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Mujahid MS, Peterson PN. JAHA Go Red for Women Spotlight on Women and Cardiovascular Disease and Stroke. J Am Heart Assoc 2024; 13:e035104. [PMID: 38410949 PMCID: PMC10944069 DOI: 10.1161/jaha.124.035104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 02/21/2024] [Indexed: 02/28/2024]
Affiliation(s)
| | - Pamela N. Peterson
- Department of MedicineDenver Health Medical CenterDenverCOUSA
- Department of MedicineUniversity of Colorado Anschutz Medical CenterAuroraCOUSA
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El Ayadi AM, Lyndon A, Kan P, Mujahid MS, Leonard SA, Main EK, Carmichael SL. Trends and Disparities in Severe Maternal Morbidity Indicator Categories during Childbirth Hospitalization in California from 1997 to 2017. Am J Perinatol 2024. [PMID: 38057087 DOI: 10.1055/a-2223-3520] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
OBJECTIVE Severe maternal morbidity (SMM) is increasing and characterized by substantial racial and ethnic disparities. Analyzing trends and disparities across time by etiologic or organ system groups instead of an aggregated index may inform specific, actionable pathways to equitable care. We explored trends and racial and ethnic disparities in seven SMM categories at childbirth hospitalization. STUDY DESIGN We analyzed California birth cohort data on all live and stillbirths ≥ 20 weeks' gestation from 1997 to 2017 (n = 10,580,096) using the Centers for Disease Control and Prevention's SMM index. Cases were categorized into seven nonmutually exclusive indicator categories (cardiac, renal, respiratory, hemorrhage, sepsis, other obstetric, and other medical SMM). We compared prevalence and trends in SMM indicator categories overall and by racial and ethnic group using logistic and linear regression. RESULTS SMM occurred in 1.16% of births and nontransfusion SMM in 0.54%. Hemorrhage SMM occurred most frequently (27 per 10,000 births), followed by other obstetric (11), respiratory (7), and sepsis, cardiac, and renal SMM (5). Hemorrhage, renal, respiratory, and sepsis SMM increased over time for all racial and ethnic groups. The largest disparities were for Black individuals, including over 3-fold increased odds of other medical SMM. Renal and sepsis morbidity had the largest relative increases over time (717 and 544%). Sepsis and hemorrhage SMM had the largest absolute changes over time (17 per 10,000 increase). Disparities increased over time for respiratory SMM among Black, U.S.-born Hispanic, and non-U.S.-born Hispanic individuals and for sepsis SMM among Asian or Pacific Islander individuals. Disparities decreased over time for sepsis SMM among Black individuals yet remained substantial. CONCLUSION Our research further supports the critical need to address SMM and disparities as a significant public health priority in the United States and suggests that examining SMM subgroups may reveal helpful nuance for understanding trends, disparities, and potential needs for intervention. KEY POINTS · By SMM subgroup, trends and racial and ethnic disparities varied yet Black individuals consistently had highest rates.. · Hemorrhage, renal, respiratory, and sepsis SMM significantly increased over time.. · Disparities increased for respiratory SMM among Black, U.S.-born Hispanic and non-U.S.-born Hispanic individuals and for sepsis SMM among Asian or Pacific Islander individuals..
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Affiliation(s)
- Alison M El Ayadi
- Department of Obstetrics, Gynecology and Reproductive Sciences, Department of Epidemiology and Biostatistics, University of California, San Francisco, California
| | - Audrey Lyndon
- NYU Rory Meyers College of Nursing, New York, New York
| | - Peiyi Kan
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Mahasin S Mujahid
- Division of Epidemiology, School of Public Health, University of California Berkeley, Berkeley, California
| | - Stephanie A Leonard
- Department of Obstetrics and Gynecology, Dunlevie Maternal-Fetal Medicine Center, Stanford University School of Medicine, Stanford, California
| | - Elliott K Main
- Department of Obstetrics and Gynecology, Dunlevie Maternal-Fetal Medicine Center, Stanford University School of Medicine, Stanford, California
| | - Suzan L Carmichael
- Department of Pediatrics, Department of Obstetrics and Gynecology, Stanford University, Stanford, California
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Hailu EM, Riddell CA, Bradshaw PT, Ahern J, Carmichael SL, Mujahid MS. Structural Racism, Mass Incarceration, and Racial and Ethnic Disparities in Severe Maternal Morbidity. JAMA Netw Open 2024; 7:e2353626. [PMID: 38277143 PMCID: PMC10818215 DOI: 10.1001/jamanetworkopen.2023.53626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 12/06/2023] [Indexed: 01/27/2024] Open
Abstract
Importance Racial and ethnic inequities in the criminal-legal system are an important manifestation of structural racism. However, how these inequities may influence the risk of severe maternal morbidity (SMM) and its persistent racial and ethnic disparities remains underinvestigated. Objective To examine the association between county-level inequity in jail incarceration rates comparing Black and White individuals and SMM risk in California. Design, Setting, and Participants This population-based cross-sectional study used state-wide data from California on all live hospital births at 20 weeks of gestation or later from January 1, 1997, to December 31, 2018. Data were obtained from hospital discharge and vital statistics records, which were linked with publicly available county-level data. Data analysis was performed from January 2022 to February 2023. Exposure Jail incarceration inequity was determined from the ratio of jail incarceration rates of Black individuals to those of White individuals and was categorized as tertile 1 (low), tertile 2 (moderate), tertile 3 (high), with mean cutoffs across all years of 0 to 2.99, 3.00 to 5.22, and greater than 5.22, respectively. Main Outcome and Measures This study used race- and ethnicity-stratified mixed-effects logistic regression models with birthing people nested within counties and adjusted for individual- and county-level characteristics to estimate the odds of non-blood transfusion SMM (NT SMM) and SMM including blood transfusion-only cases (SMM; as defined by the Centers for Disease Control and Prevention SMM index) associated with tertiles of incarceration inequity. Results This study included 10 200 692 births (0.4% American Indian or Alaska Native, 13.4% Asian or Pacific Islander, 5.8% Black, 50.8% Hispanic or Latinx, 29.6% White, and 0.1% multiracial or other [individuals who self-identified with ≥2 racial groups and those who self-identified as "other" race or ethnicity]). In fully adjusted models, residing in counties with high jail incarceration inequity (tertile 3) was associated with higher odds of SMM for Black (odds ratio [OR], 1.14; 95% CI, 1.01-1.29 for NT SMM; OR, 1.20, 95% CI, 1.01-1.42 for SMM), Hispanic or Latinx (OR, 1.24; 95% CI, 1.14-1.34 for NT SMM; OR, 1.20; 95% CI, 1.14-1.27 for SMM), and White (OR, 1.02; 95% CI, 0.93-1.12 for NT SMM; OR, 1.09; 95% CI, 1.02-1.17 for SMM) birthing people, compared with residing in counties with low inequity (tertile 1). Conclusions and Relevance The findings of this study highlight the adverse maternal health consequences of structural racism manifesting via the criminal-legal system and underscore the need for community-based alternatives to inequitable punitive practices.
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Affiliation(s)
- Elleni M. Hailu
- Division of Epidemiology, School of Public Health, University of California, Berkeley
| | - Corinne A. Riddell
- Division of Epidemiology, School of Public Health, University of California, Berkeley
- Division of Biostatistics, School of Public Health, University of California, Berkeley
| | - Patrick T. Bradshaw
- Division of Epidemiology, School of Public Health, University of California, Berkeley
| | - Jennifer Ahern
- Division of Epidemiology, School of Public Health, University of California, Berkeley
| | - Suzan L. Carmichael
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University, Palo Alto, California
- Division of Maternal-Fetal Medicine and Obstetrics, School of Medicine, Stanford University, Palo Alto, California
| | - Mahasin S. Mujahid
- Division of Epidemiology, School of Public Health, University of California, Berkeley
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Kershaw KN, Magnani JW, Diez Roux AV, Camacho-Rivera M, Jackson EA, Johnson AE, Magwood GS, Morgenstern LB, Salinas JJ, Sims M, Mujahid MS. Neighborhoods and Cardiovascular Health: A Scientific Statement From the American Heart Association. Circ Cardiovasc Qual Outcomes 2024; 17:e000124. [PMID: 38073532 DOI: 10.1161/hcq.0000000000000124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Abstract
The neighborhoods where individuals reside shape environmental exposures, access to resources, and opportunities. The inequitable distribution of resources and opportunities across neighborhoods perpetuates and exacerbates cardiovascular health inequities. Thus, interventions that address the neighborhood environment could reduce the inequitable burden of cardiovascular disease in disenfranchised populations. The objective of this scientific statement is to provide a roadmap illustrating how current knowledge regarding the effects of neighborhoods on cardiovascular disease can be used to develop and implement effective interventions to improve cardiovascular health at the population, health system, community, and individual levels. PubMed/Medline, CINAHL, Cochrane Library reviews, and ClinicalTrials.gov were used to identify observational studies and interventions examining or targeting neighborhood conditions in relation to cardiovascular health. The scientific statement summarizes how neighborhoods have been incorporated into the actions of health care systems, interventions in community settings, and policies and interventions that involve modifying the neighborhood environment. This scientific statement presents promising findings that can be expanded and implemented more broadly and identifies methodological challenges in designing studies to evaluate important neighborhood-related policies and interventions. Last, this scientific statement offers recommendations for areas that merit further research to promote a deeper understanding of the contributions of neighborhoods to cardiovascular health and health inequities and to stimulate the development of more effective interventions.
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Chiu DT, Brown EM, Tomiyama AJ, Brownell KE, Abrams B, Mujahid MS, Epel ES, Laraia BA. Adverse Childhood Experiences and BMI: Lifecourse Associations in a Black-White U.S. Women Cohort. Am J Prev Med 2024; 66:73-82. [PMID: 37690590 DOI: 10.1016/j.amepre.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 09/03/2023] [Accepted: 09/04/2023] [Indexed: 09/12/2023]
Abstract
INTRODUCTION Although adverse childhood experiences (ACEs) have been positively associated with adiposity, few studies have examined long-term race-specific ACE-BMI relationships. METHODS A Black and White all-women cohort (N=611; 48.6% Black) was followed between 1987 and 1997 from childhood (ages 9-10 years) through adolescence (ages 19-20 years) to midlife (ages 36-43 years, between 2015 and 2019). In these 2020-2022 analyses, the interaction between race and individual ACE exposures (physical abuse, sexual abuse, household substance abuse, multiple ACEs) on continuous BMI at ages 19-20 years and midlife was evaluated individually through multivariable linear regression models. Stratification by race followed as warranted at α=0.15. RESULTS Race only modified ACE-BMI associations for sexual abuse. Among Black women, sexual abuse was significantly associated with BMI (Badjusted=3.24, 95% CI=0.92, 5.57) at ages 19-20 years and marginally associated at midlife (Badjusted=2.37, 95% CI= -0.62, 5.35); among White women, corresponding associations were null. Overall, having ≥2 ACEs was significantly associated with adolescent BMI (Badjusted=1.47, 95% CI=0.13, 2.80) and was marginally associated at midlife (Badjusted=1.45, 95% CI= -0.31, 3.22). This was similarly observed for physical abuse (adolescent BMI: Badjusted=1.23, 95% CI= -0.08, 2.54; midlife BMI: Badjusted=1.03, 95% CI= -0.71, 2.78), but not for substance abuse. CONCLUSIONS Direct exposure to certain severe ACEs is associated with increased BMI among Black and White women. It is important to consider race, ACE type, and life stage to gain a more sophisticated understanding of ACE-BMI relationships. This knowledge can help strengthen intervention, prevention, and policy efforts aiming to mitigate the impacts of social adversities and trauma on persistent cardiometabolic health disparities over the lifecourse.
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Affiliation(s)
- Dorothy T Chiu
- Community Health Sciences Division, Berkeley School of Public Health, University of California, Berkeley, California; Osher Center for Integrative Health, University of California San Francisco, San Francisco, California.
| | - Erika M Brown
- Community Health Sciences Division, Berkeley School of Public Health, University of California, Berkeley, California; California Policy Lab, Berkeley, California
| | - A Janet Tomiyama
- Department of Psychology, College of Life Sciences, University of California, Los Angeles, Los Angeles, California
| | - Kristy E Brownell
- Community Health Sciences Division, Berkeley School of Public Health, University of California, Berkeley, California; Kaiser Permanente Division of Research, Oakland, California
| | - Barbara Abrams
- Epidemiology Division, Berkeley School of Public Health, University of California, Berkeley, California
| | - Mahasin S Mujahid
- Epidemiology Division, Berkeley School of Public Health, University of California, Berkeley, California
| | - Elissa S Epel
- Weill Institute of Neurosciences, Department of Psychiatry, University of California San Francisco, San Francisco, California; The Center for Health and Community, University of California San Francisco, San Francisco, California
| | - Barbara A Laraia
- Community Health Sciences Division, Berkeley School of Public Health, University of California, Berkeley, California
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Gao X, Berkowitz RL, Michaels EK, Mujahid MS. Traveling Together: A Road Map for Researching Neighborhood Effects on Population Health and Health Inequities. Am J Epidemiol 2023; 192:1731-1742. [PMID: 37246316 DOI: 10.1093/aje/kwad129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 04/12/2023] [Accepted: 05/24/2023] [Indexed: 05/30/2023] Open
Abstract
As evidence of the relationship between place and health mounts, more epidemiologists and clinical science researchers are becoming interested in incorporating place-based measures and analyses into their examination of population health and health inequities. Given the extensive literature on place and health, it can be challenging for researchers new to this area to develop neighborhood-effects research questions and apply the appropriate measures and methods. This paper provides a road map for guiding health researchers through the conceptual and methodological stages of incorporating various dimensions of place into their quantitative health research. Synthesizing across reviews, commentaries, and empirical investigations, the road map consists of 4 broad stages for considering place and health: 1) why?: articulating the motivation for assessing place and health and grounding the motivation in theory; 2) what?: identifying the relevant place-based characteristics and specifying their link to health to build a conceptual framework; 3) how?: determining how to operationalize the conceptual framework by defining, measuring, and assessing place-based characteristics and quantifying their effect on health; and 4) now what?: discussing the implications of neighborhood research findings for future research, policy, and practice. This road map supports efforts to develop conceptually and analytically rigorous neighborhood research projects.
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Gao X, Thomas TA, Morello-Frosch R, Allen AM, Snowden JM, Carmichael SL, Mujahid MS. Neighborhood gentrification, displacement, and severe maternal morbidity in California. Soc Sci Med 2023; 334:116196. [PMID: 37678111 PMCID: PMC10959124 DOI: 10.1016/j.socscimed.2023.116196] [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: 04/18/2023] [Revised: 06/29/2023] [Accepted: 08/29/2023] [Indexed: 09/09/2023]
Abstract
Gentrification, a racialized and profit-driven process in which historically disinvested neighborhoods experience an influx of development that contributes to the improvement of physical amenities, increasing housing costs, and the dispossession and displacement of existing communities, may influence the risk of severe maternal morbidity (SMM). Leveraging a racially diverse population-based sample of all live hospital births in California between 2006 and 2017, we examined associations between neighborhood-level gentrification and SMM. SMM was defined as having one of 21 procedures and diagnoses, as described in the SMM index developed by Centers for Disease Control and Prevention. We compared three gentrification measures to determine which operationalization best captures aspects of gentrification most salient to SMM: Freeman, Landis 3-D, and Urban Displacement Project Gentrification and Displacement Typology. Descriptive analysis assessed bivariate associations between gentrification and birthing people's characteristics. Overall and race and ethnicity-stratified mixed-effects logistic models assessed associations between gentrification and SMM, adjusting for individual sociodemographic and pregnancy factors while accounting for clustering by census tract. The study sample included 5,256,905 births, with 72,718 cases of SMM (1.4%). The percentage of individuals living in a gentrifying neighborhood ranged from 5.7% to 11.7% across exposure assessment methods. Net of individual and pregnancy-related factors, neighborhood-level gentrification, as measured by the Freeman method, was protective against SMM (OR = 0.89, 95% CI: 0.86-0.93); in comparison, gentrification, as measured by the Gentrification and Displacement Typology, was associated with greater risk of SMM (OR = 1.18, 95% CI: 1.14-1.23). These associations were significant among non-Hispanic White, non-Hispanic Black, and Hispanic individuals. Findings demonstrate that gentrification plays a role in shaping the risk of SMM among birthing people in California. Differences in how gentrification is conceptualized and measured, such as an emphasis on housing affordability compared to a broader characterization of gentrification's multiple aspects, may explain the heterogeneity in the directions of observed associations.
