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Yang Q, Chang A, Tong X, Jackson SL, Merritt RK. Long-term cardiovascular disease outcomes in non-hospitalized medicare beneficiaries diagnosed with COVID-19: Population-based matched cohort study. PLoS One 2024; 19:e0302593. [PMID: 38743728 PMCID: PMC11093379 DOI: 10.1371/journal.pone.0302593] [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] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 04/08/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND SARS-CoV2, the virus that causes coronavirus disease 2019 (COVID-19), can affect multiple human organs structurally and functionally, including the cardiovascular system and brain. Many studies focused on the acute effects of COVID-19 on risk of cardiovascular disease (CVD) and stroke especially among hospitalized patients with limited follow-up time. This study examined long-term mortality, hospitalization, CVD and stroke outcomes after non-hospitalized COVID-19 among Medicare fee-for-service (FFS) beneficiaries in the United States. METHODS This retrospective matched cohort study included 944,371 FFS beneficiaries aged ≥66 years diagnosed with non-hospitalized COVID-19 from April 1, 2020, to April 30, 2021, and followed-up to May 31, 2022, and 944,371 propensity score matched FFS beneficiaries without COVID-19. Primary outcomes were all-cause mortality, hospitalization, and incidence of 15 CVD and stroke. Because most outcomes violated the proportional hazards assumption, we used restricted cubic splines to model non-proportional hazards in Cox models and presented time-varying hazard ratios (HRs) and Bonferroni corrected 95% confidence intervals (CI). RESULTS The mean age was 75.3 years; 58.0% women and 82.6% non-Hispanic White. The median follow-up was 18.5 months (interquartile range 16.5 to 20.5). COVID-19 showed initial stronger effects on all-cause mortality, hospitalization and 12 incident CVD outcomes with adjusted HRs in 0-3 months ranging from 1.05 (95% CI 1.01-1.09) for mortality to 2.55 (2.26-2.87) for pulmonary embolism. The effects of COVID-19 on outcomes reduced significantly after 3-month follow-up. Risk of mortality, acute myocardial infarction, cardiomyopathy, deep vein thrombosis, and pulmonary embolism returned to baseline after 6-month follow-up. Patterns of initial stronger effects of COVID-19 were largely consistent across age groups, sex, and race/ethnicity. CONCLUSIONS Our results showed a consistent time-varying effects of COVID-19 on mortality, hospitalization, and incident CVD among non-hospitalized COVID-19 survivors.
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Affiliation(s)
- Quanhe Yang
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Anping Chang
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Xin Tong
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Sandra L. Jackson
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Robert K. Merritt
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
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Lee JS, Bhatt A, Pollack LM, Jackson SL, Omeaku N, Beasley KL, Wilson C, Luo F, Roy K. Racial and Ethnic Differences in Hypertension-Related Telehealth and In-Person Outpatient Visits Before and During the COVID-19 Pandemic Among Medicaid Beneficiaries. Telemed J E Health 2024; 30:1262-1271. [PMID: 38241486 PMCID: PMC11065593 DOI: 10.1089/tmj.2023.0516] [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: 01/21/2024] Open
Abstract
Background: Little is known about the trends and costs of hypertension management through telehealth among individuals enrolled in Medicaid. Methods: Using MarketScan® Medicaid database, we examined outpatient visits among people with hypertension aged 18-64 years. We presented the numbers of hypertension-related telehealth and in-person outpatient visits per 100 individuals and the proportion of hypertension-related telehealth outpatient visits to total outpatient visits by month, overall, and by race and ethnicity. For the cost analysis, we presented total and patient out-of-pocket (OOP) costs per visit for telehealth and in-person visits in 2021. Results: Of the 229,562 individuals, 114,445 (49.9%) were non-Hispanic White, 80,692 (35.2%) were non-Hispanic Black, 3,924 (1.71%) were Hispanic. From February to April 2020, the number of hypertension-related telehealth outpatient visits per 100 persons increased from 0.01 to 6.13, the number of hypertension-related in-person visits decreased from 61.88 to 52.63, and the proportion of hypertension-related telehealth outpatient visits increased from 0.01% to 10.44%. During that same time, the proportion increased from 0.02% to 13.9% for non-Hispanic White adults, from 0.00% to 7.58% for non-Hispanic Black adults, and from 0.12% to 19.82% for Hispanic adults. The average total and patient OOP costs per visit in 2021 were $83.82 (95% confidence interval [CI], 82.66-85.05) and $0.55 (95% CI, 0.42-0.68) for telehealth and $264.48 (95% CI, 258.87-269.51) and $0.72 (95% CI, 0.65-0.79) for in-person visits, respectively. Conclusions: Hypertension management via telehealth increased among Medicaid recipients regardless of race and ethnicity, during the COVID-19 pandemic. These findings may inform telehealth policymakers and health care practitioners.
