AND MEASURES Rates of lack of insurance coverage, lack of a usual source of care, and foregone/delayed medical care due to cost. We also estimated the gap between non-Hispanic White and the other subgroups for these outcomes. RESULTS We included 596,355 adults, of which 69.7% identified as White, 11.8% as Black, 4.7% as Asian, and 13.8% as Hispanic. The proportion uninsured and the rates of lacking a usual source of care remained stable across all 4 race/ethnicity subgroups up to 2009, while rates of foregone/delayed medical care due to cost increased. Between 2010 and 2015, the percentage of uninsured diminished for all, with the steepest reduction among Hispanics (-2.1% per year). In the same period, rates of no usual source of care declined only among Hispanics (-1.2% per year) while rates of foregone/delayed medical care due to cost decreased for all. No substantial changes were observed from 2016-2018 in any outcome across subgroups. Compared with 1999, in 2018 the rates of foregone/delayed medical care due to cost were higher for all (+3.1% among Whites, +3.1% among Blacks, +0.5% among Asians, and +2.2% among Hispanics) without significant change in gaps; rates of no usual source of care were not significantly different among Whites or Blacks but were lower among Hispanics (-4.9%) and Asians (-6.4%). CONCLUSIONS AND RELEVANCE Insurance coverage increased for all, but millions of individuals remained uninsured or underinsured with increasing rates of unmet medical needs due to cost. Those identifying as non-Hispanic Black and Hispanic continue to experience more barriers to health care services compared with non-Hispanic White individuals. KEY POINTS Question: In the last 2 decades, what has been achieved in reducing barriers to access to care and race/ethnicity-associated disparities?Findings: Using National Health Interview Survey data from 1999-2018, we found that insurance coverage increased across all 4 major race/ethnicity groups. However, rates of unmet medical needs due to cost increased without reducing the respective racial/ethnic disparities, and little-to-no change occurred in rates of individuals who have no usual source of care.Meaning: Despite increased coverage, millions of Americans continued to experience barriers to access to care, which were disproportionately more prevalent among those identifying as Black or Hispanic.
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Affiliation(s)
- César Caraballo
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Dorothy Massey
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
| | - Shiwani Mahajan
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Yuan Lu
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Amarnath R. Annapureddy
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Brita Roy
- Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Carley Riley
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Division of Critical Care Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Karthik Murugiah
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Javier Valero-Elizondo
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
- Center for Outcomes Research, Houston Methodist Research Institute, Houston, Texas
| | - Oyere Onuma
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Marcella Nunez-Smith
- Equity Research and Innovation Center, General Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Howard P. Forman
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
- Center for Outcomes Research, Houston Methodist Research Institute, Houston, Texas
| | - Jeph Herrin
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Harlan M. Krumholz
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
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Mahajan S, Caraballo C, Lu Y, Massey D, Murugiah K, Annapureddy AR, Roy B, Riley C, Onuma O, Nunez-Smith M, Valero-Elizondo J, Forman HP, Nasir K, Herrin J, Krumholz HM. Racial and Ethnic Disparities in Health of Adults in the United States: A 20-Year National Health Interview Survey Analysis, 1999-2018. medRxiv 2020:2020.10.30.20223487. [PMID: 33173885 PMCID: PMC7654876 DOI: 10.1101/2020.10.30.20223487] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
IMPORTANCE Thirty-five years ago, the Heckler Report described health disparities among minority populations in the US. Since then, policies have been implemented to address these disparities. However, a recent evaluation of progress towards improving the health and health equity among US adults is lacking. OBJECTIVES To evaluate racial/ethnic disparities in the physical and mental health of US adults over the last 2 decades. DESIGN Cross-sectional. SETTING National Health Interview Survey data, years 1999-2018. PARTICIPANTS Adults aged 18-85 years. EXPOSURE Race/ethnicity subgroups (non-Hispanic White, non-Hispanic Black, non-Hispanic Asian, Hispanic). MAIN OUTCOME AND MEASURES Proportion of adults reporting poor/fair health status, severe psychological distress, functional limitation, and insufficient sleep. We also estimated the gap between non-Hispanic White and the other subgroups for these four outcomes. RESULTS We included 596,355 adults (mean age 46 years, 51.8% women), of which 69.7%, 13.8%, 11.8% and 4.7% identified as non-Hispanic White, Hispanic, non-Hispanic Black, and non-Hispanic Asian, respectively. Between 1999 and 2018, Black individuals fared worse on most measures of health, with 18.7% (95% CI 17.1-20.4) and 41.1% (95% CI 38.7-43.5) reporting poor/fair health and insufficient sleep in 2018 compared with 11.1% (95% CI 10.5- 11.7) and 31.2% (95% CI 30.3-32.1) among White individuals. Notably, between 1999-2018, there was no significant decrease in the gap in poor/fair health status between White individuals and Black (-0.07% per year, 95% CI -0.16-0.01) and Hispanic (-0.03% per year, 95% CI -0.07- 0.02) individuals, and an increase in the gap in sleep between White individuals and Black (+0.2% per year, 95% CI 0.1-0.4) and Hispanic (+0.3% per year, 95% CI 0.1-0.4) individuals. Additionally, there was no significant decrease in adults reporting poor/fair health status and an increase in adults reporting severe psychological distress, functional limitation, and insufficient sleep. CONCLUSIONS AND RELEVANCE The marked racial/ethnic disparities in health of US adults have not improved over the last 20 years. Moreover, the self-perceived health of US adults worsened during this time. These findings highlight the need to re-examine the initiatives seeking to promote health equity and improve health.