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Affiliation(s)
- Xing Gao
- Division of Epidemiology, School of Public Health, University of California Berkeley, Berkeley, CA, USA
| | - Timothy A Thomas
- Urban Displacement Project, Institute of Governmental Studies, University of California Berkeley, Berkeley, CA, USA
| | - Rachel Morello-Frosch
- Department of Environmental Science, Policy and Management, University of California Berkeley, Berkeley, CA, USA; Division of Environmental Health Sciences, School of Public Health, University of California Berkeley, Berkeley, CA, USA; Division of Community Health Sciences, School of Public Health, University of California Berkeley, Berkeley, CA, USA
| | - Amani M Allen
- Division of Epidemiology, School of Public Health, University of California Berkeley, Berkeley, CA, USA; Division of Community Health Sciences, School of Public Health, University of California Berkeley, Berkeley, CA, USA
| | - Jonathan M Snowden
- School of Public Health, Oregon Health & Science University-Portland State University, OR, USA
| | - Suzan L Carmichael
- Department of Pediatrics, Division of Neonatal & Developmental Medicine, Stanford University, Stanford, CA, USA; Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Stanford University, Stanford, CA, USA
| | - Mahasin S Mujahid
- Division of Epidemiology, School of Public Health, University of California Berkeley, Berkeley, CA, USA.
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Mujahid MS, Maddali SR, Gao X, Oo KH, Benjamin LA, Lewis TT. The Impact of Neighborhoods on Diabetes Risk and Outcomes: Centering Health Equity. Diabetes Care 2023; 46:1609-1618. [PMID: 37354326 PMCID: PMC10465989 DOI: 10.2337/dci23-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 06/05/2023] [Indexed: 06/26/2023]
Abstract
Neighborhood environments significantly influence the development of diabetes risk factors, morbidity, and mortality throughout an individual's life. The social, economic, and physical environments of a neighborhood all affect the health risks of individuals and communities and also affect population health inequities. Factors such as access to healthy food, green spaces, safe housing, and transportation options can impact the health outcomes of residents. Social factors, including social cohesion and neighborhood safety, also play an important role in shaping neighborhood environments and can influence the development of diabetes. Therefore, understanding the complex relationships between neighborhood environments and diabetes is crucial for developing effective strategies to address health disparities and promote health equity. This review presents landmark findings from studies that examined associations between neighborhood socioeconomic, built and physical, and social environmental factors and diabetes-related risk and outcomes. Our framework emphasizes the historical context and structural and institutional racism as the key drivers of neighborhood environments that ultimately shape diabetes risk and outcomes. To address health inequities in diabetes, we propose future research areas that incorporate health equity principles and place-based interventions.
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Affiliation(s)
- Mahasin S. Mujahid
- Division of Epidemiology, School of Public Health, University of California Berkeley, Berkeley, CA
| | - Sai Ramya Maddali
- Division of Epidemiology, School of Public Health, University of California Berkeley, Berkeley, CA
| | - Xing Gao
- Division of Epidemiology, School of Public Health, University of California Berkeley, Berkeley, CA
| | - Khin H. Oo
- Division of Epidemiology, School of Public Health, University of California Berkeley, Berkeley, CA
| | - Larissa A. Benjamin
- Division of Epidemiology, School of Public Health, University of California Berkeley, Berkeley, CA
| | - Tené T. Lewis
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
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Mentias A, Mujahid MS, Sumarsono A, Nelson RK, Madron JM, Powell-Wiley TM, Essien UR, Keshvani N, Girotra S, Morris A, Sims M, Capers Q, Yancy C, Desai MY, Menon V, Rao S, Pandey A. Historical Redlining, Socioeconomic Distress, and Risk of Heart Failure Among Medicare Beneficiaries. Circulation 2023; 148:210-219. [PMID: 37459409 PMCID: PMC10797918 DOI: 10.1161/circulationaha.123.064351] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [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: 02/09/2023] [Accepted: 04/28/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND The association of historical redlining policies, a marker of structural racism, with contemporary heart failure (HF) risk among White and Black individuals is not well established. METHODS We aimed to evaluate the association of redlining with the risk of HF among White and Black Medicare beneficiaries. Zip code-level redlining was determined by the proportion of historically redlined areas using the Mapping Inequality Project within each zip code. The association between higher zip code redlining proportion (quartile 4 versus quartiles 1-3) and HF risk were assessed separately among White and Black Medicare beneficiaries using generalized linear mixed models adjusted for potential confounders, including measures of the zip code-level Social Deprivation Index. RESULTS A total of 2 388 955 Medicare beneficiaries (Black n=801 452; White n=1 587 503; mean age, 71 years; men, 44.6%) were included. Among Black beneficiaries, living in zip codes with higher redlining proportion (quartile 4 versus quartiles 1-3) was associated with increased risk of HF after adjusting for age, sex, and comorbidities (risk ratio, 1.08 [95% CI, 1.04-1.12]; P<0.001). This association remained significant after further adjustment for area-level Social Deprivation Index (risk ratio, 1.04 [95% CI, 1.002-1.08]; P=0.04). A significant interaction was observed between redlining proportion and Social Deprivation Index (Pinteraction<0.01) such that higher redlining proportion was significantly associated with HF risk only among socioeconomically distressed regions (above the median Social Deprivation Index). Among White beneficiaries, redlining was associated with a lower risk of HF after adjustment for age, sex, and comorbidities (risk ratio, 0.94 [95% CI, 0.89-0.99]; P=0.02). CONCLUSIONS Historical redlining is associated with an increased risk of HF among Black patients. Contemporary zip code-level social determinants of health modify the relationship between redlining and HF risk, with the strongest relationship between redlining and HF observed in the most socioeconomically disadvantaged communities.
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Affiliation(s)
- Amgad Mentias
- Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Mahasin S Mujahid
- Division of Epidemiology, UC Berkeley, School of Public Health, Berkeley CA
| | - Andrew Sumarsono
- Division of Hospital Medicine, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX
| | | | | | - Tiffany M. Powell-Wiley
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
- Intramural Research Program, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD
| | - Utibe R. Essien
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, CA
- Center for the Study of Healthcare Innovation, Implementation, & Policy, VA Greater Los Angeles, CA
| | - Neil Keshvani
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX
| | - Saket Girotra
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX
| | - Alanna Morris
- Division of Cardiology, Department of Internal Medicine, Emory University School of Medicine, Atlanta, GA
| | - Mario Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Quinn Capers
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Clyde Yancy
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Milind Y. Desai
- Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Venu Menon
- Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Shreya Rao
- Division of Cardiology, Department of Internal Medicine, UTHSC San Antonio, San Antonio, TX
| | - Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX
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Gao X, Snowden JM, Tucker CM, Allen A, Morello-Frosch R, Abrams B, Carmichael SL, Mujahid MS. Remapping racial and ethnic inequities in severe maternal morbidity: The legacy of redlining in California. Paediatr Perinat Epidemiol 2023; 37:379-389. [PMID: 36420897 PMCID: PMC10373920 DOI: 10.1111/ppe.12935] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 10/20/2022] [Accepted: 10/22/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Historical mortgage redlining, a racially discriminatory policy designed to uphold structural racism, may have played a role in producing the persistently elevated rate of severe maternal morbidity (SMM) among racialised birthing people. OBJECTIVE This study examined associations between Home-Owner Loan Corporation (HOLC) redlining grades and SMM in a racially and ethnically diverse birth cohort in California. METHODS We leveraged a population-based cohort of all live hospital births at ≥20 weeks of gestation between 1997 and 2017 in California. SMM was defined as having one of 21 procedures and diagnoses, per an index developed by Centers for Disease Control and Prevention. We characterised census tract-level redlining using HOLC's security maps for eight California cities. We assessed bivariate associations between HOLC grades and participant characteristics. Race and ethnicity-stratified mixed effects logistic regression models assessed the risk of SMM associated with HOLC grades within non-Hispanic Black, Asian/Pacific Islander, American Indian/Alaskan Native and Hispanic groups, adjusting for sociodemographic information, pregnancy-related factors, co-morbidities and neighbourhood deprivation index. RESULTS The study sample included 2,020,194 births, with 24,579 cases of SMM (1.2%). Living in a census tract that was graded as "Hazardous," compared to census tracts graded "Best" and "Still Desirable," was associated with 1.15 (95% confidence interval [CI] 1.03, 1.29) and 1.17 (95% CI 1.09, 1.25) times the risk of SMM among Black and Hispanic birthing people, respectively, independent of sociodemographic factors. These associations persisted after adjusting for pregnancy-related factors and neighbourhood deprivation index. CONCLUSIONS Historical redlining, a tool of structural racism that influenced the trajectory of neighbourhood social and material conditions, is associated with increased risk of experiencing SMM among Black and Hispanic birthing people in California. These findings demonstrate that addressing the enduring impact of macro-level and systemic mechanisms that uphold structural racism is a vital step in achieving racial and ethnic equity in birthing people's health.
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Affiliation(s)
- Xing Gao
- Division of Epidemiology, School of Public Health, University of California Berkeley, California, Berkeley, USA
| | - Jonathan M. Snowden
- Division of Epidemiology, School of Public Health, Oregon Health & Science University-Portland State University, Portland, Oregon, USA
| | - Curisa M. Tucker
- Division of Neonatal & Developmental Medicine, Department of Pediatrics, Stanford University, Stanford, California, USA
| | - Amani Allen
- Division of Epidemiology, School of Public Health, University of California Berkeley, California, Berkeley, USA
- Division of Community Health Sciences, School of Public Health, University of California Berkeley, Berkeley, California, USA
| | - Rachel Morello-Frosch
- Division of Community Health Sciences, School of Public Health, University of California Berkeley, Berkeley, California, USA
- Division of Environmental Health Sciences, University of California Berkeley, Berkeley, California, USA
- Department of Environmental Science, Policy and Management, University of California Berkeley, Berkeley, California, USA
| | - Barbara Abrams
- Division of Epidemiology, School of Public Health, University of California Berkeley, California, Berkeley, USA
- Division of Maternal Child and Adolescent Health, School of Public Health, University of California Berkeley, Berkeley, California, USA
- Division of Public Health Nutrition, School of Public Health, University of California Berkeley, Berkeley, California, USA
| | - Suzan L. Carmichael
- Division of Neonatal & Developmental Medicine, Department of Pediatrics, Stanford University, Stanford, California, USA
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Stanford University, Stanford, California, USA
| | - Mahasin S. Mujahid
- Division of Epidemiology, School of Public Health, University of California Berkeley, California, Berkeley, USA
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11
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Mujahid MS, Wall-Wieler E, Hailu EM, Berkowitz RL, Gao X, Morris CM, Abrams B, Lyndon A, Carmichael SL. Neighborhood disinvestment and severe maternal morbidity in the state of California. Am J Obstet Gynecol MFM 2023; 5:100916. [PMID: 36905984 PMCID: PMC10959123 DOI: 10.1016/j.ajogmf.2023.100916] [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: 11/02/2022] [Revised: 02/16/2023] [Accepted: 02/28/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND Social determinants of health, including neighborhood context, may be a key driver of severe maternal morbidity and its related racial and ethnic inequities; however, investigations remain limited. OBJECTIVE This study aimed to examine the associations between neighborhood socioeconomic characteristics and severe maternal morbidity, as well as whether the associations between neighborhood socioeconomic characteristics and severe maternal morbidity were modified by race and ethnicity. STUDY DESIGN This study leveraged a California statewide data resource on all hospital births at ≥20 weeks of gestation (1997-2018). Severe maternal morbidity was defined as having at least 1 of 21 diagnoses and procedures (eg, blood transfusion or hysterectomy) as outlined by the Centers for Disease Control and Prevention. Neighborhoods were defined as residential census tracts (n=8022; an average of 1295 births per neighborhood), and the neighborhood deprivation index was a summary measure of 8 census indicators (eg, percentage of poverty, unemployment, and public assistance). Mixed-effects logistic regression models (individuals nested within neighborhoods) were used to compare odds of severe maternal morbidity across quartiles (quartile 1 [the least deprived] to quartile 4 [the most deprived]) of the neighborhood deprivation index before and after adjustments for maternal sociodemographic and pregnancy-related factors and comorbidities. Moreover, cross-product terms were created to determine whether associations were modified by race and ethnicity. RESULTS Of 10,384,976 births, the prevalence of severe maternal morbidity was 1.2% (N=120,487). In fully adjusted mixed-effects models, the odds of severe maternal morbidity increased with increasing neighborhood deprivation index (odds ratios: quartile 1, reference; quartile 4, 1.23 [95% confidence interval, 1.20-1.26]; quartile 3, 1.13 [95% confidence interval, 1.10-1.16]; quartile 2, 1.06 [95% confidence interval, 1.03-1.08]). The associations were modified by race and ethnicity such that associations (quartile 4 vs quartile 1) were the strongest among individuals in the "other" racial and ethnic category (1.39; 95% confidence interval, 1.03-1.86) and the weakest among Black individuals (1.07; 95% confidence interval, 0.98-1.16). CONCLUSION Study findings suggest that neighborhood deprivation contributes to an increased risk of severe maternal morbidity. Future research should examine which aspects of neighborhood environments matter most across racial and ethnic groups.
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Affiliation(s)
- Mahasin S Mujahid
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA (Dr Mujahid, Mses Hailu, Gao, and Morris, and Dr Abrams).
| | - Elizabeth Wall-Wieler
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University (Drs Wall-Wieler and Carmichael); Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada (Dr Wall-Wieler)
| | - Elleni M Hailu
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA (Dr Mujahid, Mses Hailu, Gao, and Morris, and Dr Abrams)
| | - Rachel L Berkowitz
- Division of Health Policy and Management, School of Public Health, University of California, Berkeley, Berkeley, CA (Dr Berkowitz)
| | - Xing Gao
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA (Dr Mujahid, Mses Hailu, Gao, and Morris, and Dr Abrams)
| | - Colleen M Morris
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA (Dr Mujahid, Mses Hailu, Gao, and Morris, and Dr Abrams)
| | - Barbara Abrams
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA (Dr Mujahid, Mses Hailu, Gao, and Morris, and Dr Abrams)
| | - Audrey Lyndon
- Rory Meyers College of Nursing, New York University, New York City, NY (Dr Lyndon)
| | - Suzan L Carmichael
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University (Drs Wall-Wieler and Carmichael); Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Stanford University, Stanford, CA (Dr Carmichael)
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12
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Islam SJ, Kim JH, Li X, Ko YA, Baltrus P, Mitchell GF, Fox ER, Mujahid MS, Vaccarino V, Lewis TT, Taylor HA, Sims M, Quyyumi AA. Neighborhood characteristics and arterial stiffness among Black adults - Results from the Jackson Heart Study and Morehouse-Emory Cardiovascular Center for Health Equity. Vasc Med 2023; 28:188-196. [PMID: 36597615 DOI: 10.1177/1358863x221136163] [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] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Poor quality neighborhood environments are independent risk factors for cardiovascular disease (CVD) but are understudied in Black adults, who face large CVD health disparities. Arterial stiffness, a marker of early vascular aging, precedes development of hypertension and adverse CVD events but the effect of neighborhood on arterial stiffness among Black adults remains unknown. OBJECTIVE We compared the association between neighborhood environment and arterial stiffness among Black adults in Jackson, MS and Atlanta, GA. METHODS We studied 1582 Black adults (mean age 53 ± 10, 35% male) living in Jackson, MS from the Jackson Heart Study (JHS) and 451 Black adults (mean age 53 ± 10, 39% male) living in Atlanta, GA from the Morehouse-Emory Cardiovascular Center for Health Equity (MECA) study, without known CVD. Neighborhood problems (includes measures of aesthetic quality, walking environment, food access), social cohesion (includes activity with neighbors), and violence/safety were assessed using validated questionnaires. Arterial stiffness was measured as pulse wave velocity (PWV) using magnetic resonance imaging in JHS and as PWV and augmentation index (AIx) using applanation tonometry (SphygmoCor, Inc.) in MECA. Multivariable linear regression models were used to examine the association between neighborhood characteristics and arterial stiffness, adjusting for potential confounders. RESULTS Improved social characteristics, measured as social cohesion in JHS (β = -0.32 [-0.63, -0.02], p = 0.04) and activity with neighbors (β = -0.23 [-0.40, -0.05], p = 0.01) in MECA, were associated with lower PWV in both cohorts and lower AIx (β = -1.74 [-2.92, - 0.56], p = 0.004) in MECA, after adjustment for CVD risk factors and income. Additionally, in MECA, better food access (β = -1.18 [-2.35, - 0.01], p = 0.05) was associated with lower AIx and, in JHS, lower neighborhood problems (β = -0.33 [-0.64, - 0.02], p = 0.04) and lower violence (β = -0.30 [-0.61, 0.002], p = 0.05) were associated with lower PWV. CONCLUSION Neighborhood social characteristics show an independent association with the vascular health of Black adults, findings that were reproducible in two distinct American cities.