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Affiliation(s)
- Jun Soo Lee
- Division for Heart Disease and Stroke Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ami Bhatt
- Applied Science, Research, and Technology Inc., (ASRT Inc.), Atlanta, Georgia, USA
| | - Lisa M. Pollack
- Division for Heart Disease and Stroke Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sandra L. Jackson
- Division for Heart Disease and Stroke Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Nina Omeaku
- Applied Science, Research, and Technology Inc., (ASRT Inc.), Atlanta, Georgia, USA
| | - Kincaid Lowe Beasley
- Division for Heart Disease and Stroke Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Feijun Luo
- Division for Heart Disease and Stroke Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kakoli Roy
- National Center for Chronic Disease Prevention and Health Promotion, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Woodruff RC, Tong X, Wadhera RK, Loustalot F, Jackson SL, Vaughan AS. Cardiovascular Disease Mortality Disparities in Black and White Adults, 2010‒2022. Am J Prev Med 2024; 66:914-916. [PMID: 38101465 PMCID: PMC11034707 DOI: 10.1016/j.amepre.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/07/2023] [Accepted: 12/07/2023] [Indexed: 12/17/2023]
Affiliation(s)
- Rebecca C Woodruff
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Chamblee, Georgia.
| | - Xin Tong
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Chamblee, Georgia
| | - Rishi K Wadhera
- Section of Health Policy and Equity at the Richard A. and Susan F. Smith Center, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Fleetwood Loustalot
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Chamblee, Georgia
| | - Sandra L Jackson
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Chamblee, Georgia
| | - Adam S Vaughan
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Chamblee, Georgia
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Yang PK, Jackson SL, Charest BR, Cheng YJ, Sun YV, Raghavan S, Litkowski EM, Legvold BT, Rhee MK, Oram RA, Kuklina EV, Vujkovic M, Reaven PD, Cho K, Leong A, Wilson PWF, Zhou J, Miller DR, Sharp SA, Staimez LR, North KE, Highland HM, Phillips LS. Type 1 Diabetes Genetic Risk in 109,954 Veterans With Adult-Onset Diabetes: The Million Veteran Program (MVP). Diabetes Care 2024:dc231927. [PMID: 38608262 DOI: 10.2337/dc23-1927] [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] [Received: 10/13/2023] [Accepted: 03/11/2024] [Indexed: 04/14/2024]
Abstract
OBJECTIVE To characterize high type 1 diabetes (T1D) genetic risk in a population where type 2 diabetes (T2D) predominates. RESEARCH DESIGN AND METHODS Characteristics typically associated with T1D were assessed in 109,594 Million Veteran Program participants with adult-onset diabetes, 2011-2021, who had T1D genetic risk scores (GRS) defined as low (0 to <45%), medium (45 to <90%), high (90 to <95%), or highest (≥95%). RESULTS T1D characteristics increased progressively with higher genetic risk (P < 0.001 for trend). A GRS ≥ 90% was more common with diabetes diagnoses before age 40 years, but 95% of those participants were diagnosed at age ≥40 years, and they resembled T2D in mean age (64.3 years) and BMI (32.3 kg/m2). Compared with the low risk group, the highest-risk group was more likely to have diabetic ketoacidosis (low 0.9% vs. highest GRS 3.7%), hypoglycemia prompting emergency visits (3.7% vs. 5.8%), outpatient plasma glucose <50 mg/dL (7.5% vs. 13.4%), a shorter median time to start insulin (3.5 vs. 1.4 years), use of a T1D diagnostic code (16.3% vs. 28.1%), low C-peptide levels if tested (1.8% vs. 32.4%), and glutamic acid decarboxylase antibodies (6.9% vs. 45.2%), all P < 0.001. CONCLUSIONS Characteristics associated with T1D were increased with higher genetic risk, and especially with the top 10% of risk. However, the age and BMI of those participants resemble people with T2D, and a substantial proportion did not have diagnostic testing or use of T1D diagnostic codes. T1D genetic screening could be used to aid identification of adult-onset T1D in settings in which T2D predominates.
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Affiliation(s)
- Peter K Yang
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
- Atlanta Veterans Administration Medical Center, Atlanta, GA
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - Sandra L Jackson
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Brian R Charest
- Massachusetts Veterans Epidemiology Research and Information Center, Boston, MA
| | - Yiling J Cheng
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Yan V Sun
- Atlanta Veterans Administration Medical Center, Atlanta, GA
- Rollins School of Public Health, Emory University, Atlanta, GA
| | - Sridharan Raghavan
- Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO
- University of Colorado School of Medicine, Denver, CO
| | - Elizabeth M Litkowski
- Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO
- University of Colorado School of Medicine, Denver, CO
| | - Brian T Legvold
- Division of Endocrinology and Metabolism, Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Mary K Rhee
- Atlanta Veterans Administration Medical Center, Atlanta, GA
- Division of Endocrinology and Metabolism, Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Richard A Oram
- College of Medicine and Health, University of Exeter Medical School, Devon, U.K
| | - Elena V Kuklina
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Marijana Vujkovic
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Peter D Reaven
- Phoenix Veterans Affairs Health Care System, Phoenix, AZ
| | - Kelly Cho
- Massachusetts Veterans Epidemiology Research and Information Center, Boston, MA
- Brigham and Women's Hospital, Boston, MA
| | - Aaron Leong
- Harvard Medical School, Boston, MA
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA