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Affiliation(s)
- Shiwani Mahajan
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - César Caraballo
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Yuan Lu
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Dorothy Massey
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT
| | - Karthik Murugiah
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Amarnath R. Annapureddy
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Brita Roy
- Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT
| | - Carley Riley
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
- Division of Critical Care Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Oyere Onuma
- Equity Research and Innovation Center, General Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Marcella Nunez-Smith
- Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Javier Valero-Elizondo
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX
- Center for Outcomes Research, Houston Methodist, TX
| | - Howard P. Forman
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX
- Center for Outcomes Research, Houston Methodist, TX
| | - Jeph Herrin
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Harlan M. Krumholz
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT
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Mszar R, Mahajan S, Valero-Elizondo J, Yahya T, Sharma R, Grandhi GR, Khera R, Virani SS, Lichtman J, Khan SU, Cainzos-Achirica M, Vahidy FS, Krumholz HM, Nasir K. Association Between Sociodemographic Determinants and Disparities in Stroke Symptom Awareness Among US Young Adults. Stroke 2020; 51:3552-3561. [PMID: 33100188 DOI: 10.1161/strokeaha.120.031137] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Despite declining stroke rates in the general population, stroke incidence and hospitalizations are rising among younger individuals. Awareness of and prompt response to stroke symptoms are crucial components of a timely diagnosis and disease management. We assessed awareness of stroke symptoms and response to a perceived stroke among young adults in the United States. METHODS Using data from the 2017 National Health Interview Survey, we assessed awareness of 5 common stroke symptoms and the knowledge of planned response (ie, calling emergency medical services) among young adults (<45 years) across diverse sociodemographic groups. Common stroke symptoms included: (1) numbness of face/arm/leg, (2) confusion/trouble speaking, (3) difficulty walking/dizziness/loss of balance, (4) trouble seeing in one/both eyes, and (5) severe headache. RESULTS Our study population included 24 769 adults, of which 9844 (39.7%) were young adults who were included in our primary analysis, and represented 107.2 million US young adults (mean age 31.3 [±7.5] years, 50.6% women, and 62.2% non-Hispanic White). Overall, 2718 young adults (28.9%) were not aware of all 5 stroke symptoms, whereas 242 individuals (2.7%; representing 2.9 million young adults in the United States) were not aware of a single symptom. After adjusting for confounders, Hispanic ethnicity (odds ratio, 1.96 [95% CI, 1.17-3.28]), non-US born immigration status (odds ratio, 2.02 [95% CI, 1.31-3.11]), and lower education level (odds ratio, 2.77 [95% CI, 1.76-4.35]), were significantly associated with lack of symptom awareness. Individuals with 5 high-risk characteristics (non-White, non-US born, low income, uninsured, and high school educated or lower) had nearly a 4-fold higher odds of not being aware of all symptoms (odds ratio, 3.70 [95% CI, 2.43-5.62]). CONCLUSIONS Based on data from the National Health Interview Survey, a large proportion of young adults may not be aware of stroke symptoms. Certain sociodemographic subgroups with decreased awareness may benefit from focused public health interventions.