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Affiliation(s)
- Shabatun J Islam
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Jeong Hwan Kim
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Xiaona Li
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Yi-An Ko
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Peter Baltrus
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA, USA
- National Center for Primary Care, Morehouse School of Medicine, Atlanta, GA, USA
| | | | - Ervin R Fox
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Mahasin S Mujahid
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Viola Vaccarino
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Tené T Lewis
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Herman A Taylor
- Department of Medicine, Morehouse School of Medicine, Atlanta, GA, USA
| | - Mario Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Arshed A Quyyumi
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
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Affiliation(s)
| | - Pamela N. Peterson
- Division of Cardiology, Department of MedicineUniversity of Colorado Anschutz Medical Campus, Aurora and Denver Health Medical CenterDenverCOUSA
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Duarte CDP, Moses C, Brown M, Kajeepeta S, Prins SJ, Scott J, Mujahid MS. Punitive school discipline as a mechanism of structural marginalization with implications for health inequity: A systematic review of quantitative studies in the health and social sciences literature. Ann N Y Acad Sci 2023; 1519:129-152. [PMID: 36385456 PMCID: PMC10929984 DOI: 10.1111/nyas.14922] [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] [Indexed: 11/18/2022]
Abstract
Punitive school discipline deploys surveillance, exclusion, and corporal punishment to deter or account for perceived student misbehavior. Yet, education and legal scholarship suggests it fails to achieve stated goals and exacerbates harm. Furthermore, it is disproportionately imposed upon Black, Latinx, Native/Indigenous, LGBTQIA, and disabled students, concentrating its harms among marginalized young people. Its implications for health, however, are less clear. Using public health theories of sociostructural embodiment, we propose a framework characterizing pathways linking societal ideologies (e.g., racism) to punitive discipline with implications for health and health inequity and then present our systematic review of the punitive school discipline-health literature (N = 19 studies) conducted in accordance with PRISMA guidelines. Data were extracted on guiding theories, study characteristics, measurement, methods, and findings. This literature links punitive school discipline to greater risk for numerous health outcomes, including persistent depressive symptoms, depression, drug use disorder in adulthood, borderline personality disorder, antisocial behavior, death by suicide, injuries, trichomoniasis, pregnancy in adolescence, tobacco use, and smoking, with documented implications for racial health inequity. Using our adapted framework, we contextualize results and recommend avenues for future research. Our findings support demands to move away from punitive school discipline toward health-affirming interventions to promote school connectedness, safety, and wellbeing.
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Affiliation(s)
- Catherine dP Duarte
- Department of Epidemiology & Population Health, Stanford University School of Medicine, Stanford, California, USA
- Division of Epidemiology, School of Public Health, University of California, Berkeley, California, USA
| | - Candice Moses
- Division of Epidemiology, School of Public Health, University of California, Berkeley, California, USA
| | - Melissa Brown
- Health and Social Behavior, School of Public Health, University of California, Berkeley, California, USA
| | - Sandhya Kajeepeta
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Seth J Prins
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Janelle Scott
- Graduate School of Education, University of California, Berkeley, California, USA
| | - Mahasin S Mujahid
- Division of Epidemiology, School of Public Health, University of California, Berkeley, California, USA
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Hailu EM, Carmichael SL, Berkowitz RL, Snowden JM, Lyndon A, Main E, Mujahid MS. Racial/ethnic disparities in severe maternal morbidity: An intersectional lifecourse approach. Ann N Y Acad Sci 2022; 1518:239-248. [PMID: 36166238 PMCID: PMC11019852 DOI: 10.1111/nyas.14901] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Despite long-existing calls to address alarming racial/ethnic gaps in severe maternal morbidity (SMM), research that considers the impact of intersecting social inequities on SMM risk remains scarce. Invoking intersectionality theory, we sought to assess SMM risk at the nexus of racial/ethnic marginalization, weathering, and neighborhood/individual socioeconomic disadvantage. We used birth hospitalization records from California across 20 years (1997-2017, N = 9,806,406) on all live births ≥20 weeks gestation. We estimated adjusted average predicted probabilities of SMM at the combination of levels of race/ethnicity, age, and neighborhood deprivation or individual socioeconomic status (SES). The highest risk of SMM was observed among Black birthing people aged ≥35 years who either resided in the most deprived neighborhoods or had the lowest SES. Black birthing people conceptualized to be better off due to their social standing (aged 20-34 years and living in the least deprived neighborhoods or college graduates) had comparable and at times worse risk than White birthing people conceptualized to be worse off (aged ≥35 years and living in the most deprived neighborhoods or had a high-school degree or less). Our findings highlight the need to explicitly address structural racism as the driver of racial/ethnic health inequities and the imperative to incorporate intersectional approaches.
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Affiliation(s)
- Elleni M Hailu
- Division of Epidemiology, School of Public Health, University of California Berkeley, Berkeley, California, USA
| | - Suzan L Carmichael
- Division of Neonatal & Developmental Medicine, Department of Pediatrics, and Division of Maternal-Fetal Medicine and Obstetrics, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Palo Alto, USA
| | - Rachel L Berkowitz
- Department of Public Health and Recreation, College of Health and Human Sciences, San Jose State University, San Jose, California, USA
| | - Jonathan M Snowden
- School of Public Health, Oregon Health & Science University-Portland State University, Portland, Oregon, USA
| | - Audrey Lyndon
- Rory Meyers College of Nursing, New York University, New York, New York, USA
| | - Elliott Main
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Mahasin S Mujahid
- Division of Epidemiology, School of Public Health, University of California Berkeley, Berkeley, California, USA
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16
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Hailu EM, Maddali SR, Snowden JM, Carmichael SL, Mujahid MS. Structural racism and adverse maternal health outcomes: A systematic review. Health Place 2022; 78:102923. [PMID: 36401939 DOI: 10.1016/j.healthplace.2022.102923] [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: 05/31/2022] [Revised: 08/19/2022] [Accepted: 09/22/2022] [Indexed: 11/18/2022]
Abstract
In the United States, racial disparities in adverse maternal health outcomes remain a pressing issue, with Black women experiencing a 3-4 times higher risk of maternal mortality and a 2-3 times higher risk of severe maternal morbidity. Despite recent encouraging efforts, fundamental determinants of these alarming inequities (e.g. structural racism) remain understudied. Approaches that address these structural drivers are needed to then intervene upon root causes of adverse maternal outcomes and their disparities and to ultimately improve maternal health across the U.S. In this paper, we offer a conceptual framework for studies of structural racism and maternal health disparities and systematically synthesize the current empirical epidemiologic literature on the links between structural racism measures and adverse maternal health outcomes. For the systematic review, we searched electronic databases (Pubmed, Web of Science, and EMBASE) to identify peer-reviewed U.S. based quantitative articles published between 1990 and 2021 that assessed the link between measures of structural racism and indicators of maternal morbidity/mortality. Our search yielded 2394 studies and after removing duplicates, 1408 were included in the title and abstract screening, of which 18 were included in the full text screening. Only 6 studies met all the specified inclusion criteria for this review. Results revealed that depending on population sub-group analyzed, measures used, and covariates considered, there was evidence that structural racism may increase the risk of adverse maternal health outcomes. This review also highlighted several areas for methodological and theoretical development in this body of work. Future work should more comprehensively assess structural racism in a way that informs policy and interventions, which can ameliorate its negative consequences on racial/ethnic disparities in maternal morbidity/mortality.
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Affiliation(s)
- Elleni M Hailu
- Division of Epidemiology, School of Public Health, University of California, 2121 Berkeley Way, Berkeley, CA, 94720, USA.
| | - Sai Ramya Maddali
- Interdisciplinary Division, School of Public Health, University of California, 2121 Berkeley Way, Berkeley, CA, 94720, USA
| | - Jonathan M Snowden
- School of Public Health, Oregon Health & Science University-Portland State University, 1805 SW 4th Ave #623T, Portland, OR, 97201, USA
| | - Suzan L Carmichael
- Division of Neonatal & Developmental Medicine, Department of Pediatrics, Division of Maternal-Fetal Medicine and Obstetrics, Department of Obstetrics and Gynecology, Stanford University School of Medicine, 3145 Porter Drive #A103, Palo Alto, CA, 94304, USA
| | - Mahasin S Mujahid
- Division of Epidemiology, School of Public Health, University of California, 2121 Berkeley Way, Berkeley, CA, 94720, USA
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17
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Parker JE, Enders CK, Mujahid MS, Laraia BA, Epel ES, Tomiyama AJ. Prospective relationships between skin color satisfaction, body satisfaction, and binge eating in Black girls. Body Image 2022; 41:342-353. [PMID: 35551032 DOI: 10.1016/j.bodyim.2022.04.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 08/27/2021] [Revised: 04/04/2022] [Accepted: 04/04/2022] [Indexed: 11/25/2022]
Abstract
Although it has been demonstrated that (a) body dissatisfaction and internalization of societal appearance standards contribute to disordered eating and (b) that internalization of societal appearance standards leads to decreased skin color satisfaction among Black women, it has not been established whether skin color dissatisfaction contributes to disordered eating among Black women or girls. The objective of the present study is to determine the influence of skin color satisfaction as a potential predictor for binge eating, and its effect through body image in Black girls during the vulnerable developmental period of adolescence. Using data from ten annual measurements in 1213 Black girls across ages 10-19, we sought to determine whether skin color satisfaction predicts Binge Eating Disorder (BED) risk and symptoms using pre-registered logistic and multilevel models. We found that lower skin color satisfaction at ages 13 and 14 significantly predicted greater odds of BED and lower skin color satisfaction at all ages predicted greater BED symptoms. Body satisfaction mediated the relationship between skin color satisfaction and BED symptoms. Our results suggest that skin color dissatisfaction is a novel component of body image for Black girls that is also related to binge eating.
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Affiliation(s)
- Jordan E Parker
- University of California Los Angeles, Department of Psychology, 502 Portola Plaza, Los Angeles, CA 90095, United States
| | - Craig K Enders
- University of California Los Angeles, Department of Psychology, 502 Portola Plaza, Los Angeles, CA 90095, United States
| | - Mahasin S Mujahid
- University of California Berkeley, School of Public Health, Division of Epidemiology, Haviland Hall, Berkeley, CA 94720-7358, United States
| | - Barbara A Laraia
- University of California, Berkeley School of Public Health, Division of Public Health Nutrition, 207B University Hall, Berkeley, CA 94720, United States
| | - Elissa S Epel
- Department of Psychiatry and Behavioral Sciences, UCSF Weill Institute for Neurosciences, & Center for Health and Community, University of California, 3333 California St, Ste 465, San Francisco, CA 94122, United States
| | - A Janet Tomiyama
- University of California Los Angeles, Department of Psychology, 502 Portola Plaza, Los Angeles, CA 90095, United States.
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Leonard SA, Main EK, Lyell DJ, Carmichael SL, Kennedy CJ, Johnson C, Mujahid MS. Obstetric comorbidity scores and disparities in severe maternal morbidity across marginalized groups. Am J Obstet Gynecol MFM 2022; 4:100530. [PMID: 34798329 PMCID: PMC10980357 DOI: 10.1016/j.ajogmf.2021.100530] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/30/2021] [Accepted: 11/10/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND A recently developed obstetrical comorbidity scoring system enables the comparison of severe maternal morbidity rates independent of health status at the time of birth hospitalization. However, the scoring system has not been evaluated in racial-ethnic and socioeconomic groups or used to assess disparities in severe maternal morbidity. OBJECTIVE This study aimed to evaluate the performance of an obstetrical comorbidity scoring system when applied across racial-ethnic and socioeconomic groups and to determine the effect of comorbidity score risk adjustment on disparities in severe maternal morbidity. STUDY DESIGN We analyzed a population-based cohort of live births that occurred in California during 2011 through 2017 with linked birth certificates and birth hospitalization discharge data (n=3,308,554). We updated a previously developed comorbidity scoring system to include the International Classification of Diseases, Ninth and Tenth Revisions, Clinical Modifications diagnosis codes and applied the scoring system to subpopulations (groups) defined by race-ethnicity, nativity, payment method, and educational attainment. We then calculated the risk-adjusted rates of severe maternal morbidity (including and excluding blood transfusion-only cases) for each group and estimated the disparities for these outcomes before and after adjustment for the comorbidity score using logistic regression. RESULTS The obstetric comorbidity scores performed consistently across groups (C-statistics ranged from 0.68 to 0.76; calibration curves demonstrated overall excellent prediction of absolute risk). All non-White groups had significantly elevated rates of severe maternal morbidity before and after risk adjustment for comorbidities when compared with the White group (1.3% before, 1.3% after) (American Indian-Alaska Native: 2.1% before, 1.8% after; Asian: 1.5% before, 1.7% after; Black: 2.5% before, 2.0% after; Latinx: 1.6% before, 1.7% after; Pacific Islander: 2.2% before, 1.9% after; and multi-race groups: 1.7% before, 1.6% after). Risk adjustment also modestly increased disparities for the foreign-born group and government insurance groups. Higher educational attainment was associated with decreased severe maternal morbidity rates, which was largely unaffected by comorbidity risk adjustment. The pattern of results was the same whether or not transfusion-only cases were included as severe maternal morbidity. CONCLUSION These results support the use of an updated comorbidity scoring system to assess disparities in severe maternal morbidity. Disparities in severe maternal morbidity decreased in magnitude for some racial-ethnic and socioeconomic groups and increased in magnitude for other groups after adjustment for the comorbidity score.