- Diabetes Unit, Endocrine Division, Massachusetts General Hospital, Boston, MA
| | - Peter W F Wilson
- Atlanta Veterans Administration Medical Center, Atlanta, GA
- Rollins School of Public Health, Emory University, Atlanta, GA
- College of Medicine and Health, University of Exeter Medical School, Devon, U.K
| | - Jin Zhou
- Phoenix Veterans Affairs Health Care System, Phoenix, AZ
- UCLA Department of Medicine, University of California, Los Angeles, CA
| | | | - Seth A Sharp
- Division of Endocrinology and Diabetes, Stanford University, Palo Alto, CA
| | - Lisa R Staimez
- Rollins School of Public Health, Emory University, Atlanta, GA
| | - Kari E North
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - Heather M Highland
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - Lawrence S Phillips
- Atlanta Veterans Administration Medical Center, Atlanta, GA
- Division of Endocrinology and Metabolism, Department of Medicine, Emory University School of Medicine, Atlanta, GA
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Woodruff RC, Tong X, Khan SS, Shah NS, Jackson SL, Loustalot F, Vaughan AS. Trends in Cardiovascular Disease Mortality Rates and Excess Deaths, 2010-2022. Am J Prev Med 2024; 66:582-589. [PMID: 37972797 PMCID: PMC10957309 DOI: 10.1016/j.amepre.2023.11.009] [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: 09/07/2023] [Revised: 11/07/2023] [Accepted: 11/07/2023] [Indexed: 11/19/2023]
Abstract
INTRODUCTION Cardiovascular disease (CVD) mortality increased during the initial years of the COVID-19 pandemic, but whether these trends endured in 2022 is unknown. This analysis describes temporal trends in CVD death rates from 2010 to 2022 and estimates excess CVD deaths from 2020 to 2022. METHODS Using national mortality data from the National Vital Statistics System, deaths among adults aged ≥35 years were classified by underlying cause of death International Classification of Diseases 10th Revision codes for CVD (I00-I99), heart disease (I00-I09, I11, I13, I20-I51), and stroke (I60-I69). Analyses in Joinpoint software identified trends in CVD age-adjusted mortality rates (AAMR) per 100,000 and estimated the number of excess CVD deaths from 2020 to 2022. RESULTS During 2010-2022, 10,951,403 CVD deaths occurred (75.6% heart disease, 16.9% stroke). The national CVD AAMR declined by 8.9% from 2010 to 2019 (456.6-416.0 per 100,000) and then increased by 9.3% from 2019 to 2022 to 454.5 per 100,000, which approximated the 2010 rate (456.7 per 100,000). From 2020 to 2022, 228,524 excess CVD deaths occurred, which was 9% more CVD deaths than expected based on trends from 2010 to 2019. Results varied by CVD subtype and population subgroup. CONCLUSIONS Despite stabilization of the public health emergency, declines in CVD mortality rates reversed in 2020 and remained high in 2022, representing almost a decade of lost progress and over 228,000 excess CVD deaths. Findings underscore the importance of prioritizing prevention and management of CVD to improve outcomes.
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Affiliation(s)
- Rebecca C Woodruff
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Chamblee, Georgia.
| | - Xin Tong
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Chamblee, Georgia
| | - Sadiya S Khan
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Nilay S Shah
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Sandra L Jackson
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Chamblee, Georgia
| | - Fleetwood Loustalot
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Chamblee, Georgia
| | - Adam S Vaughan
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Chamblee, Georgia
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DeLara DL, Pollack LM, Wall HK, Chang A, Schieb L, Matthews K, Stolp H, Pack QR, Casper M, Jackson SL. County-Level Cardiac Rehabilitation and Broadband Availability: Opportunities for Hybrid Care in the United States. J Cardiopulm Rehabil Prev 2024:01273116-990000000-00145. [PMID: 38669319 DOI: 10.1097/hcr.0000000000000865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
PURPOSE Cardiac rehabilitation (CR) improves patient outcomes and quality of life and can be provided virtually through hybrid CR. However, little is known about CR availability in conjunction with broadband access, a requirement for hybrid CR. This study examined the intersection of CR and broadband availability at the county level, nationwide. METHODS Data were gathered and analyzed in 2022 from the 2019 American Community Survey, the Centers for Medicare & Medicaid Services, and the Federal Communications Commission. Spatially adaptive floating catchments were used to calculate county-level percent CR availability among Medicare fee-for-service beneficiaries. Counties were categorized: by CR availability, whether lowest (ie, CR deserts), medium, or highest; and by broadband availability, whether CR deserts with majority-available broadband, or dual deserts. Results were stratified by state. County-level characteristics were examined for statistical significance by CR availability category. RESULTS Almost half of US adults (n = 116 325 976, 47.2%) lived in CR desert counties (1691 counties). Among adults in CR desert counties, 96.8% were in CR deserts with majority-available broadband (112 626 906). By state, the percentage of the adult population living in CR desert counties ranged from 3.2% (New Hampshire) to 100% (Hawaii and Washington, DC). Statistically significant differences in county CR availability existed by race/ethnicity, education, and income. CONCLUSIONS Almost half of US adults live in CR deserts. Given that up to 97% of adults living in CR deserts may have broadband access, implementation of hybrid CR programs that include a telehealth component could expand CR availability to as many as 113 million US adults.