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Affiliation(s)
- Reed Mszar
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (R.M., J.L.). Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (S.M., H.M.K.). Section of Cardiovascular Medicine, Department of Internal Medicine (S.M., H.M.K.) and Department of Neurology (R.K.), Yale School of Medicine, New Haven, CT. Division of Cardiovascular Prevention and Wellness (J.V.-E., M.C.-A., K.N.) and Center for Outcomes Research (K.N.), Houston Methodist DeBakey Heart and Vascular Center, TX. Houston Methodist Research Institute, TX (T.Y.). University of Texas Southwestern Medical Center, Dallas (R.S.). Department of Medicine, Medstar Union Memorial Hospital, Baltimore, MD (G.R.G.). Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX (S.S.V.). Department of Medicine, West Virginia University School of Medicine, Morgantown (S.U.K.). Center for Outcomes Research, Houston Methodist Neurological Institute, TX (F.S.V.)
| | - Shiwani Mahajan
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (R.M., J.L.). Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (S.M., H.M.K.). Section of Cardiovascular Medicine, Department of Internal Medicine (S.M., H.M.K.) and Department of Neurology (R.K.), Yale School of Medicine, New Haven, CT. Division of Cardiovascular Prevention and Wellness (J.V.-E., M.C.-A., K.N.) and Center for Outcomes Research (K.N.), Houston Methodist DeBakey Heart and Vascular Center, TX. Houston Methodist Research Institute, TX (T.Y.). University of Texas Southwestern Medical Center, Dallas (R.S.). Department of Medicine, Medstar Union Memorial Hospital, Baltimore, MD (G.R.G.). Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX (S.S.V.). Department of Medicine, West Virginia University School of Medicine, Morgantown (S.U.K.). Center for Outcomes Research, Houston Methodist Neurological Institute, TX (F.S.V.)
| | - Javier Valero-Elizondo
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (R.M., J.L.). Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (S.M., H.M.K.). Section of Cardiovascular Medicine, Department of Internal Medicine (S.M., H.M.K.) and Department of Neurology (R.K.), Yale School of Medicine, New Haven, CT. Division of Cardiovascular Prevention and Wellness (J.V.-E., M.C.-A., K.N.) and Center for Outcomes Research (K.N.), Houston Methodist DeBakey Heart and Vascular Center, TX. Houston Methodist Research Institute, TX (T.Y.). University of Texas Southwestern Medical Center, Dallas (R.S.). Department of Medicine, Medstar Union Memorial Hospital, Baltimore, MD (G.R.G.). Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX (S.S.V.). Department of Medicine, West Virginia University School of Medicine, Morgantown (S.U.K.). Center for Outcomes Research, Houston Methodist Neurological Institute, TX (F.S.V.)
| | - Tamer Yahya
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (R.M., J.L.). Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (S.M., H.M.K.). Section of Cardiovascular Medicine, Department of Internal Medicine (S.M., H.M.K.) and Department of Neurology (R.K.), Yale School of Medicine, New Haven, CT. Division of Cardiovascular Prevention and Wellness (J.V.-E., M.C.-A., K.N.) and Center for Outcomes Research (K.N.), Houston Methodist DeBakey Heart and Vascular Center, TX. Houston Methodist Research Institute, TX (T.Y.). University of Texas Southwestern Medical Center, Dallas (R.S.). Department of Medicine, Medstar Union Memorial Hospital, Baltimore, MD (G.R.G.). Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX (S.S.V.). Department of Medicine, West Virginia University School of Medicine, Morgantown (S.U.K.). Center for Outcomes Research, Houston Methodist Neurological Institute, TX (F.S.V.)
| | - Richa Sharma
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (R.M., J.L.). Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (S.M., H.M.K.). Section of Cardiovascular Medicine, Department of Internal Medicine (S.M., H.M.K.) and Department of Neurology (R.K.), Yale School of Medicine, New Haven, CT. Division of Cardiovascular Prevention and Wellness (J.V.-E., M.C.-A., K.N.) and Center for Outcomes Research (K.N.), Houston Methodist DeBakey Heart and Vascular Center, TX. Houston Methodist Research Institute, TX (T.Y.). University of Texas Southwestern Medical Center, Dallas (R.S.). Department of Medicine, Medstar Union Memorial Hospital, Baltimore, MD (G.R.G.). Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX (S.S.V.). Department of Medicine, West Virginia University School of Medicine, Morgantown (S.U.K.). Center for Outcomes Research, Houston Methodist Neurological Institute, TX (F.S.V.)