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Affiliation(s)
- Stephanie A Leonard
- Department of Obstetrics and Gynecology, Stanford University, Stanford, CA; California Maternal Quality Care Collaborative, Stanford University, Stanford, CA.
| | - Elliott K Main
- Department of Obstetrics and Gynecology, Stanford University, Stanford, CA; California Maternal Quality Care Collaborative, Stanford University, Stanford, CA
| | - Deirdre J Lyell
- Department of Obstetrics and Gynecology, Stanford University, Stanford, CA; California Maternal Quality Care Collaborative, Stanford University, Stanford, CA
| | - Suzan L Carmichael
- Department of Obstetrics and Gynecology, Stanford University, Stanford, CA; Department of Pediatrics, Stanford University, Stanford, CA
| | - Chris J Kennedy
- Department of Biomedical Informatics, Harvard University, Boston, MA
| | - Christina Johnson
- Department of Obstetrics and Gynecology, Stanford University, Stanford, CA
| | - Mahasin S Mujahid
- Division of Epidemiology and Biostatistics, University of California, Berkeley, CA
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Abstract
BACKGROUND In recent years, there has been growing interest in "moving beyond the individual" to measure area-level racism as a social determinant of health. Much of this work has aggregated racial prejudice data collected at the individual-level to the area-level. OBJECTIVE As this is a rapidly emerging area of research, we conducted a systematic literature review to describe evidence of the relationship between area-level racial prejudice and health, whether results differed by race/ethnicity, and to characterize key conceptual and methodological considerations to guide future research. METHOD We searched four interdisciplinary databases for US-based, peer-reviewed articles measuring area level racial prejudice by aggregating individual-level indicators of racial prejudice and examining associations with mental or physical health outcome(s). Data extraction followed PRISMA guidelines and also included theory and conceptualization, pathways to health, and strengths and limitations. RESULTS Fourteen of 14,632 identified articles met inclusion criteria and were included in the review. Health outcomes spanned all-cause (n = 4) and cause-specific (n = 4) mortality, birth outcomes (n = 4), cardiovascular outcomes (n = 2), mental health (n = 1), and self-rated health (n = 1). All studies found a positive association between area-level racial prejudice and adverse health outcomes among racial/ethnic minoritized groups, with four studies also showing a similar association among Whites. Engagement with formal theory was limited and exposure conceptualization was mixed. Methodological considerations included unmeasured confounding and trade-offs between generalizability, self-censorship, and specificity of measurement. CONCLUSIONS Future research should continue to develop the conceptual and methodological rigor of this work and test hypotheses to inform evidence-based interventions to advance population health and reduce racial health inequities. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Eli K. Michaels
- Division of Epidemiology, School of Public Health, University of California, Berkeley
| | - Christine Board
- Division of Epidemiology, School of Public Health, University of California, Berkeley
| | - Mahasin S. Mujahid
- Division of Epidemiology, School of Public Health, University of California, Berkeley
| | - Corinne A. Riddell
- Division of Epidemiology, School of Public Health, University of California, Berkeley
- Division of Biostatistics, School of Public Health, University of California, Berkeley
| | - David H. Chae
- Department of Global Community Health & Behavioral Sciences, Tulane School of Public Health and Tropical Medicine
| | | | - Amani M. Allen
- Division of Epidemiology, School of Public Health, University of California, Berkeley
- Division of Community Health Sciences, School of Public Health, University of California, Berkeley
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Singh A, Ding EY, Mehawej J, Joshi S, Soni A, Mujahid MS. Technology, Community, and Equity: Considerations for Collecting Social Determinants Data. Cardiovascular Digital Health Journal 2022; 3:107-109. [PMID: 35493271 PMCID: PMC9043379 DOI: 10.1016/j.cvdhj.2022.01.003] [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] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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Gao X, Kershaw KN, Barber S, Schreiner PJ, Do DP, Diez Roux AV, Mujahid MS. Associations Between Residential Segregation and Incident Hypertension: The Multi-Ethnic Study of Atherosclerosis. J Am Heart Assoc 2022; 11:e023084. [PMID: 35048712 PMCID: PMC9238487 DOI: 10.1161/jaha.121.023084] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background Residential segregation, a geospatial manifestation of structural racism, is a fundamental driver of racial and ethnic health inequities, and longitudinal studies examining segregation's influence on cardiovascular health are limited. This study investigates the impact of segregation on hypertension in a multiracial and multiethnic cohort and explores whether neighborhood environment modifies this association. Methods and Results Leveraging data from a diverse cohort of adults recruited from 6 sites in the United States with 2 decades of follow-up, we used race- and ethnicity-stratified Cox models to examine the association between time-varying segregation with incident hypertension in 1937 adults free of hypertension at baseline. Participants were categorized as residing in segregated and nonsegregated neighborhoods using a spatial-weighted measure. We used a robust covariance matrix estimator to account for clustering within neighborhoods and assessed effect measure modification by neighborhood social or physical environment. Over an average follow-up of 7.35 years, 65.5% non-Hispanic Black, 48.1% Chinese, and 53.7% Hispanic participants developed hypertension. Net of confounders, Black and Hispanic residents in segregated neighborhoods were more likely to develop hypertension relative to residents in nonsegregated neighborhoods (Black residents: hazard ratio [HR], 1.33; 95% CI, 1.09-1.62; Hispanic residents: HR, 1.33; 95% CI, 1.04-1.70). Results were similar but not significant among Chinese residents (HR, 1.20; 95% CI, 0.83-1.73). Among Black residents, neighborhood social environment significantly modified this association such that better social environment was associated with less pronounced impact of segregation on hypertension. Conclusions This study underscores the importance of continued investigations of groups affected by the health consequences of racial residential segregation while taking contextual neighborhood factors, such as social environment, into account.
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Affiliation(s)
- Xing Gao
- Division of Epidemiology School of Public Health University of California Berkeley CA
| | - Kiarri N Kershaw
- Department of Preventive Medicine Feinberg School of Medicine Northwestern University Chicago IL
| | - Sharrelle Barber
- Department of Epidemiology & Biostatistics Dornsife School of Public Health Drexel University Philadelphia PA
| | - Pamela J Schreiner
- Division of Epidemiology & Community Health School of Public Health University of Minnesota Minneapolis MN
| | - D Phuong Do
- Public Health Policy and Administration Zilber School of Public Health University of Wisconsin-Milwaukee Milwaukee WI
| | - Ana V Diez Roux
- Department of Epidemiology & Biostatistics Dornsife School of Public Health Drexel University Philadelphia PA
| | - Mahasin S Mujahid
- Division of Epidemiology School of Public Health University of California Berkeley CA
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22
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Gao X, Engeda J, Moore LV, Auchincloss AH, Moore K, Mujahid MS. Longitudinal associations between objective and perceived healthy food environment and diet: The Multi-Ethnic Study of Atherosclerosis. Soc Sci Med 2022; 292:114542. [PMID: 34802783 PMCID: PMC8748383 DOI: 10.1016/j.socscimed.2021.114542] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 06/18/2021] [Accepted: 11/04/2021] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Research examining the influence of neighborhood healthy food environment on diet has been mostly cross-sectional and has lacked robust characterization of the food environment. We examined longitudinal associations between features of the local food environment and healthy diet, and whether associations were modified by race/ethnicity. METHODS Data on 3634 adults aged 45-84 followed for 10 years were obtained from the Multi-Ethnic Study of Atherosclerosis. Diet quality was assessed using the Alternative Healthy Eating Index at Exam 1 (2000-2002) and Exam 5 (2010-2012). We assessed four measures of the local food environment using survey-based measures (e.g. perceptions of healthier food availability) and geographic information system (GIS)-based measures (e.g. distance to and density of healthier food stores) at Exam 1 and Exam 5. Random effects models adjusted for age, sex, education, moving status, per capita adjusted income, and neighborhood socioeconomic status, and used interaction terms to assess effect measure modification by race/ethnicity. RESULTS Net of confounders, one standard z-score higher average composite local food environment was associated with higher average AHEI diet score (β=1.39, 95% CI: 1.05, 1.73) over the follow-up period from Exam 1 to 5. This pattern of association was consistent across both GIS-based and survey-based measures of local food environment and was more pronounced among minoritized racial/ethnic groups. There was no association between changes in neighborhood environment and change in AHEI score, or effect measure modification by race/ethnicity. CONCLUSION Our findings suggest that neighborhood-level food environment is associated with better diet quality, especially among racially/ethnically minoritized populations.
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Affiliation(s)
- Xing Gao
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA, USA.
| | - Joseph Engeda
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA, USA; Social & Scientific Systems, Durham, NC, USA
| | - Latetia V Moore
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Amy H Auchincloss
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA; Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Kari Moore
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Mahasin S Mujahid
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA, USA.
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23
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Islam SJ, Kim JH, Baltrus P, Topel ML, Liu C, Ko YA, Mujahid MS, Vaccarino V, Sims M, Mubasher M, Khan A, Ejaz K, Searles C, Dunbar S, Pemu P, Taylor HA, Quyyumi AA, Lewis TT. Neighborhood characteristics and ideal cardiovascular health among Black adults: results from the Morehouse-Emory Cardiovascular (MECA) Center for Health Equity. Ann Epidemiol 2022; 65:120.e1-120.e10. [PMID: 33285258 PMCID: PMC8178422 DOI: 10.1016/j.annepidem.2020.11.009] [Citation(s) in RCA: 12] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 11/25/2020] [Accepted: 11/30/2020] [Indexed: 01/03/2023]
Abstract
PURPOSE Neighborhood environment is increasingly recognized as an important determinant of cardiovascular health (CVH) among Black adults. Most research to date has focused on negative aspects of the neighborhood environment, with little attention being paid to the specific positive features, in particular the social environment, that promote cardiovascular resilience among Black adults.We examined whether better neighborhood physical and social characteristics are associated with ideal CVH among Black adults, as measured by Life's Simple 7 (LS7) scores. METHODS We recruited 392 Black adults (age 53 ± 10 years, 39% men) without known CV disease living in Atlanta, GA. Seven neighborhood domains were assessed via questionnaire: asthetic quality, walking environment, safety, food access, social cohesion, activity with neighbors, and violence. CVH was determined by LS7 scores calculated from measured blood pressure; glucose; cholesterol; body mass index (BMI); and self-reported exercise, diet, and smoking, and categorized into poor (0-8), intermediate (9-10), and ideal (11-14). Multinomial logistic regression was used to examine the association between neighborhood characteristics and the odds of intermediate/ideal CVH categories compared with poor CVH after adjustment for age, gender, household income, education, marital status, and employment status. RESULTS Better scores in the neighborhood domains of social cohesion and activity with neighbors were significantly associated with higher adjusted odds of ideal LS7 scores (OR 2.02, 95% CI [1.36-3.01] and 1.71 [1.20-2.45] per 1 standard deviation [SD] increase in respective scores). These associations were stronger for both social cohesion (OR 2.61, 95% CI [1.48-4.61] vs. 1.40 [0.82-2.40]) and activity with neighbors (OR 1.82, 95% CI [1.15-2.86] vs. 1.53 [0.84-2.78]) in Black women than men. Specifically, better scores in social cohesion were associated with higher odds of ideal CVH in exercise (OR 1.73 [1.16-2.59]), diet (OR 1.90 [1.11-3.26]), and BMI (OR 1.52 [1.09-2.09]); better scores in activity with neighbors were also similarly associated with higher odds of ideal CVH in exercise (OR 1.48 [1.00-2.19]), diet (OR 2.15 [1.23-3.77]), and BMI (OR 1.45 [1.07-1.98]; per 1 SD in respective scores). CONCLUSIONS More desirable neighborhood characteristics, particularly social cohesion and activity with neighbors, were associated with better CVH among Black adults.
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Affiliation(s)
- Shabatun J. Islam
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Jeong Hwan Kim
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Peter Baltrus
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA,National Center for Primary Care, Morehouse School of Medicine, Atlanta, GA
| | - Matthew L. Topel
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Chang Liu
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Yi-An Ko
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Mahasin S. Mujahid
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA
| | - Viola Vaccarino
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Mario Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Mohamed Mubasher
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA
| | - Ahsan Khan
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Kiran Ejaz
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Charles Searles
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Sandra Dunbar
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA
| | - Priscilla Pemu
- Department of Medicine, Morehouse School of Medicine, Atlanta, GA
| | - Herman A. Taylor
- Department of Medicine, Morehouse School of Medicine, Atlanta, GA
| | - Arshed A. Quyyumi
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Tené T. Lewis
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
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24
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Thompson IJB, Ritchie LD, Bradshaw PT, Mujahid MS, Au LE. Earlier Introduction to Sugar-Sweetened Beverages Associated With Lower Diet Quality Among WIC Children at Age 3 Years. J Nutr Educ Behav 2021; 53:912-920. [PMID: 34229969 DOI: 10.1016/j.jneb.2021.04.468] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 04/26/2021] [Accepted: 04/29/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Examine the association between the timing of sugar-sweetened beverages (SSBs) and 100% juice introduction with subsequent diet quality at age 3 years. DESIGN Secondary analysis of a publicly available, national longitudinal dataset. PARTICIPANTS A total of 2,218 children from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). MAIN OUTCOME MEASURE Dietary intakes were assessed using a 24-hour dietary recall completed by caregivers of children aged 3 years. Diet quality was assessed using the Healthy Eating Index Score-2015 (HEI-2015). ANALYSIS Linear regression was used to assess the relationship between the timing of introduction to 100% juice and SSBs with HEI-2015. Adjustments were made for child- and maternal-related factors. RESULTS Delayed introduction of SSBs during the first 2 years of life was associated with an increased HEI-2015 score. In adjusted analyses, for every 1-month delay in the introduction, there was a 0.09-point increase (95% confidence interval, 0.04-0.13) in the HEI-2015 score at 3 years. CONCLUSIONS AND IMPLICATIONS Earlier introduction to SSBs may be associated with subsequent lower diet quality in WIC participants. This association may be driven by total fruit, whole grains, and added sugars HEI component scores. Further research is needed to support changes to existing WIC nutrition practices regarding SSBs and 100% juice.
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Affiliation(s)
- Isabel J B Thompson
- Division of Epidemiology and Biostatistics, School of Public Health, University of California Berkeley, Berkeley, CA
| | - Lorrene D Ritchie
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Oakland, CA
| | - Patrick T Bradshaw
- Division of Epidemiology and Biostatistics, School of Public Health, University of California Berkeley, Berkeley, CA
| | - Mahasin S Mujahid
- Division of Epidemiology and Biostatistics, School of Public Health, University of California Berkeley, Berkeley, CA
| | - Lauren E Au
- Department of Nutrition, University of California Davis, Davis, CA.
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25
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Mehta LS, Sharma G, Creanga AA, Hameed AB, Hollier LM, Johnson JC, Leffert L, McCullough LD, Mujahid MS, Watson K, White CJ. Call to Action: Maternal Health and Saving Mothers: A Policy Statement From the American Heart Association. Circulation 2021; 144:e251-e269. [PMID: 34493059 DOI: 10.1161/cir.0000000000001000] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The United States has the highest maternal mortality rates among developed countries, and cardiovascular disease is the leading cause. Therefore, the American Heart Association has a unique role in advocating for efforts to improve maternal health and to enhance access to and delivery of care before, during, and after pregnancy. Several initiatives have shaped the time course of major milestones in advancing maternal and reproductive health equity in the United States. There have been significant strides in improving the timeliness of data reporting in maternal mortality surveillance and epidemiological programs in maternal and child health, yet more policy reforms are necessary. To make a sustainable and systemic impact on maternal health, further efforts are necessary at the societal, institutional, stakeholder, and regulatory levels to address the racial and ethnic disparities in maternal health, to effectively reduce inequities in care, and to mitigate maternal morbidity and mortality. In alignment with American Heart Association's mission "to be a relentless force for longer, healthier lives," this policy statement outlines the inequities that influence disparities in maternal outcomes and current policy approaches to improving maternal health and suggests additional potentially impactful actions to improve maternal outcomes and ultimately save mothers' lives.
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26
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Islam SJ, Beydoun N, Mehta A, Kim JH, Ko YA, Jin Q, Baltrus P, Topel ML, Liu C, Mujahid MS, Vaccarino V, Sims M, Ejaz K, Searles C, Dunbar SB, Lewis TT, Taylor HA, Pemu P, Quyyumi AA. Association of physical activity with arterial stiffness among Black adults. Vasc Med 2021; 27:13-20. [PMID: 34549642 DOI: 10.1177/1358863x211032725] [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] [Indexed: 11/15/2022]
Abstract
Arterial stiffness is a precursor for the development of hypertension and premature cardiovascular disease (CVD). Physical activity has been associated with lower arterial stiffness among largely White populations, but the types of activity required and whether these findings apply to Black adults remain unknown. We examined whether physical activity levels were associated with arterial stiffness among Black adults in two independent cohorts. In the Morehouse-Emory Cardiovascular (MECA) Center for Health Equity, 378 Black adults (age 52.8 ± 10.3, 39.7% male) without known CVD living in Atlanta, GA were recruited. Arterial stiffness was measured as pulse wave velocity (PWV). Total and domain-specific physical activity were assessed by self-report. Multiple linear regression models were used to investigate differences across physical activity levels after adjusting for age, sex, CVD risk factors, and socioeconomic status. Findings were validated in an independent cohort of Black adults (n = 55, age 50.4 ± 9.2, 23.6% male). After adjustment for covariates, lower arterial stiffness was associated with higher self-reported levels of sport/exercise (6.92 ± 1.13 vs 7.75 ± 1.14, p < 0.001, highest vs lowest quartile) and home/life activities (7.34 ± 1.24 vs 7.73 ± 1.07, p = 0.04, highest vs lowest quartile), but not work, active living, or the overall physical activity scores. These findings were replicated in the independent cohort where higher levels of sport/exercise remained associated with lower arterial stiffness (6.66 ± 0.57 vs 8.21 ± 0.66, p < 0.001, highest vs lowest quartile). Higher levels of sport/exercise and home/life-related physical activities (in comparison to occupational physical activity) are associated with lower arterial stiffness in Black adults.