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Affiliation(s)
- David L DeLara
- Author Affiliations: Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia (Mr DeLara, Drs Pollack, Casper, and Jackson, and Mss Wall, Chang, Schieb, and Stolp); Office of the Associate Director for Policy and Strategy, Centers for Disease Control and Prevention, Atlanta, Georgia (Dr Matthews); ASRT Inc, Smyrna, Georgia (Ms Stolp); and Division of Cardiovascular Medicine, Baystate Medical Center, Springfield, Massachusetts (Dr Pack)
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Weng X, Woodruff RC, Park S, Thompson-Paul AM, He S, Hayes D, Kuklina EV, Therrien NL, Jackson SL. Hypertension Prevalence and Control Among U.S. Women of Reproductive Age. Am J Prev Med 2024; 66:492-502. [PMID: 37884175 PMCID: PMC10922595 DOI: 10.1016/j.amepre.2023.10.016] [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: 07/25/2023] [Revised: 10/19/2023] [Accepted: 10/20/2023] [Indexed: 10/28/2023]
Abstract
INTRODUCTION Hypertension is a risk factor for cardiovascular disease, a leading cause of death among women of reproductive age (women aged 18-44 years). This study estimated hypertension prevalence and control among women of reproductive age at the national and state levels using electronic health record data. METHODS Nonpregnant women of reproductive age were included in this cross-sectional study using 2019 IQVIA Ambulatory Electronic Medical Records - U.S. national data (analyzed in 2023). Suspected hypertension was identified using any of these criteria: ≥1 hypertension diagnosis code, ≥2 blood pressure readings ≥140/90 mmHg on separate days, or ≥1 antihypertensive medication. Among women of reproductive age with hypertension, the latest blood pressure in 2019 was used to identify hypertension control (blood pressure <140/90 mmHg). Estimates were age standardized and stratified by race or Hispanic ethnicity, region, and states with sufficient data. Tukey tests compared estimates by race or Hispanic ethnicity, region, and comorbidities. RESULTS Among 2,125,084 women of reproductive age (62.1% White, 8.8% Black, and 29.1% other [including Hispanic, Asian, other, or unknown]) with a mean age of 31.7 years, hypertension prevalence was 14.5%. Of those with hypertension, 71.9% had controlled blood pressure. Black women of reproductive age had a higher hypertension prevalence (22.3% vs 14.4%, p<0.05) but lower control (60.6% vs 74.0%, p<0.05) than White women of reproductive age. State-level hypertension prevalence ranged from 13.7% (Massachusetts) to 36% (Alabama), and control ranged from 82.9% (Kansas) to 59.2% (the District of Columbia). CONCLUSIONS This study provides the first state-level estimates of hypertension control among women of reproductive age. Electronic health record data complements traditional hypertension surveillance data and provides further information for efforts to prevent and manage hypertension among women of reproductive age.
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Affiliation(s)
- Xingran Weng
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia; Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Rebecca C Woodruff
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Soyoun Park
- Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Angela M Thompson-Paul
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia; United States Public Health Service, Rockville, Maryland
| | - Siran He
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Donald Hayes
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Elena V Kuklina
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nicole L Therrien
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sandra L Jackson
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Zhang Z, Jackson SL, Steele EM, Hayes DK, Yang Q. Relationship Between Ultra-Processed and Minimally Processed Food Intake and Cardiovascular Health Among US Women of Reproductive Age. J Womens Health (Larchmt) 2024. [PMID: 38386796 DOI: 10.1089/jwh.2023.0739] [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: 02/24/2024] Open
Abstract
Objectives: Ultra-processed food (UPF) intake is associated with worse cardiovascular health (CVH), but associations between unprocessed/minimally processed foods (MPFs) and CVH are limited, especially among women of reproductive age (WRA). Materials and Methods: For 5,773 WRA (20-44 years) in National Health and Nutrition Examination Survey (NHANES) 2007-2018, we identified UPFs and MPFs using the Nova classification and based on 24-hour dietary recalls. We calculated usual percentages of calories from UPFs and MPFs using the National Cancer Institute's usual intake method. Seven CVH metrics were scored, and CVH levels were grouped by tertile. We used multivariable linear and multinomial logistic regression to assess associations between UPFs and MPFs and CVH. Results: The average usual percentage of calories from UPFs and MPFs was 57.2% and 29.3%, respectively. There was a graded, positive association between higher UPF intake and higher odds of poor CVH: adjusted odds ratios (aORs) for the lowest versus highest CVH were 1.74 (95% confidence interval: 1.51-2.01), 2.67 (2.07-3.44) and 4.66 (3.13-6.97), respectively, comparing quartile 2 (Q2)-Q4 to the lowest quartile (Q1) of UPF intake. Higher MPF intake was associated with lower odds of poor CVH: aORs for the lowest CVH were 0.61 (0.54-0.69), 0.39 (0.31-0.50), and 0.21 (0.14-0.31). Patterns of association remained consistent across subgroups and in sensitivity analyses. Conclusions: Higher UPF intake was associated with worse CVH, while higher MPF intake was associated with better CVH among WRA in the United States. Our analyses highlight an opportunity for WRA to improve nutrition and their CVH.
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Affiliation(s)
- Zefeng Zhang
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sandra L Jackson
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Euridice Martinez Steele
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
- Center for Epidemiological Studies in Health and Nutrition, University of São Paulo, São Paulo, Brazil
| | - Donald K Hayes
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Quanhe Yang
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Zhang D, Lee JS, Pollack LM, Dong X, Taliano JM, Rajan A, Therrien NL, Jackson SL, Popoola A, Luo F. Association of Economic Policies With Hypertension Management and Control: A Systematic Review. JAMA Health Forum 2024; 5:e235231. [PMID: 38334993 PMCID: PMC10858400 DOI: 10.1001/jamahealthforum.2023.5231] [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] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 11/30/2023] [Indexed: 02/10/2024] Open
Abstract
Importance Economic policies have the potential to impact management and control of hypertension. Objectives To review the evidence on the association between economic policies and hypertension management and control among adults with hypertension in the US. Evidence Review A search was carried out of PubMed/MEDLINE, Cochrane Library, Embase, PsycINFO, CINAHL, EconLit, Sociological Abstracts, and Scopus from January 1, 2000, through November 1, 2023. Included were randomized clinical trials, difference-in-differences, and interrupted time series studies that evaluated the association of economic policies with hypertension management. Economic policies were grouped into 3 categories: insurance coverage expansion such as Medicaid expansion, cost sharing in health care such as increased drug copayments, and financial incentives for quality such as pay-for-performance. Antihypertensive treatment was measured as taking antihypertensive medications or medication adherence among those who have a hypertension diagnosis; and hypertension control, measured as blood pressure (BP) lower than 140/90 mm Hg or a reduction in BP. Evidence was extracted and synthesized through dual review of titles, abstracts, full-text articles, study quality, and policy effects. Findings In total, 31 articles were included. None of the studies examined economic policies outside of the health care system. Of these, 16 (52%) assessed policies for insurance coverage expansion, 8 (26%) evaluated policies related to patient cost sharing for prescription drugs, and 7 (22%) evaluated financial incentive programs for improving health care quality. Of the 16 studies that evaluated coverage expansion policies, all but 1 found that policies such as Medicare Part D and Medicaid expansion were associated with significant improvement in antihypertensive treatment and BP control. Among the 8 studies that examined patient cost sharing, 4 found that measures such as prior authorization and increased copayments were associated with decreased adherence to antihypertensive medication. Finally, all 7 studies evaluating financial incentives aimed at improving quality found that they were associated with improved antihypertensive treatment and BP control. Overall, most studies had a moderate or low risk of bias in their policy evaluation. Conclusions and Relevance The findings of this systematic review suggest that economic policies aimed at expanding insurance coverage or improving health care quality successfully improved medication use and BP control among US adults with hypertension. Future research is needed to investigate the potential effects of non-health care economic policies on hypertension control.