| | - Gowtham R Grandhi
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (R.M., J.L.). Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (S.M., H.M.K.). Section of Cardiovascular Medicine, Department of Internal Medicine (S.M., H.M.K.) and Department of Neurology (R.K.), Yale School of Medicine, New Haven, CT. Division of Cardiovascular Prevention and Wellness (J.V.-E., M.C.-A., K.N.) and Center for Outcomes Research (K.N.), Houston Methodist DeBakey Heart and Vascular Center, TX. Houston Methodist Research Institute, TX (T.Y.). University of Texas Southwestern Medical Center, Dallas (R.S.). Department of Medicine, Medstar Union Memorial Hospital, Baltimore, MD (G.R.G.). Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX (S.S.V.). Department of Medicine, West Virginia University School of Medicine, Morgantown (S.U.K.). Center for Outcomes Research, Houston Methodist Neurological Institute, TX (F.S.V.)
| | - Rohan Khera
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (R.M., J.L.). Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (S.M., H.M.K.). Section of Cardiovascular Medicine, Department of Internal Medicine (S.M., H.M.K.) and Department of Neurology (R.K.), Yale School of Medicine, New Haven, CT. Division of Cardiovascular Prevention and Wellness (J.V.-E., M.C.-A., K.N.) and Center for Outcomes Research (K.N.), Houston Methodist DeBakey Heart and Vascular Center, TX. Houston Methodist Research Institute, TX (T.Y.). University of Texas Southwestern Medical Center, Dallas (R.S.). Department of Medicine, Medstar Union Memorial Hospital, Baltimore, MD (G.R.G.). Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX (S.S.V.). Department of Medicine, West Virginia University School of Medicine, Morgantown (S.U.K.). Center for Outcomes Research, Houston Methodist Neurological Institute, TX (F.S.V.)
| | - Salim S Virani
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (R.M., J.L.). Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (S.M., H.M.K.). Section of Cardiovascular Medicine, Department of Internal Medicine (S.M., H.M.K.) and Department of Neurology (R.K.), Yale School of Medicine, New Haven, CT. Division of Cardiovascular Prevention and Wellness (J.V.-E., M.C.-A., K.N.) and Center for Outcomes Research (K.N.), Houston Methodist DeBakey Heart and Vascular Center, TX. Houston Methodist Research Institute, TX (T.Y.). University of Texas Southwestern Medical Center, Dallas (R.S.). Department of Medicine, Medstar Union Memorial Hospital, Baltimore, MD (G.R.G.). Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX (S.S.V.). Department of Medicine, West Virginia University School of Medicine, Morgantown (S.U.K.). Center for Outcomes Research, Houston Methodist Neurological Institute, TX (F.S.V.)
| | - Judith Lichtman
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (R.M., J.L.). Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (S.M., H.M.K.). Section of Cardiovascular Medicine, Department of Internal Medicine (S.M., H.M.K.) and Department of Neurology (R.K.), Yale School of Medicine, New Haven, CT. Division of Cardiovascular Prevention and Wellness (J.V.-E., M.C.-A., K.N.) and Center for Outcomes Research (K.N.), Houston Methodist DeBakey Heart and Vascular Center, TX. Houston Methodist Research Institute, TX (T.Y.). University of Texas Southwestern Medical Center, Dallas (R.S.). Department of Medicine, Medstar Union Memorial Hospital, Baltimore, MD (G.R.G.). Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX (S.S.V.). Department of Medicine, West Virginia University School of Medicine, Morgantown (S.U.K.). Center for Outcomes Research, Houston Methodist Neurological Institute, TX (F.S.V.)
| | - Safi U Khan
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (R.M., J.L.). Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (S.M., H.M.K.). Section of Cardiovascular Medicine, Department of Internal Medicine (S.M., H.M.K.) and Department of Neurology (R.K.), Yale School of Medicine, New Haven, CT. Division of Cardiovascular Prevention and Wellness (J.V.-E., M.C.-A., K.N.) and Center for Outcomes Research (K.N.), Houston Methodist DeBakey Heart and Vascular Center, TX. Houston Methodist Research Institute, TX (T.Y.). University of Texas Southwestern Medical Center, Dallas (R.S.). Department of Medicine, Medstar Union Memorial Hospital, Baltimore, MD (G.R.G.). Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX (S.S.V.). Department of Medicine, West Virginia University School of Medicine, Morgantown (S.U.K.). Center for Outcomes Research, Houston Methodist Neurological Institute, TX (F.S.V.)
