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Salerno PRVO, Qian A, Dong W, Deo S, Nasir K, Rajagopalan S, Al-Kindi S. County-level socio-environmental factors and obesity prevalence in the United States. Diabetes Obes Metab 2024; 26:1766-1774. [PMID: 38356053 DOI: 10.1111/dom.15488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/22/2024] [Accepted: 01/22/2024] [Indexed: 02/16/2024]
Abstract
AIMS To investigate high-risk sociodemographic and environmental determinants of health (SEDH) potentially associated with adult obesity in counties in the United States using machine-learning techniques. MATERIALS AND METHODS We performed a cross-sectional analysis of county-level adult obesity prevalence (body mass index ≥30 kg/m2) in the United States using data from the Diabetes Surveillance System 2017. We harvested 49 county-level SEDH factors that were used in a classification and regression trees (CART) model to identify county-level clusters. The CART model was validated using a 'hold-out' set of counties and variable importance was evaluated using Random Forest. RESULTS Overall, we analysed 2752 counties in the United States, identifying a national median (interquartile range) obesity prevalence of 34.1% (30.2%, 37.7%). The CART method identified 11 clusters with a 60.8% relative increase in prevalence across the spectrum. Additionally, seven key SEDH variables were identified by CART to guide the categorization of clusters, including Physically Inactive (%), Diabetes (%), Severe Housing Problems (%), Food Insecurity (%), Uninsured (%), Population over 65 years (%) and Non-Hispanic Black (%). CONCLUSION There is significant county-level geographical variation in obesity prevalence in the United States, which can in part be explained by complex SEDH factors. The use of machine-learning techniques to analyse these factors can provide valuable insights into the importance of these upstream determinants of obesity and, therefore, aid in the development of geo-specific strategic interventions and optimize resource allocation to help battle the obesity pandemic.
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Affiliation(s)
- Pedro R V O Salerno
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center & Case Western Reserve University, Cleveland, Ohio, USA
| | - Alice Qian
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Weichuan Dong
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Salil Deo
- Surgical Services, Louis Stokes VA Medical Center, and Case Western Reserve University, Cleveland, Ohio, USA
| | - Khurram Nasir
- Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Sanjay Rajagopalan
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center & Case Western Reserve University, Cleveland, Ohio, USA
| | - Sadeer Al-Kindi
- Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
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Salerno PRVO, Motairek I, Dong W, Nasir K, Fotedar N, Omran SS, Ganatra S, Hahad O, Deo SV, Rajagopalan S, Al-Kindi SG. County-Level Socio-Environmental Factors Associated With Stroke Mortality in the United States: A Cross-Sectional Study. Angiology 2024:33197241244814. [PMID: 38569060 DOI: 10.1177/00033197241244814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
We used machine learning methods to explore sociodemographic and environmental determinants of health (SEDH) associated with county-level stroke mortality in the USA. We conducted a cross-sectional analysis of individuals aged ≥15 years who died from all stroke subtypes between 2016 and 2020. We analyzed 54 county-level SEDH possibly associated with age-adjusted stroke mortality rates/100,000 people. Classification and Regression Tree (CART) was used to identify specific county-level clusters associated with stroke mortality. Variable importance was assessed using Random Forest analysis. A total of 501,391 decedents from 2397 counties were included. CART identified 10 clusters, with 77.5% relative increase in stroke mortality rates across the spectrum (28.5 vs 50.7 per 100,000 persons). CART identified 8 SEDH to guide the classification of the county clusters. Including, annual Median Household Income ($), live births with Low Birthweight (%), current adult Smokers (%), adults reporting Severe Housing Problems (%), adequate Access to Exercise (%), adults reporting Physical Inactivity (%), adults with diagnosed Diabetes (%), and adults reporting Excessive Drinking (%). In conclusion, SEDH exposures have a complex relationship with stroke. Machine learning approaches can help deconstruct this relationship and demonstrate associations that allow improved understanding of the socio-environmental drivers of stroke and development of targeted interventions.