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Affiliation(s)
- Shabatun J Islam
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Nour Beydoun
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Anurag Mehta
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Jeong Hwan Kim
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Yi-An Ko
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Qingchun Jin
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Peter Baltrus
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA, USA.,National Center for Primary Care, Morehouse School of Medicine, Atlanta, GA, USA
| | - Matthew L Topel
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Chang Liu
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Mahasin S Mujahid
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Viola Vaccarino
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Mario Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Kiran Ejaz
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Charles Searles
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Sandra B Dunbar
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Tené T Lewis
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Herman A Taylor
- Department of Medicine, Morehouse School of Medicine, Atlanta, GA, USA
| | - Priscilla Pemu
- Department of Medicine, Morehouse School of Medicine, Atlanta, GA, USA
| | - Arshed A Quyyumi
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
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27
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Islam SJ, Hwan Kim J, Joseph E, Topel M, Baltrus P, Liu C, Ko YA, Almuwaqqat Z, Mujahid MS, Sims M, Mubasher M, Ejaz K, Searles C, Dunbar SB, Pemu P, Taylor H, Bremner JD, Vaccarino V, Quyyumi AA, Lewis TT. Association Between Early Trauma and Ideal Cardiovascular Health Among Black Americans: Results From the Morehouse-Emory Cardiovascular (MECA) Center for Health Equity. Circ Cardiovasc Qual Outcomes 2021; 14:e007904. [PMID: 34380328 PMCID: PMC8455434 DOI: 10.1161/circoutcomes.121.007904] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Early trauma (general, emotional, physical, and sexual abuse before age 18 years) has been associated with both cardiovascular disease risk and lifestyle-related risk factors for cardiovascular disease, including smoking, obesity, and physical inactivity. Despite higher prevalence, the association between early trauma and cardiovascular health (CVH) has been understudied in Black Americans, especially those from low-income backgrounds, who may be doubly vulnerable. Therefore, we investigated the association between early trauma and CVH, particularly among low-income Black Americans. METHODS We recruited 457 Black adults (age 53±10, 38% male) without known cardiovascular disease from the Atlanta, GA, metropolitan area using personalized, community-based recruitment methods. The Early Trauma Inventory was administered to assess overall early traumatic life experiences which include physical, sexual, emotional abuse, and general trauma. Our primary outcome was the American Heart Association Life's Simple 7, which is a set of 7 CVH metrics, including 4 lifestyle-related factors (smoking, body mass index, physical activity, and diet) and three physiologically measured health factors (blood pressure, total blood cholesterol, and blood glucose). We used linear regression models adjusting for age, sex, socioeconomic status, and depression to test the association between early trauma and CVH and tested the early trauma by household income (<$50 000) interaction. RESULTS Higher levels of early trauma were associated with lower Life's Simple 7 scores (β, -0.05 [95% CI, -0.09 to -0.01], P=0.02, per 1 unit increase in the Early Trauma Inventory score) among lower, but not higher, income Black participants (P value for interaction=0.04). Subtypes of early trauma linked to Life's Simple 7 were general trauma, emotional abuse, and sexual abuse. Exploratory analyses demonstrated that early trauma was only associated with the body mass index and smoking components of Life's Simple 7. CONCLUSIONS Early trauma, including general trauma, emotional abuse, and sexual abuse, may be associated with worse CVH among low-, but not higher-income Black adults.
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Affiliation(s)
- Shabatun J Islam
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA. (S.J.I., J.H.K., E.J., M.T., C.L., Z.A., K.E., C.S., V.V., A.A.Q.)
| | - Jeong Hwan Kim
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA. (S.J.I., J.H.K., E.J., M.T., C.L., Z.A., K.E., C.S., V.V., A.A.Q.)
| | - Emma Joseph
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA. (S.J.I., J.H.K., E.J., M.T., C.L., Z.A., K.E., C.S., V.V., A.A.Q.)
| | - Matthew Topel
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA. (S.J.I., J.H.K., E.J., M.T., C.L., Z.A., K.E., C.S., V.V., A.A.Q.)
| | - Peter Baltrus
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA. (P.B., M.M.).,National Center for Primary Care, Morehouse School of Medicine, Atlanta, GA. (P.B.)
| | - Chang Liu
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA. (S.J.I., J.H.K., E.J., M.T., C.L., Z.A., K.E., C.S., V.V., A.A.Q.).,Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA. (C.L., Y.-A.K.)
| | - Yi-An Ko
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA. (C.L., Y.-A.K.)
| | - Zakaria Almuwaqqat
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA. (S.J.I., J.H.K., E.J., M.T., C.L., Z.A., K.E., C.S., V.V., A.A.Q.)
| | - Mahasin S Mujahid
- Division of Epidemiology, School of Public Health, University of California, Berkeley (M.S.M.)
| | - Mario Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson (M.S.)
| | - Mohamed Mubasher
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA. (P.B., M.M.)
| | - Kiran Ejaz
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA. (S.J.I., J.H.K., E.J., M.T., C.L., Z.A., K.E., C.S., V.V., A.A.Q.)
| | - Charles Searles
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA. (S.J.I., J.H.K., E.J., M.T., C.L., Z.A., K.E., C.S., V.V., A.A.Q.)
| | - Sandra B Dunbar
- Rollins School of Public Health, and Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA. (S.B.D.)
| | - Priscilla Pemu
- Department of Medicine, Morehouse School of Medicine, Atlanta, GA. (P.P., H.T.)
| | - Herman Taylor
- Department of Medicine, Morehouse School of Medicine, Atlanta, GA. (P.P., H.T.)
| | - J Douglas Bremner
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA. (J.D.B.).,Department of Radiology, Emory University School of Medicine, Atlanta, GA.(J.D.B.)
| | - Viola Vaccarino
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA. (S.J.I., J.H.K., E.J., M.T., C.L., Z.A., K.E., C.S., V.V., A.A.Q.).,Department of Epidemiology, Emory University, Atlanta, GA. (V.V., T.T.L.)
| | - Arshed A Quyyumi
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA. (S.J.I., J.H.K., E.J., M.T., C.L., Z.A., K.E., C.S., V.V., A.A.Q.)
| | - Tené T Lewis
- Department of Epidemiology, Emory University, Atlanta, GA. (V.V., T.T.L.)
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Hailu EM, Lewis TT, Needham BL, Lin J, Seeman TE, Mujahid MS. Longitudinal Associations between Discrimination, Neighborhood Social Cohesion, and Telomere Length: The Multi-Ethnic Study of Atherosclerosis (MESA). J Gerontol A Biol Sci Med Sci 2021; 77:glab193. [PMID: 34282826 PMCID: PMC8824602 DOI: 10.1093/gerona/glab193] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND We aimed to examine if neighborhood social cohesion moderated longitudinal associations between baseline reports of discrimination and 10-year changes in Leukocyte Telomere Length (LTL). METHODS Data are from the Multi-Ethnic Study of Atherosclerosis (MESA; N=1,064; age range 45-84 years). Baseline discrimination was measured using the Major Experiences of Discrimination Scale (MDS; none, 1 domain, ≥2 domains) and the Experiences of Discrimination Scale (EDS; none, moderate, high). Neighborhood social cohesion at baseline was assessed via a community survey within census tract defined neighborhoods. 10-year change in LTL was defined as Regression to the Mean corrected 10-year difference in the ratio of telomeric DNA to a single copy gene (T/S). RESULTS In linear mixed effects models, we found that neighborhood social cohesion modified the effect of baseline reports of MDS on 10-year changes in LTL, independent of sociodemographic characteristics, health behaviors, and health conditions (p(χ 2)=0.01). Among those residing in neighborhoods with low social cohesion, experiencing major discrimination in ≥2 domains was associated with faster LTL attrition over 10-years, compared to reporting no discrimination (β=-0.03; 95% CI: -0.06, -0.003). We found no main associations for either discrimination measure and no interaction between EDS and neighborhood social cohesion. CONCLUSIONS Results indicate that neighborhood social cohesion is an important dimension of the neighborhood context that may moderate the impact of major experiences of discrimination on telomere length attrition. These findings help advance our understanding of the integral role that neighborhood environments play in attenuating the effect of discrimination on accelerated cell aging.
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Affiliation(s)
- Elleni M Hailu
- Division of Epidemiology, School of Public Health, University of California Berkeley, USA
| | - Tené T Lewis
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Belinda L Needham
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, USA
| | - Jue Lin
- Department of Biochemistry and Biophysics, University of California San Francisco, USA
| | - Teresa E Seeman
- Department of Geriatrics, David Geffen School of Medicine, University of California Los Angeles, USA
| | - Mahasin S Mujahid
- Division of Epidemiology, School of Public Health, University of California Berkeley, USA
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Islam S, Kim JH, Li X, Ko YA, Baltrus P, Mitchell GF, Fox ER, Mujahid MS, Vaccarino V, Lewis TT, Taylor HA, Sims M, Quyyumi AA. Abstract 003: Neighborhood Characteristics And Arterial Stiffness Among Black Adults - Results From The Jackson Heart Study & Morehouse Emory Center For Health Equity. Circulation 2021. [DOI: 10.1161/circ.143.suppl_1.003] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Poor quality neighborhoods are independent risk factors for cardiovascular disease (CVD) but are understudied in Blacks, who face large CVD health disparities. Arterial stiffness (AS) precedes development of hypertension and adverse CVD events but the effect of neighborhood on AS among Blacks remain unknown.
Objective:
We compared the association between neighborhood environment and AS among Blacks in Jackson, MS and Atlanta, GA.
Methods:
We studied 1592 Blacks (age 58 ± 10, 38% male) living in Jackson, MS from the Jackson Heart Study (JHS) and 451 Blacks (age 53 ± 10, 39% male) living in Atlanta, GA from the Morehouse/Emory Center for Health Equity (MECA) study, without known CVD. Neighborhood problems (includes measures of aesthetic quality, walking environment, food access), social cohesion (includes activity with neighbors), and violence/safety were assessed using validated questionnaires. AS was measured as pulse wave velocity (PWV) using MRI in JHS and as PWV and augmentation index (AIx) using applanation tonometry (Sphygmocor Inc) in MECA. Multivariable linear regression models were used to examine the association between neighborhood characteristics and AS, adjusting for potential confounders.
Results:
Improved social characteristics, measured as social cohesion in JHS (β = -0.32 [-0.63, - 0.02], p=0.04) and activity with neighbors (β = -0.23 [-0.40, - 0.05] p=0.01) in MECA, were associated with lower PWV in both cohorts and lower AIx (β = -1.74 [-2.92, - 0.56], p=0.004) in MECA, after adjustment for CVD risk factors and income. Additionally, in MECA better food access (β = -1.18 [-2.35, - 0.01], p=0.05) was associated with lower AIx, and in JHS, lower neighborhood problems (β = -0.33 [-0.64, - 0.02], p=0.04) and lower violence (β = -0.30 [-0.61, 0.002], p=0.05) were associated with lower PWV (Fig).
Conclusion:
Neighborhood social characteristics show an independent association with vascular health of Blacks, findings that were reproducible in two distinct American cities.
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Affiliation(s)
| | | | | | | | | | | | - Ervin R Fox
- UNIVERSITY MISSISSIPPI MEDICAL CTR, Jackson, MS
| | | | | | | | | | - Mario Sims
- UNIV MISSISSIPPI MEDICAL CTR, Jackson, MS
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Goff DC, Khan SS, Lloyd-Jones D, Arnett DK, Carnethon MR, Labarthe DR, Loop MS, Luepker RV, McConnell MV, Mensah GA, Mujahid MS, O'Flaherty ME, Prabhakaran D, Roger V, Rosamond WD, Sidney S, Wei GS, Wright JS. Bending the Curve in Cardiovascular Disease Mortality: Bethesda + 40 and Beyond. Circulation 2021; 143:837-851. [PMID: 33617315 PMCID: PMC7905830 DOI: 10.1161/circulationaha.120.046501] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
More than 40 years after the 1978 Bethesda Conference on the Declining Mortality from Coronary Heart Disease provided the scientific community with a blueprint for systematic analysis to understand declining rates of coronary heart disease, there are indications the decline has ended or even reversed despite advances in our knowledge about the condition and treatment. Recent data show a more complex situation, with mortality rates for overall cardiovascular disease, including coronary heart disease and stroke, decelerating, whereas those for heart failure are increasing. To mark the 40th anniversary of the Bethesda Conference, the National Heart, Lung, and Blood Institute and the American Heart Association cosponsored the "Bending the Curve in Cardiovascular Disease Mortality: Bethesda + 40" symposium. The objective was to examine the immediate and long-term outcomes of the 1978 conference and understand the current environment. Symposium themes included trends and future projections in cardiovascular disease (in the United States and internationally), the evolving obesity and diabetes epidemics, and harnessing emerging and innovative opportunities to preserve and promote cardiovascular health and prevent cardiovascular disease. In addition, participant-led discussion explored the challenges and barriers in promoting cardiovascular health across the lifespan and established a potential framework for observational research and interventions that would begin in early childhood (or ideally in utero). This report summarizes the relevant research, policy, and practice opportunities discussed at the symposium.
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Affiliation(s)
- David Calvin Goff
- Division of Cardiovascular Sciences (D.C.G., G.S.W.), National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Sadiya Sana Khan
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.S.K., D.L-J., M.R.C., D.R.L.)
| | - Donald Lloyd-Jones
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.S.K., D.L-J., M.R.C., D.R.L.)
| | - Donna K Arnett
- College of Public Health, University of Kentucky, Lexington (D.K.A.)
| | - Mercedes R Carnethon
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.S.K., D.L-J., M.R.C., D.R.L.)
| | - Darwin R Labarthe
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.S.K., D.L-J., M.R.C., D.R.L.)
| | - Matthew Shane Loop
- Department of Biostatistics (M.S.L.), Gillings School of Global Public Health, University of North Carolina Chapel Hill
| | - Russell V Luepker
- School of Public Health, University of Minnesota, Minneapolis (R.V.L.)
| | - Michael V McConnell
- Department of Medicine, Cardiovascular Medicine, School of Medicine, Stanford University, CA (M.V.M.)
- Google Health, Palo Alto, CA (M.V.M.)
| | - George A Mensah
- Center for Translation Research and Implementation Science (G.A.M.), National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Mahasin S Mujahid
- Department of Epidemiology, School of Public Health, University of California, Berkeley (M.S.M.)
| | | | - Dorairaj Prabhakaran
- Public Health Foundation of India, Gurgaon (D.P.)
- Centre for Chronic Disease Control, New Delhi, India (D.P.)
- London School of Hygiene and Tropical Medicine, United Kingdom (D.P.)
| | - Véronique Roger
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (V.R.)
| | - Wayne D Rosamond
- Department of Epidemiology (W.D.R.), Gillings School of Global Public Health, University of North Carolina Chapel Hill
| | - Stephen Sidney
- Division of Research, Kaiser Permanente Northern California, Oakland (S.S.)
| | - Gina S Wei
- Division of Cardiovascular Sciences (D.C.G., G.S.W.), National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Janet S Wright
- Office of the Surgeon General, US Department of Health and Human Services, Washington, DC (J.S.W.)