| | - Miguel Cainzos-Achirica
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (R.M., J.L.). Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (S.M., H.M.K.). Section of Cardiovascular Medicine, Department of Internal Medicine (S.M., H.M.K.) and Department of Neurology (R.K.), Yale School of Medicine, New Haven, CT. Division of Cardiovascular Prevention and Wellness (J.V.-E., M.C.-A., K.N.) and Center for Outcomes Research (K.N.), Houston Methodist DeBakey Heart and Vascular Center, TX. Houston Methodist Research Institute, TX (T.Y.). University of Texas Southwestern Medical Center, Dallas (R.S.). Department of Medicine, Medstar Union Memorial Hospital, Baltimore, MD (G.R.G.). Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX (S.S.V.). Department of Medicine, West Virginia University School of Medicine, Morgantown (S.U.K.). Center for Outcomes Research, Houston Methodist Neurological Institute, TX (F.S.V.)
| | - Farhaan S Vahidy
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (R.M., J.L.). Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (S.M., H.M.K.). Section of Cardiovascular Medicine, Department of Internal Medicine (S.M., H.M.K.) and Department of Neurology (R.K.), Yale School of Medicine, New Haven, CT. Division of Cardiovascular Prevention and Wellness (J.V.-E., M.C.-A., K.N.) and Center for Outcomes Research (K.N.), Houston Methodist DeBakey Heart and Vascular Center, TX. Houston Methodist Research Institute, TX (T.Y.). University of Texas Southwestern Medical Center, Dallas (R.S.). Department of Medicine, Medstar Union Memorial Hospital, Baltimore, MD (G.R.G.). Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX (S.S.V.). Department of Medicine, West Virginia University School of Medicine, Morgantown (S.U.K.). Center for Outcomes Research, Houston Methodist Neurological Institute, TX (F.S.V.)
| | - Harlan M Krumholz
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (R.M., J.L.). Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (S.M., H.M.K.). Section of Cardiovascular Medicine, Department of Internal Medicine (S.M., H.M.K.) and Department of Neurology (R.K.), Yale School of Medicine, New Haven, CT. Division of Cardiovascular Prevention and Wellness (J.V.-E., M.C.-A., K.N.) and Center for Outcomes Research (K.N.), Houston Methodist DeBakey Heart and Vascular Center, TX. Houston Methodist Research Institute, TX (T.Y.). University of Texas Southwestern Medical Center, Dallas (R.S.). Department of Medicine, Medstar Union Memorial Hospital, Baltimore, MD (G.R.G.). Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX (S.S.V.). Department of Medicine, West Virginia University School of Medicine, Morgantown (S.U.K.). Center for Outcomes Research, Houston Methodist Neurological Institute, TX (F.S.V.)
| | - Khurram Nasir
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (R.M., J.L.). Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (S.M., H.M.K.). Section of Cardiovascular Medicine, Department of Internal Medicine (S.M., H.M.K.) and Department of Neurology (R.K.), Yale School of Medicine, New Haven, CT. Division of Cardiovascular Prevention and Wellness (J.V.-E., M.C.-A., K.N.) and Center for Outcomes Research (K.N.), Houston Methodist DeBakey Heart and Vascular Center, TX. Houston Methodist Research Institute, TX (T.Y.). University of Texas Southwestern Medical Center, Dallas (R.S.). Department of Medicine, Medstar Union Memorial Hospital, Baltimore, MD (G.R.G.). Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX (S.S.V.). Department of Medicine, West Virginia University School of Medicine, Morgantown (S.U.K.). Center for Outcomes Research, Houston Methodist Neurological Institute, TX (F.S.V.)