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Affiliation(s)
- Donglan Zhang
- Center for Population Health and Health Services Research, Department of Foundations of Medicine, New York University Grossman Long Island School of Medicine, Mineola
- Department of Population Health, New York University Grossman School of Medicine, New York
| | - Jun Soo Lee
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lisa M. Pollack
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Xiaobei Dong
- Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee
| | - Joanna M. Taliano
- Office of Science Quality and Library Services, Office of Science, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Anand Rajan
- Center for Population Health and Health Services Research, Department of Foundations of Medicine, New York University Grossman Long Island School of Medicine, Mineola
| | - Nicole L. Therrien
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sandra L. Jackson
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Adebola Popoola
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Feijun Luo
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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Koyama AK, McKeever Bullard K, Xu F, Onufrak S, Jackson SL, Saelee R, Miyamoto Y, Pavkov ME. Prevalence of Cardiometabolic Diseases Among Racial and Ethnic Subgroups in Adults - Behavioral Risk Factor Surveillance System, United States, 2013-2021. MMWR Morb Mortal Wkly Rep 2024; 73:51-56. [PMID: 38271277 PMCID: PMC10824545 DOI: 10.15585/mmwr.mm7303a1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
Although diabetes and cardiovascular disease account for substantial disease prevalence among adults in the United States, their prevalence among racial and ethnic subgroups is inadequately characterized. To fill this gap, CDC described the prevalence of diagnosed cardiometabolic diseases among U.S. adults, by disaggregated racial and ethnic subgroups, among 3,970,904 respondents to the Behavioral Risk Factor Surveillance System during 2013-2021. Prevalence of each disease (diabetes, myocardial infarction, angina or coronary heart disease, and stroke), stratified by race and ethnicity, was based on self-reported diagnosis by a health care professional, adjusting for age, sex, and survey year. Overall, mean respondent age was 47.5 years, and 51.4% of respondents were women. Prevalence of cardiometabolic diseases among disaggregated race and ethnicity subgroups varied considerably. For example, diabetes prevalence within the aggregated non-Hispanic Asian category (11.5%) ranged from 6.3% in the Vietnamese subgroup to 15.2% in the Filipino subgroup. Prevalence of angina or coronary heart disease for the aggregated Hispanic or Latino category (3.8%) ranged from 3.1% in the Cuban subgroup to 6.3% in the Puerto Rican subgroup. Disaggregation of cardiometabolic disease prevalence data by race and ethnicity identified health disparities among subgroups that can be used to better help guide prevention programs and develop culturally relevant interventions.
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Lee JS, Bhatt A, Jackson SL, Pollack LM, Omeaku N, Beasley KL, Wilson C, Luo F, Roy K. Rural and Urban Differences in Hypertension Management Through Telehealth Before and During the COVID-19 Pandemic Among Commercially Insured Patients. Am J Hypertens 2024; 37:107-111. [PMID: 37772661 PMCID: PMC10900132 DOI: 10.1093/ajh/hpad093] [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: 09/18/2023] [Revised: 09/25/2023] [Accepted: 09/26/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic prompted a rapid increase in telehealth use. However, limited evidence exists on how rural and urban residents used telehealth and in-person outpatient services to manage hypertension during the pandemic. METHODS This longitudinal study analyzed 701,410 US adults (18-64 years) in the MarketScan Commercial Claims Database, who were continuously enrolled from January 2017 through March 2022. We documented monthly numbers of hypertension-related telehealth and in-person outpatient visits (per 100 individuals), and the proportion of telehealth visits among all hypertension-related outpatient visits, from January 2019 through March 2022. We used Welch's two-tail t-test to differentiate monthly estimates by rural-urban status and month-to-month changes. RESULTS From February through April 2020, the monthly number of hypertension-related telehealth visits per 100 individuals increased from 0.01 to 6.05 (P < 0.001) for urban residents and from 0.01 to 4.56 (P < 0.001) for rural residents. Hypertension-related in-person visits decreased from 20.12 to 8.30 (P < 0.001) for urban residents and from 20.48 to 10.15 (P < 0.001) for rural residents. The proportion of hypertension-related telehealth visits increased from 0.04% to 42.15% (P < 0.001) for urban residents and from 0.06% to 30.98% (P < 0.001) for rural residents. From March 2020 to March 2022, the monthly average of the proportions of hypertension-related telehealth visits was higher for urban residents than for rural residents (10.19% vs. 6.96%; P < 0.001). CONCLUSIONS Data show that rural residents were less likely to use telehealth for hypertension management. Understanding trends in hypertension-related telehealth utilization can highlight disparities in the sustained use of telehealth to advance accessible health care.