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Mujahid MS, Kan P, Leonard SA, Hailu EM, Wall-Wieler E, Abrams B, Main E, Profit J, Carmichael SL. Birth hospital and racial and ethnic differences in severe maternal morbidity in the state of California. Am J Obstet Gynecol 2021; 224:219.e1-219.e15. [PMID: 32798461 DOI: 10.1016/j.ajog.2020.08.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 07/10/2020] [Accepted: 08/10/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Birth hospital has recently emerged as a potential key contributor to disparities in severe maternal morbidity, but investigations on its contribution to racial and ethnic differences remain limited. OBJECTIVE We leveraged statewide data from California to examine whether birth hospital explained racial and ethnic differences in severe maternal morbidity. STUDY DESIGN This cohort study used data on all births at ≥20 weeks gestation in California (2007-2012). Severe maternal morbidity during birth hospitalization was measured using the Centers for Disease Control and Prevention index of having at least 1 of the 21 diagnoses and procedures (eg, eclampsia, blood transfusion, hysterectomy). Mixed-effects logistic regression models (ie, women nested within hospitals) were used to compare racial and ethnic differences in severe maternal morbidity before and after adjustment for maternal sociodemographic and pregnancy-related factors, comorbidities, and hospital characteristics. We also estimated the risk-standardized severe maternal morbidity rates for each hospital (N=245) and the percentage reduction in severe maternal morbidity if each group of racially and ethnically minoritized women gave birth at the same distribution of hospitals as non-Hispanic white women. RESULTS Of the 3,020,525 women who gave birth, 39,192 (1.3%) had severe maternal morbidity (2.1% Black; 1.3% US-born Hispanic; 1.3% foreign-born Hispanic; 1.3% Asian and Pacific Islander; 1.1% white; 1.6% American Indian and Alaska Native, and Mixed-race referred to as Other). Risk-standardized rates of severe maternal morbidity ranged from 0.3 to 4.0 per 100 births across hospitals. After adjusting for covariates, the odds of severe maternal morbidity were greater among nonwhite women than white women in a given hospital (Black: odds ratio, 1.25; 95% confidence interval, 1.19-1.31); US-born Hispanic: odds ratio, 1.25; 95% confidence interval, 1.20-1.29; foreign-born Hispanic: odds ratio, 1.17; 95% confidence interval, 1.11-1.24; Asian and Pacific Islander: odds ratio, 1.26; 95% confidence interval, 1.21-1.32; Other: odds ratio, 1.31; 95% confidence interval, 1.15-1.50). Among the studied hospital factors, only teaching status was associated with severe maternal morbidity in fully adjusted models. Although 33% of white women delivered in hospitals with the highest tertile of severe maternal morbidity rates compared with 53% of Black women, birth hospital only accounted for 7.8% of the differences in severe maternal morbidity comparing Black and white women and accounted for 16.1% to 24.2% of the differences for all other racial and ethnic groups. CONCLUSION In California, excess odds of severe maternal morbidity among racially and ethnically minoritized women were not fully explained by birth hospital. Structural causes of racial and ethnic disparities in severe maternal morbidity may vary by region, which warrants further examination to inform effective policies.
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Affiliation(s)
- Mahasin S Mujahid
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA.
| | - Peiyi Kan
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Stephanie A Leonard
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA
| | - Elleni M Hailu
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA
| | - Elizabeth Wall-Wieler
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Barbara Abrams
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA
| | - Elliott Main
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA
| | - Jochen Profit
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Suzan L Carmichael
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA
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32
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Brown R, Hailu EM, Needham BL, Roux AD, Seeman TE, Lin J, Mujahid MS. Neighborhood social environment and changes in leukocyte telomere length: The Multi-Ethnic Study of Atherosclerosis (MESA). Health Place 2020; 67:102488. [PMID: 33276262 DOI: 10.1016/j.healthplace.2020.102488] [Citation(s) in RCA: 2] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 11/10/2020] [Accepted: 11/16/2020] [Indexed: 12/01/2022]
Abstract
Given limited research on the impact of neighborhood environments on accelerated biological aging, we examined whether changes in neighborhood socioeconomic and social conditions were associated with change in leukocyte telomere length using 10 years of longitudinal data from the Multi-Ethnic Study of Atherosclerosis (years 2000-2011; N = 1031; mean age = 61, SD = 9.4). Leukocyte telomere length change was corrected for regression to the mean and neighborhood was defined as census tract. Neighborhood socioeconomic indicators (factor-based score of income, education, occupation, and wealth of neighborhood) and neighborhood social environment indicators (aesthetic quality, social cohesion, safety) were obtained from the U.S Census/American Community Survey and via study questionnaire, respectively. Results of linear mixed-effects models showed that independent of individual sociodemographic characteristics, each unit of improvement in neighborhood socioeconomic status was associated with slower telomere length attrition over 10-years (β = 0.002; 95% Confidence Interval (CI): 0.0001, 0.004); whereas each unit of increase in safety (β = -0.043; 95% CI: -0.069, -0.016) and overall neighborhood social environment score (β = -0.005; 95% CI: -0.009, -0.0004) were associated with more pronounced telomere attrition, after additionally adjusting for neighborhood socioeconomic status. This study provides support for considerations of the broader social and socioeconomic contexts in relation to biological aging. Future research should explore potential psychosocial mechanisms underlying these associations using longitudinal study designs with repeated observations.
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Affiliation(s)
- Rashida Brown
- Division of Epidemiology, School of Public Health, University of California Berkeley, 2121 Berkeley Way West #5302, Berkeley, CA, 94720, USA
| | - Elleni M Hailu
- Division of Epidemiology, School of Public Health, University of California Berkeley, 2121 Berkeley Way West #5302, Berkeley, CA, 94720, USA.
| | - Belinda L Needham
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - Ana Diez Roux
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, 3215 Market Street, Philadelphia, PA, 19104, USA
| | - Teresa E Seeman
- Department of Geriatrics, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA
| | - Jue Lin
- Department of Biochemistry and Biophysics, University of California San Francisco, 600 16th St, San Francisco, CA, 94158, USA
| | - Mahasin S Mujahid
- Division of Epidemiology, School of Public Health, University of California Berkeley, 2121 Berkeley Way West #5302, Berkeley, CA, 94720, USA
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Kim JH, Islam SJ, Topel ML, Ko YA, Mujahid MS, Vaccarino V, Liu C, Sims M, Mubasher M, Searles CD, Dunbar SB, Pemu P, Taylor HA, Quyyumi AA, Baltrus P, Lewis TT. Individual Psychosocial Resilience, Neighborhood Context, and Cardiovascular Health in Black Adults: A Multilevel Investigation From the Morehouse-Emory Cardiovascular Center for Health Equity Study. Circ Cardiovasc Qual Outcomes 2020; 13:e006638. [PMID: 33023334 DOI: 10.1161/circoutcomes.120.006638] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Despite well-documented cardiovascular disparities between racial groups, within-race determinants of cardiovascular health among Black adults remain understudied. Factors promoting cardiovascular resilience among Black adults in particular warrant further investigation. Our objective was to examine whether individual psychosocial resilience and neighborhood-level cardiovascular resilience were associated with better cardiovascular health in Black adults, measured utilizing Life's Simple 7 (LS7) scores. METHODS We assessed LS7 scores in 389 Black adults (mean age, 53±10 years; 39% men) living in Atlanta, Georgia. A composite score of individual psychosocial resilience was created by assessing environmental mastery, purpose in life, optimism, resilient coping, and depressive symptoms. Neighborhood-level cardiovascular resilience was separately determined by the census tract-level rates of cardiovascular mortality/morbidity events. Generalized linear mixed regression models were used to examine the association between individual psychosocial resilience, neighborhood cardiovascular resilience, and LS7 scores. RESULTS Higher individual psychosocial resilience was significantly associated with higher LS7 (β=0.38 [0.16-0.59] per 1 SD) after adjustment for sociodemographic factors. Similarly, higher neighborhood-level cardiovascular resilience was significantly associated with higher LS7 (β=0.23 [0.02-0.45] per 1 SD). When jointly examined, high individual psychosocial resilience (>median) was independently associated with higher LS7 (β=0.73 [0.31-1.17]), whereas living in high-resilience neighborhoods (>median) was not. The largest difference in LS7 score was between those with high and low psychosocial resilience living in low-resilience neighborhoods (8.38 [7.90-8.86] versus 7.42 [7.04-7.79]). CONCLUSIONS Individual psychosocial resilience in Black adults is associated with better cardiovascular health.
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Affiliation(s)
- Jeong Hwan Kim
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (J.H.K., S.J.I., M.L.T., V.V., C.L., C.D.S., A.A.Q.)
| | - Shabatun J Islam
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (J.H.K., S.J.I., M.L.T., V.V., C.L., C.D.S., A.A.Q.)
| | - Matthew L Topel
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (J.H.K., S.J.I., M.L.T., V.V., C.L., C.D.S., A.A.Q.)
| | - Yi-An Ko
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health (Y.-A.K.), Emory University, Atlanta, GA
| | - Mahasin S Mujahid
- Division of Epidemiology, School of Public Health, University of California, Berkeley (M.S.M.)
| | - Viola Vaccarino
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (J.H.K., S.J.I., M.L.T., V.V., C.L., C.D.S., A.A.Q.).,Department of Epidemiology, Rollins School of Public Health (V.V., T.T.L.), Emory University, Atlanta, GA
| | - Chang Liu
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (J.H.K., S.J.I., M.L.T., V.V., C.L., C.D.S., A.A.Q.)
| | - Mario Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson (M.S.)
| | - Mohamed Mubasher
- Department of Community Health and Preventive Medicine (M.M., P.B.), Morehouse School of Medicine, Atlanta, GA
| | - Charles D Searles
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (J.H.K., S.J.I., M.L.T., V.V., C.L., C.D.S., A.A.Q.)
| | - Sandra B Dunbar
- Nell Hodgson Woodruff School of Nursing (S.B.D.), Emory University, Atlanta, GA
| | - Priscilla Pemu
- Department of Medicine (P.P., H.A.T.), Morehouse School of Medicine, Atlanta, GA
| | - Herman A Taylor
- Department of Medicine (P.P., H.A.T.), Morehouse School of Medicine, Atlanta, GA
| | - Arshed A Quyyumi
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (J.H.K., S.J.I., M.L.T., V.V., C.L., C.D.S., A.A.Q.)
| | - Peter Baltrus
- Department of Community Health and Preventive Medicine (M.M., P.B.), Morehouse School of Medicine, Atlanta, GA.,National Center for Primary Care (P.B.), Morehouse School of Medicine, Atlanta, GA
| | - Tené T Lewis
- Department of Epidemiology, Rollins School of Public Health (V.V., T.T.L.), Emory University, Atlanta, GA
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Berkowitz RL, Gao X, Michaels EK, Mujahid MS. Structurally vulnerable neighbourhood environments and racial/ethnic COVID-19 inequities. ACTA ACUST UNITED AC 2020; 5:S59-S62. [DOI: 10.1080/23748834.2020.1792069] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Rachel L. Berkowitz
- Division of Health Policy and Management, School of Public Health, University of California, Berkeley
- Sutter Health Center for Health Systems Research
| | - Xing Gao
- Division of Epidemiology, School of Public Health, University of California, Berkeley
| | - Eli K. Michaels
- Division of Epidemiology, School of Public Health, University of California, Berkeley
| | - Mahasin S. Mujahid
- Division of Epidemiology, School of Public Health, University of California, Berkeley
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Sims M, Kershaw KN, Breathett K, Jackson EA, Lewis LM, Mujahid MS, Suglia SF. Importance of Housing and Cardiovascular Health and Well-Being: A Scientific Statement From the American Heart Association. Circ Cardiovasc Qual Outcomes 2020; 13:e000089. [PMID: 32673512 DOI: 10.1161/hcq.0000000000000089] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Cardiovascular disease disparities are shaped by differences in risk factors across racial and ethnic groups. Housing remains an important social determinant of health. The objective of this statement is to review and summarize research that has examined the associations of housing status with cardiovascular health and overall health. PubMed/Medline, Centers for Disease Control and Prevention data, US Census data, Cochrane Library reviews, and the annual Heart Disease and Stroke Statistics report from the American Heart Association were used to identify empirical research studies that examined associations of housing with cardiovascular health and overall well-being. Health is affected by 4 prominent dimensions of housing: stability, quality and safety, affordability and accessibility, and neighborhood environment. Vulnerable and underserved populations are adversely affected by housing insecurity and homelessness, are at risk for lower-quality and unsafe housing conditions, confront structural barriers that limit access to affordable housing, and are at risk for living in areas with substandard built environment features that are linked to cardiovascular disease. Research linking select pathways to cardiovascular health is relatively strong, but research gaps in other housing pathways and cardiovascular health remain. Efforts to eliminate cardiovascular disease disparities have recently emphasized the importance of social determinants of health. Housing is a prominent social determinant of cardiovascular health and well-being and should be considered in the evaluation of prevention efforts to reduce and eliminate racial/ethnic and socioeconomic disparities.
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Islam SJ, Kim JH, Topel M, Liu C, Ko YA, Mujahid MS, Sims M, Mubasher M, Ejaz K, Morgan-Billingslea J, Jones K, Waller EK, Jones D, Uppal K, Dunbar SB, Pemu P, Vaccarino V, Searles CD, Baltrus P, Lewis TT, Quyyumi AA, Taylor H. Cardiovascular Risk and Resilience Among Black Adults: Rationale and Design of the MECA Study. J Am Heart Assoc 2020; 9:e015247. [PMID: 32340530 PMCID: PMC7428584 DOI: 10.1161/jaha.119.015247] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 12/19/2022]
Abstract
Background Cardiovascular disease incidence, prevalence, morbidity, and mortality have declined in the past several decades; however, disparities persist among subsets of the population. Notably, blacks have not experienced the same improvements on the whole as whites. Furthermore, frequent reports of relatively poorer health statistics among the black population have led to a broad assumption that black race reliably predicts relatively poorer health outcomes. However, substantial intraethnic and intraracial heterogeneity exists; moreover, individuals with similar risk factors and environmental exposures are often known to experience vastly different cardiovascular health outcomes. Thus, some individuals have good outcomes even in the presence of cardiovascular risk factors, a concept known as resilience. Methods and Results The MECA (Morehouse‐Emory Center for Health Equity) Study was designed to investigate the multilevel exposures that contribute to “resilience” in the face of risk for poor cardiovascular health among blacks in the greater Atlanta, GA, metropolitan area. We used census tract data to determine “at‐risk” and “resilient” neighborhoods with high or low prevalence of cardiovascular morbidity and mortality, based on cardiovascular death, hospitalization, and emergency department visits for blacks. More than 1400 individuals from these census tracts assented to demographic, health, and psychosocial questionnaires administered through telephone surveys. Afterwards, ≈500 individuals were recruited to enroll in a clinical study, where risk biomarkers, such as oxidative stress, and inflammatory markers, endothelial progenitor cells, metabolomic and microRNA profiles, and subclinical vascular dysfunction were measured. In addition, comprehensive behavioral questionnaires were collected and ideal cardiovascular health metrics were assessed using the American Heart Association's Life Simple 7 measure. Last, 150 individuals with low Life Simple 7 were recruited and randomized to a behavioral mobile health (eHealth) plus health coach or eHealth only intervention and followed up for improvement. Conclusions The MECA Study is investigating socioenvironmental and individual behavioral measures that promote resilience to cardiovascular disease in blacks by assessing biological, functional, and molecular mechanisms. REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT03308812.