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Bhugra P, Mszar R, Valero-Elizondo J, Grandhi GR, Virani SS, Cainzos-Achirica M, Vahidy FS, Omer S, Nasir K. Prevalence of and Sociodemographic Disparities in Influenza Vaccination Among Adults With Diabetes in the United States. J Endocr Soc 2020; 4:bvaa139. [PMID: 33123656 PMCID: PMC7575128 DOI: 10.1210/jendso/bvaa139] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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] [Received: 07/06/2020] [Accepted: 09/21/2020] [Indexed: 12/01/2022] Open
Abstract
National estimates describing the overall prevalence of and disparities in influenza vaccination among patients with diabetes mellitus (DM) in United States are not well described. Therefore, we analyzed the prevalence of influenza vaccination among adults with DM, overall and by sociodemographic characteristics, using the Medical Expenditure Panel Survey database from 2008 to 2016. Associations between sociodemographic factors and lack of vaccination were examined using adjusted logistic regression. Among adults with DM, 36% lacked influenza vaccination. Independent predictors of lacking influenza vaccination included age 18 to 39 years (odds ratio [OR] 2.54; 95% confidence interval [CI], 2.14-3.00), Black race/ethnicity (OR 1.29; 95% CI, 1.14-1.46), uninsured status (OR 1.88; 95% CI, 1.59-2.21), and no usual source of care (OR 1.61; 95% CI, 1.39-1.85). Nearly 64% individuals with ≥ 4 higher-risk sociodemographic characteristics lacked influenza vaccination (OR 3.50; 95% CI 2.79-4.39). One-third of adults with DM in the United States lack influenza vaccination, with younger age, Black race, and lower socioeconomic status serving as strong predictors. These findings highlight the continued need for focused public health interventions to increase vaccine coverage and utilization among disadvantaged communities.
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Affiliation(s)
- Priyanka Bhugra
- Hospital Medicine, Houston Methodist Hospital, Houston, Texas
| | - Reed Mszar
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Javier Valero-Elizondo
- Center for Outcomes Research, Houston Methodist Research Institute, Houston Texas.,Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
| | - Gowtham R Grandhi
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, Maryland
| | - Salim S Virani
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.,Baylor College of Medicine, Houston, Texas
| | - Miguel Cainzos-Achirica
- Center for Outcomes Research, Houston Methodist Research Institute, Houston Texas.,Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
| | - Farhaan S Vahidy
- Center for Outcomes Research, Houston Methodist Research Institute, Houston Texas
| | - Saad Omer
- Yale Institute of Global Health, Yale University, New Haven, Connecticut.,Department of Internal Medicine (Infectious Disease), Yale School of Medicine, Yale University, New Haven, Connecticut.,Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, Connecticut.,Yale School of Nursing, Yale University, Orange, Connecticut
| | - Khurram Nasir
- Center for Outcomes Research, Houston Methodist Research Institute, Houston Texas.,Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
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Abstract
Atherosclerotic cardiovascular disease (ASCVD) has posed an increasing burden on Americans and the United States healthcare system for decades. In addition, ASCVD has had a substantial economic impact, with national expenditures for ASCVD projected to increase by over 2.5‐fold from 2015 to 2035. This rapid increase in costs associated with health care for ASCVD has consequences for payers, healthcare providers, and patients. The issues to patients are particularly relevant in recent years, with a growing trend of shifting costs of treatment expenses to patients in various forms, such as high deductibles, copays, and coinsurance. Therefore, the issue of “financial toxicity” of health care is gaining significant attention. The term encapsulates the deleterious impact of healthcare expenditures for patients. This includes the economic burden posed by healthcare costs, but also the unintended consequences it creates in form of barriers to necessary medical care, quality of life as well tradeoffs related to non‐health–related necessities. While the societal impact of rising costs related to ASCVD management have been actively studied and debated in policy circles, there is lack of a comprehensive assessment of the current literature on the financial impact of cost sharing for ASCVD patients and their families. In this review we systematically describe the scope and domains of financial toxicity, the instruments that measure various facets of healthcare‐related financial toxicity, and accentuating factors and consequences on patient health and well‐being. We further identify avenues and potential solutions for clinicians to apply in medical practice to mitigate the burden and consequences of out‐of‐pocket costs for ASCVD patients and their families.