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Affiliation(s)
- Jun Soo Lee
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ami Bhatt
- Applied Science, Research, and Technology Inc. (ASRT Inc.), Atlanta, Georgia, USA
| | - Sandra L. Jackson
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lisa M. Pollack
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Nina Omeaku
- Applied Science, Research, and Technology Inc. (ASRT Inc.), Atlanta, Georgia, USA
| | - Kincaid Lowe Beasley
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Feijun Luo
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kakoli Roy
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Lee JS, Bhatt A, Pollack LM, Jackson SL, Chang JE, Tong X, Luo F. Telehealth use during the early COVID-19 public health emergency and subsequent health care costs and utilization. Health Aff Sch 2024; 2. [PMID: 38410743 PMCID: PMC10895996 DOI: 10.1093/haschl/qxae001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
Telehealth utilization increased during the COVID-19 pandemic, yet few studies have documented associations of telehealth use with subsequent medical costs and health care utilization. We examined associations of telehealth use during the early COVID-19 public health emergency (March-June 2020) with subsequent total medical costs and health care utilization among people with heart disease (HD). We created a longitudinal cohort of individuals with HD using MarketScan Commercial Claims data (2018-2022). We used difference-in-differences methodology adjusting for patients' characteristics, comorbidities, COVID-19 infection status, and number of in-person visits. We found that using telehealth during the stay-at-home order period was associated with a reduction in total medical costs (by -$1814 per person), number of emergency department visits (by -88.6 per 1000 persons), and number of inpatient admissions (by -32.4 per 1000 persons). Telehealth use increased per-person per-year pharmacy prescription claims (by 0.514) and average number of days' drug supply (by 0.773 days). These associated benefits of telehealth use can inform decision makers, insurance companies, and health care professionals, especially in the context of disrupted health care access.
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Affiliation(s)
- Jun Soo Lee
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30341, United States
| | - Ami Bhatt
- ASRT, Inc, Atlanta, GA 30346, United States
| | - Lisa M Pollack
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30341, United States
| | - Sandra L Jackson
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30341, United States
| | - Ji Eun Chang
- Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, NY 10003, United States
| | - Xin Tong
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30341, United States
| | - Feijun Luo
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30341, United States
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Fulmer EB, Rasool A, Jackson SL, Vaughan M, Luo F. A National Approach to Promoting Health Equity in Cardiovascular Disease Prevention: Implementation Science Strengths, Opportunities, and a Changing Chronic Disease Context. Prev Sci 2024:10.1007/s11121-023-01585-3. [PMID: 38190045 DOI: 10.1007/s11121-023-01585-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2023] [Indexed: 01/09/2024]
Abstract
In the USA, structural racism contributes to higher rates of cardiovascular disease (CVD) including hypertension, heart disease, and stroke among African American persons. Evidence-based interventions (EBIs), which include programs, policies, and practices, can help mitigate health inequities, but have historically been underutilized or misapplied among communities experiencing discrimination and exclusion. This commentary on the special issue of Prevention Science, "Advancing the Adaptability of Chronic Disease Prevention and Management Through Implementation Science," describes the Centers for Disease Control and Prevention, Division for Heart Disease and Stroke Prevention's (DHDSP's) efforts to support implementation practice and highlights several studies in the issue that align with DHDSP's methods and mission. This work includes EBI identification, scale, and spread as well as health services and policy research. We conclude that implementation practice to enhance CVD health equity will require greater coordination with diverse implementation science partners as well as continued innovation and capacity building to ensure meaningful community engagement throughout EBI development, translation, dissemination, and implementation.
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Affiliation(s)
- Erika B Fulmer
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, 4770 Buford Highway, Building 107, Atlanta, GA, 30341, USA.
| | - Aysha Rasool
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, 4770 Buford Highway, Building 107, Atlanta, GA, 30341, USA
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | - Sandra L Jackson
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, 4770 Buford Highway, Building 107, Atlanta, GA, 30341, USA
| | - Marla Vaughan
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, 4770 Buford Highway, Building 107, Atlanta, GA, 30341, USA
| | - Feijun Luo
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, 4770 Buford Highway, Building 107, Atlanta, GA, 30341, USA
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He S, Park S, Fujii Y, Pierce SL, Kraus EM, Wall HK, Therrien NL, Jackson SL. State-Level Hypertension Prevalence and Control Among Adults in the U.S. Am J Prev Med 2024; 66:46-54. [PMID: 37877903 PMCID: PMC10898652 DOI: 10.1016/j.amepre.2023.09.010] [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: 06/16/2023] [Revised: 09/08/2023] [Accepted: 09/08/2023] [Indexed: 10/26/2023]
Abstract
INTRODUCTION Improving hypertension control is a national priority. Electronic health record data have the potential to augment traditional surveillance systems. This study aimed to assess hypertension prevalence and control at the state level using a previously established electronic health record-based phenotype for hypertension. METHODS Adult patients (N=11,031,368) were included from the IQVIA ambulatory electronic medical record-U.S. 2019 data set. IQVIA ambulatory electronic medical record comprises electronic health records from >100,000 providers and includes patients from every U.S. state and Washington DC. Authors compared hypertension prevalence and control estimates against those from the Behavioral Risk Factor Surveillance System 2019. Results were age-standardized and stratified by state and sociodemographic characteristics. Statistical analyses were conducted in 2022-2023. RESULTS IQVIA ambulatory electronic medical record-U.S. patients had a median age of 55 years, and 56.7% were women. Overall age-standardized hypertension prevalence was higher in IQVIA ambulatory electronic medical record-U.S. (35.0%) than in the Behavioral Risk Factor Surveillance System (29.7%), however, state-level geographic patterns were similar, with the highest burden in the South and Appalachia. Similar patterns were also observed by sociodemographic characteristics in both data sets: hypertension prevalence was higher in older age groups (than younger), men (than women), and Black patients (than other races). Hypertension control varied widely across states: among states with >1% data coverage, control rates were lowest in Nevada (51.1%), Washington DC (52.0%), and Mississippi (55.2%); highest in Kansas (73.4%), New Jersey (72.3%), and Iowa (71.9%). CONCLUSIONS This study provided the first-ever estimates of hypertension control for all states and Washington DC. Electronic health record-based surveillance could support hypertension prevention and control efforts at the state level.