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Affiliation(s)
- Pedro R V O Salerno
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Issam Motairek
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Weichuan Dong
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Khurram Nasir
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Neel Fotedar
- Neurological Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Setareh S Omran
- University of Colorado Health, Stroke and Brain Aneurysm Center, Anschutz Medical Campus, Aurora, CO, USA
| | - Sarju Ganatra
- Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, MA, USA
| | - Omar Hahad
- Department of Cardiology, University Medical Center Mainz, Mainz, Germany
| | - Salil V Deo
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Louis Stokes VA Medical Center, Cleveland, OH, USA
| | - Sanjay Rajagopalan
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Sadeer G Al-Kindi
- Center for Health and Nature and Department of Cardiology, Houston Methodist, Houston, TX, USA
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Rajagopalan S, Brook RD, Salerno PRVO, Bourges-Sevenier B, Landrigan P, Nieuwenhuijsen MJ, Munzel T, Deo SV, Al-Kindi S. Air pollution exposure and cardiometabolic risk. Lancet Diabetes Endocrinol 2024; 12:196-208. [PMID: 38310921 DOI: 10.1016/s2213-8587(23)00361-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 11/15/2023] [Accepted: 11/23/2023] [Indexed: 02/06/2024]
Abstract
The Global Burden of Disease assessment estimates that 20% of global type 2 diabetes cases are related to chronic exposure to particulate matter (PM) with a diameter of 2·5 μm or less (PM2·5). With 99% of the global population residing in areas where air pollution levels are above current WHO air quality guidelines, and increasing concern in regard to the common drivers of air pollution and climate change, there is a compelling need to understand the connection between air pollution and cardiometabolic disease, and pathways to address this preventable risk factor. This Review provides an up to date summary of the epidemiological evidence and mechanistic underpinnings linking air pollution with cardiometabolic risk. We also outline approaches to improve awareness, and discuss personal-level, community, governmental, and policy interventions to help mitigate the growing global public health risk of air pollution exposure.
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Affiliation(s)
- Sanjay Rajagopalan
- University Hospitals, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
| | - Robert D Brook
- Division of Cardiovascular Diseases, Department of Internal Medicine, Wayne State University, Detroit, MI, USA
| | - Pedro R V O Salerno
- University Hospitals, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | | | - Philip Landrigan
- Program for Global Public Health and the Common Good, Boston College, Boston, MA, USA; Centre Scientifique de Monaco, Monaco
| | | | - Thomas Munzel
- Department of Cardiology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany; German Center of Cardiovascular Research, Partner-Site Rhine-Main, Germany
| | - Salil V Deo
- Louis Stokes Cleveland VA Medical Center, Case Western Reserve School of Medicine, Cleveland, OH, USA
| | - Sadeer Al-Kindi
- DeBakey Heart and Vascular Center, Houston Methodist, Houston, TX, USA
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Salerno PRVO, Chen Z, Vieira de Oliveira Salerno J, Motairek I, Dazard JE, Deo S, Rajagopalan S, Al-Kindi S. Thoracic Surgery Deserts in the United States: A Geospatial Analysis. Chest 2024:S0012-3692(24)00137-5. [PMID: 38301743 DOI: 10.1016/j.chest.2024.01.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 02/03/2024] Open
Affiliation(s)
- Pedro R V O Salerno
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Zhuo Chen
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH
| | | | - Issam Motairek
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH
| | | | - Salil Deo
- Surgical Services, Louis Stokes VA Medical Center, Cleveland, OH; Western Reserve University School of Medicine, Cleveland, OH
| | - Sanjay Rajagopalan
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH; Western Reserve University School of Medicine, Cleveland, OH.