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Affiliation(s)
- Rohan Khera
- Section of Cardiovascular Medicine, Department of Internal Medicine Yale School of Medicine New Haven CT.,Center for Outcomes Research and Evaluation Yale-New Haven Hospital New Haven CT
| | - Javier Valero-Elizondo
- Division of Cardiovascular Prevention and Wellness Houston Methodist DeBakey Heart and Vascular Center Houston TX.,Center for Outcomes Research Houston Methodist Houston TX
| | - Khurram Nasir
- Section of Cardiovascular Medicine, Department of Internal Medicine Yale School of Medicine New Haven CT.,Division of Cardiovascular Prevention and Wellness Houston Methodist DeBakey Heart and Vascular Center Houston TX.,Center for Outcomes Research Houston Methodist Houston TX
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50
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Grandhi GR, Mszar R, Vahidy F, Valero-Elizondo J, Blankstein R, Blaha MJ, Virani SS, Andrieni JD, Omer SB, Nasir K. Sociodemographic Disparities in Influenza Vaccination Among Adults With Atherosclerotic Cardiovascular Disease in the United States. JAMA Cardiol 2020; 6:87-91. [PMID: 32902562 DOI: 10.1001/jamacardio.2020.3978] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Atherosclerotic cardiovascular disease (ASCVD) remains a leading cause of death and disability in the US and worldwide. Influenza vaccination has shown to decrease overall morbidity, mortality, severity of infection, and hospital readmissions among these individuals. However, national estimates of influenza vaccination among individuals with ASCVD in the US are not well studied. Objective To evaluate the prevalence of and sociodemographic disparities in influenza vaccination among a nationally representative sample of individuals with ASCVD. Design, Setting, and Participants Pooled Medical Expenditure Panel Survey data from 2008 to 2016 were used and included adults 40 years or older with ASCVD. Participants' ASCVD status was ascertained via self-report and/or International Classification of Diseases, Ninth Revision diagnosis of coronary heart disease, peripheral artery disease, and/or cerebrovascular disease. Analysis began April 2020. Main Outcomes and Measures Prevalence and characteristics of adults with ASCVD who lacked influenza vaccination during the past year. Covariates including age, sex, race/ethnicity, family income, insurance status, education level, and usual source of care were assessed. Results Of 131 881 adults, 19 793 (15.7%) had ASCVD, corresponding to 22.8 million US adults annually. A total of 7028 adults with ASCVD (32.7%), representing 7.4 million adults, lacked influenza vaccination. The highest odds of lacking vaccination were observed among individuals aged 40 to 64 years (odds ratio [OR], 2.32; 95% CI, 2.06-2.62), without a usual source of care (OR, 2.00; 95% CI, 1.71-2.33), without insurance (OR, 2.05; 95% CI, 1.63-2.58), with a lower education level (OR, 1. 25; 95% CI, 1.12-1.40), with a lower income level (OR, 1.14; 95% CI, 1.01-1.27), and of non-Hispanic Black race/ethnicity (OR, 1.24, 95% CI, 1.10-1.41). A stepwise increase was found in the prevalence and odds of lacking influenza vaccination among individuals with increase in high-risk characteristics. Overall, 1171 individuals (59.7%; 95% CI, 55.8%-63.5%) with 4 or more high-risk characteristics and ASCVD (representing 732 524 US adults annually) reported lack of influenza vaccination (OR, 6.06; 95% CI, 4.88-7.53). Conclusion and Relevance Despite current recommendations, a large proportion of US adults with established ASCVD lack influenza vaccination, with several sociodemographic subgroups having greater risk. Focused public health initiatives are needed to increase access to influenza vaccinations for high-risk and underserved populations.
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Affiliation(s)
- Gowtham R Grandhi
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, Maryland
| | - Reed Mszar
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut.,Center for Outcomes Research and Evaluation, Yale New Haven Health, New Haven, Connecticut
| | - Farhaan Vahidy
- Center for Outcomes Research, The Houston Methodist Research Institute, Houston, Texas.,Houston Methodist Neurological Institute, Houston Methodist Hospital, Houston, Texas
| | - Javier Valero-Elizondo
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
| | - Ron Blankstein
- Cardiovascular Imaging Program, Cardiovascular Division and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland
| | - Salim S Virani
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.,Baylor College of Medicine, Houston, Texas
| | - Julia D Andrieni
- Department of Medicine, Houston Methodist Hospital, Houston, Texas
| | - Saad B Omer
- Yale Institute of Global Health, New Haven, Connecticut.,Yale School of Nursing, New Haven, Connecticut.,Department of Internal Medicine (Infectious Diseases), Yale School of Medicine, New Haven, Connecticut.,Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
| | - Khurram Nasir
- Center for Outcomes Research, The Houston Methodist Research Institute, Houston, Texas.,Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas.,Division of Cardiology, Yale University, New Haven, Connecticut
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