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Affiliation(s)
- Siran He
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Soyoun Park
- Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta Georgia
| | - Yui Fujii
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia; Bizzell U.S., New Carrollton, Maryland
| | - Samantha L Pierce
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Emily M Kraus
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia; Public Health Informatics Institute, Taskforce for Global Health, Decatur, Georgia; Kraushold Consulting, Denver, Colorado
| | - Hilary K Wall
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nicole L Therrien
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sandra L Jackson
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Essaid S, Andre J, Brooks IM, Hohman KH, Hull M, Jackson SL, Kahn MG, Kraus EM, Mandadi N, Martinez AK, Mui JY, Zambarano B, Soares A. MENDS-on-FHIR: Leveraging the OMOP common data model and FHIR standards for national chronic disease surveillance. medRxiv 2023:2023.08.09.23293900. [PMID: 38045364 PMCID: PMC10690355 DOI: 10.1101/2023.08.09.23293900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Objective The Multi-State EHR-Based Network for Disease Surveillance (MENDS) is a population-based chronic disease surveillance distributed data network that uses institution-specific extraction-transformation-load (ETL) routines. MENDS-on-FHIR examined using Health Language Seven's Fast Healthcare Interoperability Resources (HL7 ® FHIR ® ) and US Core Implementation Guide (US Core IG) compliant resources derived from the Observational Medical Outcomes Partnership (OMOP) Common Data Model (CDM) to create a standards-based ETL pipeline. Materials and Methods The input data source was a research data warehouse containing clinical and administrative data in OMOP CDM Version 5.3 format. OMOP-to-FHIR transformations, using a unique JavaScript Object Notation (JSON)-to-JSON transformation language called Whistle, created FHIR R4 V4.0.1/US Core IG V4.0.0 conformant resources that were stored in a local FHIR server. A REST-based Bulk FHIR $export request extracted FHIR resources to populate a local MENDS database. Results Eleven OMOP tables were used to create 10 FHIR/US Core compliant resource types. A total of 1.13 trillion resources were extracted and inserted into the MENDS repository. A very low rate of non-compliant resources was observed. Discussion OMOP-to-FHIR transformation results passed validation with less than a 1% non-compliance rate. These standards-compliant FHIR resources provided standardized data elements required by the MENDS surveillance use case. The Bulk FHIR application programming interface (API) enabled population-level data exchange using interoperable FHIR resources. The OMOP-to-FHIR transformation pipeline creates a FHIR interface for accessing OMOP data. Conclusion MENDS-on-FHIR successfully replaced custom ETL with standards-based interoperable FHIR resources using Bulk FHIR. The OMOP-to-FHIR transformations provide an alternative mechanism for sharing OMOP data. LAY ABSTRACT Many chronic conditions, such as hypertension, obesity, and diabetes are becoming more prevalent, especially in high-risk individuals, such as minorities and low-income patients. Public health surveillance networks measure the presence of specific conditions repeatedly over time, seeking to detect changes in the amount of a disease conditions so that public health officials can implement new early-prevention programs or evaluate the impact of an existing prevention program. Data stored in electronic health records (EHRs) could be used to measure the presence of health conditions, but significant technical barriers make current methods for data extraction laborious and costly. HL7 BULK FHIR is a new data standard that is required to be available in all commercial EHR systems in the United States. We examined the use of BULK FHIR to provide EHR data to an existing public health surveillance network called MENDS. We found that HL7 BULK FHIR can provide the necessary data elements for MENDS in a standardized format. Using HL7 BULK FHIR could significantly reduce barriers to data for public health surveillance needs, enabling public health officials to expand the diversity of locations and patient populations being monitored.