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Affiliation(s)
- Shabatun J Islam
- Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA
| | - Jeong Hwan Kim
- Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA
| | - Matthew Topel
- Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA
| | - Chang Liu
- Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA.,Department of Epidemiology Rollins School of Public Health Emory University Atlanta GA
| | - Yi-An Ko
- Department of Biostatistics and Bioinformatics Rollins School of Public Health Emory University Atlanta GA
| | - Mahasin S Mujahid
- Division of Epidemiology School of Public Health University of California Berkeley CA
| | - Mario Sims
- Department of Medicine University of Mississippi Medical Center Jackson MS
| | - Mohamed Mubasher
- Department of Community Health and Preventive Medicine Morehouse School of Medicine Atlanta GA
| | - Kiran Ejaz
- Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA
| | - Jan Morgan-Billingslea
- Department of Community Health and Preventive Medicine Morehouse School of Medicine Atlanta GA
| | - Kia Jones
- Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA
| | - Edmund K Waller
- Department of Hematology and Oncology Winship Cancer Institute Emory University School of Medicine Atlanta GA
| | - Dean Jones
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine Department of Medicine Emory University School of Medicine Atlanta GA
| | - Karan Uppal
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine Department of Medicine Emory University School of Medicine Atlanta GA
| | - Sandra B Dunbar
- Nell Hodgson Woodruff School of Nursing Emory University Atlanta GA
| | - Priscilla Pemu
- Department of Medicine Morehouse School of Medicine Atlanta GA
| | - Viola Vaccarino
- Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA.,Department of Epidemiology Rollins School of Public Health Emory University Atlanta GA
| | - Charles D Searles
- Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA
| | - Peter Baltrus
- Department of Community Health and Preventive Medicine Morehouse School of Medicine Atlanta GA.,National Center for Primary Care Morehouse School of Medicine Atlanta GA
| | - Tené T Lewis
- Department of Epidemiology Rollins School of Public Health Emory University Atlanta GA
| | - Arshed A Quyyumi
- Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA
| | - Herman Taylor
- Department of Medicine Morehouse School of Medicine Atlanta GA
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Abdel Magid HS, Halpern-Felsher B, Ling PM, Bradshaw PT, Mujahid MS, Henriksen L. Tobacco Retail Density and Initiation of Alternative Tobacco Product Use Among Teens. J Adolesc Health 2020; 66:423-430. [PMID: 31784411 PMCID: PMC7089810 DOI: 10.1016/j.jadohealth.2019.09.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 09/05/2019] [Accepted: 09/06/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE The rise of noncigarette, alternative tobacco product (ATP) use among adolescents may be due in part to an increase in retail availability of ATPs. We examined whether proximity and density of tobacco retailers near students' homes are associated with a higher likelihood of initiating ATP use over time. METHODS Using data from 728 adolescents (aged 13-19 years at baseline) residing in 191 different neighborhoods and attending 10 different California high schools, longitudinal multilevel and cross-classified random effect models evaluated individual-level, neighborhood-level, and school-level risk factors for ATP initiation after 1 year. Covariates were obtained from the American Community Survey and the California Department of Education. RESULTS The sample was predominantly female (63.5%) and was racially and ethnically diverse. Approximately one third of participants (32.5%) reported ever ATP use at baseline, with 106 (14.5%) initiating ATP use within 1 year. The mean number of tobacco retailers per square mile within a tract was 5.66 (standard deviation = 6.3), and the average distance from each participant's residence to the nearest tobacco retailer was .61 miles (standard deviation = .4). Living in neighborhoods with greater tobacco retailer density at baseline was associated with higher odds of ATP initiation (odds ratio = 1.22, 95% confidence interval = 1.07-2.12), controlling for individual and school factors. CONCLUSIONS Tobacco retailers clustered in students' home neighborhood may be an environmental influence on adolescents' ATP use. Policy efforts to reduce adolescent ATP use should aim to reduce the density of tobacco retailers and limit the proximity of tobacco retailers near adolescents' homes and schools.
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Affiliation(s)
- Hoda S Abdel Magid
- Department of Epidemiology and Population Health, Stanford University, Palo Alto, California
| | - Bonnie Halpern-Felsher
- Division of Adolescent Medicine, Department of Pediatrics, Stanford University, Palo Alto, California.
| | - Pamela M Ling
- Center for Tobacco Control Research and Education, University of California, San Francisco, San Francisco, California
| | - Patrick T Bradshaw
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, California
| | - Mahasin S Mujahid
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, California
| | - Lisa Henriksen
- Stanford Prevention Research Center, Stanford University School of Medicine, Stanford University, Palo Alto, California
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Suglia SF, Campo RA, Brown AGM, Stoney C, Boyce CA, Appleton AA, Bleil ME, Boynton-Jarrett R, Dube SR, Dunn EC, Ellis BJ, Fagundes CP, Heard-Garris NJ, Jaffee SR, Johnson SB, Mujahid MS, Slopen N, Su S, Watamura SE. Social Determinants of Cardiovascular Health: Early Life Adversity as a Contributor to Disparities in Cardiovascular Diseases. J Pediatr 2020; 219:267-273. [PMID: 32111376 PMCID: PMC7883398 DOI: 10.1016/j.jpeds.2019.12.063] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 12/16/2019] [Accepted: 12/30/2019] [Indexed: 12/22/2022]
Affiliation(s)
| | - Rebecca A Campo
- National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD
| | - Alison G M Brown
- National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD
| | - Catherine Stoney
- National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD
| | - Cheryl A Boyce
- National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, MD
| | - Allison A Appleton
- Department of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York, Albany, NY
| | - Maria E Bleil
- Department of Family and Child Nursing, University of Washington, Seattle, WA
| | - Renée Boynton-Jarrett
- Department of Pediatrics, Boston University School of Medicine, Boston Medical Center, Boston, MA
| | - Shanta R Dube
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA
| | - Erin C Dunn
- Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, MA; Department of Psychiatry, Harvard Medical School, Boston, MA; Stanley Center for Psychiatric Research, The Broad Institute of Harvard and MIT, Boston, MA
| | - Bruce J Ellis
- Departments of Psychology and Anthropology, University of Utah, Salt Lake City, UT
| | - Christopher P Fagundes
- Department of Psychology, Rice University, Houston, TX; Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Psychiatry, Baylor College of Medicine, Waco, TX
| | - Nia J Heard-Garris
- Division of Academic General Pediatrics, Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago, IL; Mary Ann and J. Milburn Smith Child Health Research, Outreach, and Advocacy Center, Stanley Manne Children's Research Institute, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Sara R Jaffee
- Department of Psychology, University of Pennsylvania, Philadelphia, PA
| | - Sara B Johnson
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD
| | - Mahasin S Mujahid
- Division of Epidemiology, Berkeley School of Public Health, University of California, Berkeley CA
| | - Natalie Slopen
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD
| | - Shaoyong Su
- Department of Population Health Sciences, Medical College of Georgia, Georgia Prevention Institute, Augusta University, Augusta, GA
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Hailu EM, Needham BL, Lewis TT, Lin J, Seeman TE, Roux AD, Mujahid MS. Discrimination, social support, and telomere length: the Multi-Ethnic Study of Atherosclerosis (MESA). Ann Epidemiol 2020; 42:58-63.e2. [PMID: 32070634 PMCID: PMC11019778 DOI: 10.1016/j.annepidem.2019.12.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 12/16/2019] [Accepted: 12/22/2019] [Indexed: 01/02/2023]
Abstract
PURPOSE We sought to assess the association of reports of discrimination with leukocyte telomere length (LTL) and effect measure modification by social support. METHODS This study used data from the Multi-Ethnic Study of Atherosclerosis Stress Ancillary Study (n = 1153). Discrimination was measured using the everyday discrimination and the major experiences of discrimination scales. LTL was defined as the ratio of telomeric DNA to single-copy control gene (mean = 0.916, SD = 0.205). Linear regression models were used to examine the relationship between discrimination and LTL. RESULTS We found no association between either measure of discrimination and LTL, but there was evidence of effect modification by social support (P (χ2) = 0.001) for everyday discrimination only. Among those with low social support, reporting moderate and high everyday discrimination was associated with a 0.35 (95% CI: -0.54 to -0.16) and a 0.17 (95% CI: -0.34 to -0.01) shorter telomere length, respectively, compared to reporting no discrimination, after adjusting for demographic factors, health behaviors, and health conditions. There were no associations between discrimination and LTL among those reporting moderate or high social support. CONCLUSIONS These findings underscore the importance of continued investigation of the potential health consequences of chronic unfair treatment in the absence of supportive resources.
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Affiliation(s)
- Elleni M Hailu
- Division of Epidemiology, School of Public Health, University of California Berkeley, Berkeley, CA.
| | - Belinda L Needham
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor
| | - Tené T Lewis
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Jue Lin
- Department of Biochemistry and Biophysics, University of California San Francisco, San Francisco, CA
| | - Teresa E Seeman
- Department of Geriatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Ana Diez Roux
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA
| | - Mahasin S Mujahid
- Division of Epidemiology, School of Public Health, University of California Berkeley, Berkeley, CA
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Tulier ME, Reid C, Mujahid MS, Allen AM. "Clear action requires clear thinking": A systematic review of gentrification and health research in the United States. Health Place 2019; 59:102173. [PMID: 31357049 PMCID: PMC6868313 DOI: 10.1016/j.healthplace.2019.102173] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [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: 03/11/2019] [Revised: 07/13/2019] [Accepted: 07/18/2019] [Indexed: 12/28/2022]
Abstract
Gentrification is a process in which formerly declining, under-resourced, neighborhoods experience reinvestment and in-migration of increasingly affluent new residents, with understudied implications for individual health and health-protective community resources for low-income and minority residents. Increased attention on urban health inequities have propelled research on the relationship between gentrification and health. Yet, there are significant challenges inherent in the study of gentrification given its non-linear process occurring at multiple levels and via various mechanisms in a complex web of urban systems. How then have empirical studies addressed questions regarding the relationship between gentrification and health and wellness from a conceptual and methodological standpoint? Applying key search terms to PubMed and Web of Science, we identified 546 papers published in the United States. This review is guided by three foundational premises informing the inclusion and exclusion of articles. These include: 1. a clear definition of gentrification and explicit health outcome; 2. identification of a specific geographic context (United States) in which gentrification occurs, and 3. use of a social determinants of health framework to identify potential health outcomes of interest. 17 papers met our inclusion criteria. Through systematic content analysis using MaxQDA software, we evaluated the included studies using three critical frames: 1. conceptualization of gentrification; 2. mechanisms linking gentrification and health; and 3. spatio-temporal considerations. Based on this analysis, we identify the strengths and limitations of existing research, and offer three methodological approaches to strengthen the current literature on gentrification and health. We recommend that future studies: 1. explicitly identify the mechanisms and levels at which processes can occur and systems are organized; 2. incorporate space and time into the analytical strategy and 3. articulate an epistemological standpoint driven by their conceptualization of the exposure and identification of the relevant mechanism and outcome of interest.
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Affiliation(s)
- Melody Esther Tulier
- Center for Interdisciplinary Research on AIDS (CIRA), Yale University, 60 College St.New Haven, CT, 06520-8034, USA.
| | - Carolina Reid
- Department of City and Regional Planning, University of California, Berkeley, 312 Wurster Hall #1850, Berkeley, CA, 94720-1820, USA
| | - Mahasin S Mujahid
- University of California, Berkeley School of Public Health Division of Epidemiology, Haviland Hall, 2121 Berkeley Way, Berkeley, CA, 94720-7360, USA
| | - Amani M Allen
- University of California, Berkeley School of Public Health Division of Epidemiology, Haviland Hall, 2121 Berkeley Way, Berkeley, CA, 94720-7360, USA; University of California, Berkeley School of Public Health Division of Community Health Sciences, 2121 Berkeley Way, MC #5302, Berkeley, CA, 94720-7360, USA
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Topel ML, Kim JH, Mujahid MS, Ko YA, Vaccarino V, Mubasher M, Liu C, Dunbar S, Sims M, Taylor HA, Quyyumi AA, Baltrus P, Lewis TT. Individual Characteristics of Resilience are Associated With Lower-Than-Expected Neighborhood Rates of Cardiovascular Disease in Blacks: Results From the Morehouse-Emory Cardiovascular (MECA) Center for Health Equity Study. J Am Heart Assoc 2019; 8:e011633. [PMID: 31203713 PMCID: PMC6645651 DOI: 10.1161/jaha.118.011633] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 12/22/2022]
Abstract
Background Factors promoting cardiovascular health in the face of high risk, ie, resilience, are unknown and may identify novel areas of intervention for reducing racial health disparities. We examined neighborhood perceptions and psychological attributes of blacks living in high and low cardiovascular–risk neighborhoods, as potential characteristics of resilience promoting cardiovascular health. Methods and Results We identified 1433 blacks residing in census tracts of Atlanta, GA, with higher‐than‐expected (“high” risk) or lower‐than‐expected (“low” risk) rates of cardiovascular mortality, hospitalizations, and emergency department visits during 2010–2014. Domains of psychosocial well‐being and neighborhood quality were assessed via telephone survey between August 2016 and October 2016. Using multilevel logistic regression, odds of reporting better resilient characteristics were compared between individuals living in low‐ versus high‐risk neighborhoods. Those from low‐risk (versus high‐risk) neighborhoods reported better neighborhood aesthetic quality (odds ratio [OR], 1.84), healthy food access (OR, 1.69), and absence of violence (OR, 0.67). Individuals from low‐risk neighborhoods reported greater optimism (OR, 1.38), purpose in life (OR, 1.42), and fewer depressive symptoms (OR, 0.69). After full adjustment, these associations remained significant for neighborhood factors (aesthetic quality, healthy food access, violence) and psychosocial well‐being (purpose in life). We found no evidence of differences in self‐reported cardiovascular risk factors or disease history between low‐ versus high‐risk neighborhoods. Conclusions Positive neighborhood environments and psychological characteristics are associated with low cardiovascular–risk neighborhoods, despite similar prevalence of cardiovascular risk factors, in the census tracts studied. These factors may confer cardiovascular resilience among blacks.
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Affiliation(s)
- Matthew L Topel
- 1 Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA
| | - Jeong Hwan Kim
- 1 Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA
| | - Mahasin S Mujahid
- 2 Division of Epidemiology School of Public Health University of California, Berkeley Berkeley CA
| | - Yi-An Ko
- 3 Department of Biostatistics and Bioinformatics Rollins School of Public Health Emory University Atlanta GA
| | - Viola Vaccarino
- 1 Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA.,4 Department of Epidemiology Rollins School of Public Health Emory University Atlanta GA
| | - Mohamed Mubasher
- 5 Department of Community Health and Preventive Medicine Morehouse School of Medicine Atlanta GA
| | - Chang Liu
- 1 Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA
| | - Sandra Dunbar
- 6 Nell Hodgson Woodruff School of Nursing Emory University Atlanta GA
| | - Mario Sims
- 7 Department of Medicine University of Mississippi Medical Center Jackson MS
| | - Herman A Taylor
- 8 Department of Medicine Morehouse School of Medicine Atlanta GA
| | - Arshed A Quyyumi
- 1 Division of Cardiology Department of Medicine Emory University School of Medicine Atlanta GA
| | - Peter Baltrus
- 5 Department of Community Health and Preventive Medicine Morehouse School of Medicine Atlanta GA.,9 National Center for Primary Care Morehouse School of Medicine Atlanta GA
| | - Tené T Lewis
- 4 Department of Epidemiology Rollins School of Public Health Emory University Atlanta GA
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Kim JH, Lewis TT, Topel ML, Mubasher M, Li C, Vaccarino V, Mujahid MS, Sims M, Quyyumi AA, Taylor HA, Baltrus PT. Identification of Resilient and At-Risk Neighborhoods for Cardiovascular Disease Among Black Residents: the Morehouse-Emory Cardiovascular (MECA) Center for Health Equity Study. Prev Chronic Dis 2019; 16:E57. [PMID: 31074715 PMCID: PMC6513475 DOI: 10.5888/pcd16.180505] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Despite the growing interest in place as a determinant of health, areas that promote rather than reduce cardiovascular disease (CVD) in blacks are understudied. We performed an ecologic analysis to identify areas with high levels of CVD resilience and risk among blacks from a large southern, US metropolitan area. METHODS We obtained census tract-level rates of cardiovascular deaths, emergency department (ED) visits, and hospitalizations for black adults aged 35 to 64 from 2010 through 2014 for the Atlanta, Georgia, metropolitan area. Census tracts with substantially lower rates of cardiovascular events on the basis of neighborhood socioeconomic status were identified as resilient and those with higher rates were identified as at risk. Logistic regression was used to estimate the odds ratios (OR) and 95% confidence intervals (CIs) of being classified as an at-risk versus resilient tract for differences in census-derived measures. RESULTS We identified 106 resilient and 121 at-risk census tracts, which differed in the rates per 5,000 person years of cardiovascular outcomes (mortality, 8.13 vs 13.81; ED visits, 32.25 vs 146.3; hospitalizations, 26.69 vs 130.0), despite similarities in their median black income ($46,123 vs $45,306). Tracts with a higher percentage of residents aged 65 or older (odds ratio [OR], 2.29; 95% CI, 1.41-3.85 per 5% increment) and those with incomes less than 200% of the federal poverty level (OR, 1.19; 95% CI, 1.02-1.39 per 5% increment) and greater Gini index (OR, 1.56; 95% CI, 1.19- 2.07 per 0.05 increment) were more likely to be classified as at risk than resilient neighborhoods. DISCUSSION Despite matching on median income level, at-risk neighborhoods for CVD among black populations were associated with a higher prevalence of socioeconomic indicators of inequality than resilient neighborhoods.