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Zelko A, Salerno PRVO, Al-Kindi S, Ho F, Rocha FP, Nasir K, Rajagopalan S, Deo S, Sattar N. Geographically Weighted Modeling to Explore Social and Environmental Factors Affecting County-Level Cardiovascular Mortality in People With Diabetes in the United States: A Cross-Sectional Analysis. Am J Cardiol 2023; 209:193-198. [PMID: 37865123 PMCID: PMC10873078 DOI: 10.1016/j.amjcard.2023.09.084] [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: 08/16/2023] [Revised: 09/15/2023] [Accepted: 09/24/2023] [Indexed: 10/23/2023]
Abstract
Disparities exist in the cardiovascular mortality rates among people with type 2 diabetes (T2D). Research has established that these disparities are often related to the environmental and social determinations of health. This study explores the spatial variation between air pollution, social determinants of health and T2D related age-adjusted cardiovascular mortality (aa-CVM) in the United States. We obtained county-level T2D related to aa-CVM (per 100,000 residents) from Centers for Disease Control and Prevention WONDER (Wide-ranging Online Data for Epidemiologic Research) (2010 to 2019). We fit a geographically weighted linear regression with aa-CVM as the outcome and the following covariates (ambient air pollution [particulate matter of 2.5 µm size], median annual household income, racial/ethnic minorities, higher education, rurality, food insecurity, and primary health care access) were included. Overall, the median aa-CVM rate was 92.9 and highest in the South (102.2). In the West, aa-CVM was significantly associated with particulate matter of 2.5 µm size, annual median household income, racial minority status and primary health care access. Food insecurity was the most significant exposure in the Midwest and Northeast, while in the South, annual median household income and food insecurity were significant. In conclusion, this study demonstrated a substantial regional variation of exposure to determinants of T2D related aa-CVM in the United States. These findings should be considered in policy frameworks and interventions as part of community-level approaches to addressing T2D related aa-CVM, and within broader state and national discussions of the importance of population health.
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Affiliation(s)
- Andrea Zelko
- College of Public Health, Kent State University, Kent, Ohio
| | - Pedro R V O Salerno
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio
| | - Sadeer Al-Kindi
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio; Case School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Fredrick Ho
- School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Fanny Petermann Rocha
- Centro de Investigación Biomédica, Facultad de Medicina, Universidad Diego Portales, Santiago, Chile; School of Metabolic and Cardiovascular Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Khurram Nasir
- Department of Cardiology, Houston Methodist Center, Houston, Texas
| | - Sanjay Rajagopalan
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio; Case School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Salil Deo
- Case School of Medicine, Case Western Reserve University, Cleveland, Ohio; School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom; Surgical Services, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio.
| | - Naveed Sattar
- School of Metabolic and Cardiovascular Sciences, University of Glasgow, Glasgow, United Kingdom
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Motairek I, Chen Z, Makhlouf MHE, Deo S, Salerno PRVO, Mentias A, Nasir K, Rajagopalan S, Al-Kindi SG. Mapping Geographic Proximity to Cardiologists Across the United States. Circ Cardiovasc Qual Outcomes 2023; 16:e010133. [PMID: 37698011 PMCID: PMC10592115 DOI: 10.1161/circoutcomes.123.010133] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Indexed: 09/13/2023]
Affiliation(s)
- Issam Motairek
- Division of Cardiovascular Medicine, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, OH (I.M., Z.C., M.H.E.M., P.R.V.O.S., S.R., S.G.A.-K.)
- Department of Internal Medicine, Cleveland Clinic Foundation, OH (I.M.)
| | - Zhuo Chen
- Division of Cardiovascular Medicine, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, OH (I.M., Z.C., M.H.E.M., P.R.V.O.S., S.R., S.G.A.-K.)
| | - Mohamed H E Makhlouf
- Division of Cardiovascular Medicine, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, OH (I.M., Z.C., M.H.E.M., P.R.V.O.S., S.R., S.G.A.-K.)
| | - Salil Deo
- Surgical Services, Louis Stokes VA Medical Center, Cleveland, OH (S.D.)
| | - Pedro R V O Salerno
- Division of Cardiovascular Medicine, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, OH (I.M., Z.C., M.H.E.M., P.R.V.O.S., S.R., S.G.A.-K.)
| | - Amgad Mentias
- Heart and Vascular Institute, Cleveland Clinic, OH (A.M.)
| | - Khurram Nasir
- Department of Cardiology, DeBakey Heart and Vascular Center, Houston Methodist Hospital, TX (K.N.)
| | - Sanjay Rajagopalan
- Division of Cardiovascular Medicine, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, OH (I.M., Z.C., M.H.E.M., P.R.V.O.S., S.R., S.G.A.-K.)
| | - Sadeer G Al-Kindi
- Division of Cardiovascular Medicine, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, OH (I.M., Z.C., M.H.E.M., P.R.V.O.S., S.R., S.G.A.-K.)
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