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Affiliation(s)
- Jeong Hwan Kim
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Tené T Lewis
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Matthew L Topel
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Mohamed Mubasher
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, Georgia
| | - Chaohua Li
- National Center for Primary Care, Morehouse School of Medicine, Atlanta, Georgia
| | - Viola Vaccarino
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia.,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Mahasin S Mujahid
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, California
| | - Mario Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Arshed A Quyyumi
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Herman A Taylor
- Department of Medicine, Morehouse School of Medicine, Atlanta, Georgia
| | - Peter T Baltrus
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, Georgia.,National Center for Primary Care, Morehouse School of Medicine, Atlanta, Georgia.,Morehouse School of Medicine, National Center for Primary Care, Room 310, 720 Westview Dr, Atlanta, GA 30310.
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Izenberg JM, Mujahid MS, Yen IH. Gentrification and binge drinking in California neighborhoods: It matters how long you've lived there. Drug Alcohol Depend 2018; 188:1-9. [PMID: 29709759 PMCID: PMC5999569 DOI: 10.1016/j.drugalcdep.2018.03.018] [Citation(s) in RCA: 12] [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] [Received: 12/18/2017] [Revised: 03/14/2018] [Accepted: 03/15/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND Neighborhood context plays a role in binge drinking, a behavior with major health and economic costs. Gentrification, the influx of capital and residents of higher socioeconomic status into historically-disinvested neighborhoods, is a growing trend with the potential to place urban communities under social and financial pressure. Hypothesizing that these pressures and other community changes resulting from gentrification could be tied to excessive alcohol consumption, we examined the relationship between gentrification and binge drinking in California neighborhoods. METHODS California census tracts were categorized as non-gentrifiable, stable (gentrifiable), or gentrifying from 2006 to 2015. Outcomes and covariates were obtained from the California Health Interview Survey using combined 2013-2015 data (n = 60,196). Survey-weighted logistic regression tested for associations between gentrification and any binge drinking in the prior 12 months. Additional models tested interactions between gentrification and other variables of interest, including housing tenure, federal poverty level, race/ethnicity, sex, and duration of neighborhood residence. RESULTS A third of respondents reported past-year binge drinking. Controlling for demographic covariates, gentrification was not associated with binge drinking in the population overall (AOR = 1.13, 95% CI = 0.95-1.34), but was associated with binge drinking among those living in the neighborhood <5 years (AOR = 1.49, 95% CI 1.15-1.93). No association was seen among those living in their neighborhood ≥5 years. CONCLUSIONS For those newer to their neighborhood, gentrification is associated with binge drinking. Further understanding the relationship between gentrification and high-risk alcohol use is important for policy and public health interventions mitigating the impact of this process.
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Affiliation(s)
- Jacob M. Izenberg
- Department of Psychiatry, UCSF School of Medicine, 401 Parnassus Avenue, Box 0984, San Francisco, CA 94143-0984
| | - Mahasin S. Mujahid
- Division of Epidemiology, UC Berkeley School of Public Health, 50 University Hall #7360, Berkeley, CA 94720-7360
| | - Irene H. Yen
- Public Health, School of Social Sciences, Humanities & Arts, University of California, Merced, 5200 North Lake Road, Merced CA 95343
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Hussein M, Diez Roux AV, Mujahid MS, Hastert TA, Kershaw KN, Bertoni AG, Baylin A. Unequal Exposure or Unequal Vulnerability? Contributions of Neighborhood Conditions and Cardiovascular Risk Factors to Socioeconomic Inequality in Incident Cardiovascular Disease in the Multi-Ethnic Study of Atherosclerosis. Am J Epidemiol 2018; 187:1424-1437. [PMID: 29186311 DOI: 10.1093/aje/kwx363] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 11/16/2017] [Indexed: 12/12/2022] Open
Abstract
Risk factors can drive socioeconomic inequalities in cardiovascular disease (CVD) through differential exposure and differential vulnerability. In this paper, we show how econometric decomposition directly enables simultaneous, policy-oriented assessment of these 2 mechanisms. We specifically estimate contributions of neighborhood environment and proximal risk factors to socioeconomic inequality in CVD incidence via these mechanisms. We followed 5,608 participants in the Multi-Ethnic Study of Atherosclerosis (2000-2012) to their first CVD event (median length of follow-up, 12.2 years). We used a summary measure of baseline socioeconomic position (SEP). Covariates included baseline demographics, neighborhood characteristics, and psychosocial, behavioral, and biomedical risk factors. Using Poisson models, we decomposed the difference (inequality) in incidence rates between low- and high-SEP groups into contributions of 1) differences in covariate means (differential exposure) and 2) differences in CVD risk associated with covariates (differential vulnerability). Notwithstanding large uncertainty in neighborhood estimates, our analysis suggested that differential exposure to poorer neighborhood socioeconomic conditions, adverse social environment, diabetes, and hypertension accounted for most of the inequality. Psychosocial and behavioral contributions were negligible. Further, neighborhood SEP, female sex, and white race were more strongly associated with CVD among low-SEP (vs. high-SEP) participants. These differentials in vulnerability also accounted for nontrivial portions of the inequality and could have important implications for intervention.
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Affiliation(s)
- Mustafa Hussein
- Joseph J. Zilber School of Public Health, University of Wisconsin–Milwaukee, Milwaukee, Wisconsin
| | - Ana V Diez Roux
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - Mahasin S Mujahid
- Department of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, California
| | - Theresa A Hastert
- Department of Oncology, School of Medicine and Karmanos Cancer Institute, Wayne State University, Detroit, Michigan
| | - Kiarri N Kershaw
- Division of Epidemiology, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Alain G Bertoni
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Ana Baylin
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
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Izenberg JM, Mujahid MS, Yen IH. Health in changing neighborhoods: A study of the relationship between gentrification and self-rated health in the state of California. Health Place 2018; 52:188-195. [PMID: 29957396 DOI: 10.1016/j.healthplace.2018.06.002] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 04/27/2018] [Accepted: 06/05/2018] [Indexed: 11/25/2022]
Affiliation(s)
- Jacob M Izenberg
- Department of Psychiatry, UCSF School of Medicine, 401 Parnassus Avenue, Box 0984, San Francisco, CA 94143-0984, USA.
| | - Mahasin S Mujahid
- Division of Epidemiology, UC Berkeley School of Public Health, 50 University Hall #7360, Berkeley, CA 94720-7360, USA.
| | - Irene H Yen
- Public Health, School of Social Sciences, Humanities & Arts, University of California, Merced, 5200 North Lake Road, Merced, CA 95343, USA
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Magnani JW, Mujahid MS, Aronow HD, Cené CW, Dickson VV, Havranek E, Morgenstern LB, Paasche-Orlow MK, Pollak A, Willey JZ. Health Literacy and Cardiovascular Disease: Fundamental Relevance to Primary and Secondary Prevention: A Scientific Statement From the American Heart Association. Circulation 2018; 138:e48-e74. [PMID: 29866648 PMCID: PMC6380187 DOI: 10.1161/cir.0000000000000579] [Citation(s) in RCA: 213] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Health literacy is the degree to which individuals are able to access and process basic health information and services and thereby participate in health-related decisions. Limited health literacy is highly prevalent in the United States and is strongly associated with patient morbidity, mortality, healthcare use, and costs. The objectives of this American Heart Association scientific statement are (1) to summarize the relevance of health literacy to cardiovascular health; (2) to present the adverse associations of health literacy with cardiovascular risk factors, conditions, and treatments; (3) to suggest strategies that address barriers imposed by limited health literacy on the management and prevention of cardiovascular disease; (4) to demonstrate the contributions of health literacy to health disparities, given its association with social determinants of health; and (5) to propose future directions for how health literacy can be integrated into the American Heart Association's mandate to advance cardiovascular treatment and research, thereby improving patient care and public health. Inadequate health literacy is a barrier to the American Heart Association meeting its 2020 Impact Goals, and this statement articulates the rationale to anticipate and address the adverse cardiovascular effects associated with health literacy.
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Barrientos-Gutierrez T, Moore KAB, Auchincloss AH, Mujahid MS, August C, Sanchez BN, Diez Roux AV. Neighborhood Physical Environment and Changes in Body Mass Index: Results From the Multi-Ethnic Study of Atherosclerosis. Am J Epidemiol 2017; 186:1237-1245. [PMID: 29206987 DOI: 10.1093/aje/kwx186] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 01/26/2017] [Indexed: 11/13/2022] Open
Abstract
Longitudinal associations between neighborhood characteristics and body mass index (BMI; weight (kg)/height (m)2) were assessed from 2000 to 2011 among 5,919 participants in the Multi-Ethnic Study of Atherosclerosis. The perceived availability of healthy food and walking environment were assessed via surveys, and 1-mile (1.6-km) densities of supermarkets, fruit-and-vegetable stores, and recreational facilities were obtained through a commercial database. Econometric fixed-effects models were used to estimate the association between within-person changes in neighborhood characteristics and within-person change in BMI. In fully adjusted models, a 1-standard-deviation increase in the healthy food environment index was associated with a 0.16-kg/m2 decrease in BMI (95% confidence interval (CI): -0.27, -0.06) among participants with obesity at baseline. A 1-standard-deviation increase in the physical activity environment index was associated with 0.13-kg/m2 (95% CI: -0.24, -0.02) and 0.14-kg/m2 (95% CI: -0.27, -0.01) decreases in BMI for participants who were overweight and obese at baseline, respectively. Paradoxically, increases in the physical activity index were associated with BMI increases in persons who were normal-weight at baseline. This study provides preliminary longitudinal evidence that favorable changes in neighborhood physical environments are related to BMI reductions in obese persons, who comprise a substantial proportion of the US population.
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Affiliation(s)
| | - Kari A B Moore
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - Amy H Auchincloss
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - Mahasin S Mujahid
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, California
| | - Carmella August
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Brisa N Sanchez
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Ana V Diez Roux
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
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Carnethon MR, Pu J, Howard G, Albert MA, Anderson CAM, Bertoni AG, Mujahid MS, Palaniappan L, Taylor HA, Willis M, Yancy CW. Cardiovascular Health in African Americans: A Scientific Statement From the American Heart Association. Circulation 2017; 136:e393-e423. [PMID: 29061565 DOI: 10.1161/cir.0000000000000534] [Citation(s) in RCA: 645] [Impact Index Per Article: 92.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND PURPOSE Population-wide reductions in cardiovascular disease incidence and mortality have not been shared equally by African Americans. The burden of cardiovascular disease in the African American community remains high and is a primary cause of disparities in life expectancy between African Americans and whites. The objectives of the present scientific statement are to describe cardiovascular health in African Americans and to highlight unique considerations for disease prevention and management. METHOD The primary sources of information were identified with PubMed/Medline and online sources from the Centers for Disease Control and Prevention. RESULTS The higher prevalence of traditional cardiovascular risk factors (eg, hypertension, diabetes mellitus, obesity, and atherosclerotic cardiovascular risk) underlies the relatively earlier age of onset of cardiovascular diseases among African Americans. Hypertension in particular is highly prevalent among African Americans and contributes directly to the notable disparities in stroke, heart failure, and peripheral artery disease among African Americans. Despite the availability of effective pharmacotherapies and indications for some tailored pharmacotherapies for African Americans (eg, heart failure medications), disease management is less effective among African Americans, yielding higher mortality. Explanations for these persistent disparities in cardiovascular disease are multifactorial and span from the individual level to the social environment. CONCLUSIONS The strategies needed to promote equity in the cardiovascular health of African Americans require input from a broad set of stakeholders, including clinicians and researchers from across multiple disciplines.
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Johnson DA, Simonelli G, Moore K, Billings M, Mujahid MS, Rueschman M, Kawachi I, Redline S, Diez Roux AV, Patel SR. The Neighborhood Social Environment and Objective Measures of Sleep in the Multi-Ethnic Study of Atherosclerosis. Sleep 2017; 40:2957268. [PMID: 28364474 DOI: 10.1093/sleep/zsw016] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2017] [Indexed: 01/22/2023] Open
Abstract
Study objectives To investigate cross-sectional associations of neighborhood social environment (social cohesion, safety) with objective measures of sleep duration, timing, and disturbances. Methods A racially/ethnically diverse population of men and women (N = 1949) aged 54 to 93 years participating in the Multi-Ethnic Study of Atherosclerosis Sleep and Neighborhood Ancillary studies. Participants underwent 1-week actigraphy between 2010 and 2013. Measures of sleep duration, timing, and disruption were averaged over all days. Neighborhood characteristics were assessed via questionnaires administered to participants and an independent sample within the same neighborhood and aggregated at the neighborhood (census tract, N = 783) level using empirical Bayes estimation. Multilevel linear regression models were used to assess the association between the neighborhood social environment and each sleep outcome. Results Neighborhood social environment characterized by higher levels of social cohesion and safety were associated with longer sleep duration and earlier sleep midpoint. Each 1 standard deviation higher neighborhood social environment score was associated with 6.1 minutes longer [95% confidence interval (CI): 2.0, 10.2] sleep duration and 6.4 minutes earlier (CI: 2.2, 10.6) sleep midpoint after adjustment for age, sex, race, socioeconomic status, and marital status. These associations persisted after adjustment for other risk factors. Neighborhood social factors were not associated with sleep efficiency or sleep fragmentation index. Conclusions A more favorable neighborhood social environment is associated with longer objectively measured sleep duration and earlier sleep timing. Intervening on the neighborhood environment may improve sleep and subsequent health outcomes.
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Affiliation(s)
- Dayna A Johnson
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA.,Division of Sleep Medicine Harvard Medical School, Boston, MA
| | - Guido Simonelli
- Department of Behavioral Biology, Walter Reed Army Institute of Research, Silver Spring, MD
| | - Kari Moore
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University,Philadelphia, PA
| | - Martha Billings
- UW Medicine Sleep Center, Division of Pulmonary Critical Care, University of Washington, Seattle, WA
| | | | - Michael Rueschman
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA.,Division of Sleep Medicine Harvard Medical School, Boston, MA
| | - Ana V Diez Roux
- UW Medicine Sleep Center, Division of Pulmonary Critical Care, University of Washington, Seattle, WA
| | - Sanjay R Patel
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA; Research performed at the Division of Sleep and Circadian Disorders at Brigham and Women's Hospital
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Zhang YT, Mujahid MS, Laraia BA, Warton EM, Blanchard SD, Moffet HH, Downing J, Karter AJ. Association Between Neighborhood Supermarket Presence and Glycated Hemoglobin Levels Among Patients With Type 2 Diabetes Mellitus. Am J Epidemiol 2017; 185:1297-1303. [PMID: 28510620 DOI: 10.1093/aje/kwx017] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 05/23/2016] [Indexed: 11/14/2022] Open
Abstract
We estimated associations between neighborhood supermarket gain or loss and glycemic control (assessed by glycated hemoglobin (HbA1c) values) in patients from the Kaiser Permanente Northern California Diabetes Registry (n = 434,806 person-years; 2007-2010). Annual clinical measures were linked to metrics from a geographic information system for each patient's address of longest residence. We estimated the association between change in supermarket presence (gain, loss, or no change) and change in HbA1c value, adjusting for individual- and area-level attributes and according to baseline glycemic control (near normal, <6.5%; good, 6.5%-7.9%; moderate, 8.0%-8.9%; and poor, ≥9.0%). Supermarket loss was associated with worse HbA1c trajectories for those with good, moderate, and poor glycemic control at baseline, while supermarket gain was associated with marginally better HbA1c outcomes only among patients with near normal HbA1c values at baseline. Patients with the poorest baseline HbA1c values (≥9.0%) had the worst associated changes in glycemic control following either supermarket loss or gain. Differences were not clinically meaningful relative to no change in supermarket presence. For patients with type 2 diabetes mellitus, gaining neighborhood supermarket presence did not benefit glycemic control in a substantive way. The significance of supermarket changes on health depends on a complex interaction of resident, neighborhood, and store characteristics.
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Affiliation(s)
- Y. Tara Zhang
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, California
| | - Mahasin S. Mujahid
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, California
| | - Barbara A. Laraia
- Division of Public Health Nutrition, School of Public Health, University of California, Berkeley, Berkeley, California
| | | | - Samuel D. Blanchard
- Department of Environmental Science, Policy and Management, University of California, Berkeley, Berkeley, California
| | | | - Janelle Downing
- Center for Health and Community, University of California, San Francisco, San Francisco, California
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