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He S, Park S, Kuklina E, Therrien NL, Lundeen EA, Wall HK, Lampley K, Kompaniyets L, Pierce SL, Sperling L, Jackson SL. Leveraging Electronic Health Records to Construct a Phenotype for Hypertension Surveillance in the United States. Am J Hypertens 2023; 36:677-685. [PMID: 37696605 PMCID: PMC10898654 DOI: 10.1093/ajh/hpad081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 05/10/2023] [Accepted: 09/06/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Hypertension is an important risk factor for cardiovascular diseases. Electronic health records (EHRs) may augment chronic disease surveillance. We aimed to develop an electronic phenotype (e-phenotype) for hypertension surveillance. METHODS We included 11,031,368 eligible adults from the 2019 IQVIA Ambulatory Electronic Medical Records-US (AEMR-US) dataset. We identified hypertension using three criteria, alone or in combination: diagnosis codes, blood pressure (BP) measurements, and antihypertensive medications. We compared AEMR-US estimates of hypertension prevalence and control against those from the National Health and Nutrition Examination Survey (NHANES) 2017-18, which defined hypertension as BP ≥130/80 mm Hg or ≥1 antihypertensive medication. RESULTS The study population had a mean (SD) age of 52.3 (6.7) years, and 56.7% were women. The selected three-criteria e-phenotype (≥1 diagnosis code, ≥2 BP measurements of ≥130/80 mm Hg, or ≥1 antihypertensive medication) yielded similar trends in hypertension prevalence as NHANES: 42.2% (AEMR-US) vs. 44.9% (NHANES) overall, 39.0% vs. 38.7% among women, and 46.5% vs. 50.9% among men. The pattern of age-related increase in hypertension prevalence was similar between AEMR-US and NHANES. The prevalence of hypertension control in AEMR-US was 31.5% using the three-criteria e-phenotype, which was higher than NHANES (14.5%). CONCLUSIONS Using an EHR dataset of 11 million adults, we constructed a hypertension e-phenotype using three criteria, which can be used for surveillance of hypertension prevalence and control.
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Affiliation(s)
- Siran He
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Soyoun Park
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Elena Kuklina
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Nicole L Therrien
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Elizabeth A Lundeen
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Hilary K Wall
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Katrice Lampley
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
- ASRT, INC, Smyrna, GA, USA
| | - Lyudmyla Kompaniyets
- 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
| | - Samantha L Pierce
- 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
| | - Laurence Sperling
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sandra L Jackson
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Jackson SL, Woodruff RC, Nagavedu K, Fearrington J, Rolka DB, Twentyman E, Carton TW, Puro J, Denson JL, Kappelman MD, Paranjape A, Thacker D, Weiner MG, Goodman AB, Lekiachvili A, Boehmer TK, Block JP. Association Between Hypertension and Diabetes Control and COVID-19 Severity: National Patient-Centered Clinical Research Network, United States, March 2020 to February 2022. J Am Heart Assoc 2023; 12:e030240. [PMID: 37850404 PMCID: PMC10727406 DOI: 10.1161/jaha.122.030240] [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: 03/29/2023] [Accepted: 08/15/2023] [Indexed: 10/19/2023]
Abstract
Background Hypertension and diabetes are associated with increased COVID-19 severity. The association between level of control of these conditions and COVID-19 severity is less well understood. Methods and Results This retrospective cohort study identified adults with COVID-19, March 2020 to February 2022, in 43 US health systems in the National Patient-Centered Clinical Research Network. Hypertension control was categorized as blood pressure (BP) <130/80, 130 to 139/80 to 89, 140 to 159/90 to 99, or ≥160/100 mm Hg, and diabetes control as glycated hemoglobin <7%, 7% to <9%, ≥9%. Adjusted, pooled logistic regression assessed associations between hypertension and diabetes control and severe COVID-19 outcomes. Among 1 494 837 adults with COVID-19, 43% had hypertension and 12% had diabetes. Among patients with hypertension, the highest baseline BP was associated with greater odds of hospitalization (adjusted odds ratio [aOR], 1.30 [95% CI, 1.23-1.37] for BP ≥160/100 versus BP <130/80), critical care (aOR, 1.30 [95% CI, 1.21-1.40]), and mechanical ventilation (aOR, 1.32 [95% CI, 1.17-1.50]) but not mortality (aOR, 1.08 [95% CI, 0.98-1.12]). Among patients with diabetes, the highest glycated hemoglobin was associated with greater odds of hospitalization (aOR, 1.61 [95% CI, 1.47-1.76] for glycated hemoglobin ≥9% versus <7%), critical care (aOR, 1.42 [95% CI, 1.31-1.54]), mechanical ventilation (aOR, 1.12 [95% CI, 1.02-1.23]), and mortality (aOR, 1.18 [95% CI, 1.09-1.27]). Black and Hispanic adults were more likely than White adults to experience severe COVID-19 outcomes, independent of comorbidity score and control of hypertension or diabetes. Conclusions Among 1.5 million patients with COVID-19, higher BP and glycated hemoglobin were associated with more severe COVID-19 outcomes. Findings suggest that adults with poorest control of hypertension or diabetes might benefit from efforts to prevent and initiate early treatment of COVID-19.
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Affiliation(s)
- Sandra L. Jackson
- Division for Heart Disease and Stroke PreventionNational Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and PreventionAtlantaGA
| | - Rebecca C. Woodruff
- Division for Heart Disease and Stroke PreventionNational Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and PreventionAtlantaGA
| | - Kshema Nagavedu
- Department of Population MedicineHarvard Pilgrim Health Care Institute, Harvard Medical SchoolBostonMA
| | - Julia Fearrington
- Department of Population MedicineHarvard Pilgrim Health Care Institute, Harvard Medical SchoolBostonMA
| | - Deborah B. Rolka
- Division of Diabetes TranslationNational Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and PreventionAtlantaGA
| | - Evelyn Twentyman
- Office of the DirectorNational Center for Immunizations and Respiratory Diseases, Centers for Disease Control and PreventionAtlantaGA
| | | | | | - Joshua L. Denson
- Section of Pulmonary, Critical Care, and Environmental MedicineTulane University School of MedicineNew OrleansLA
| | - Michael D. Kappelman
- Department of Pediatrics, UNC School of MedicineThe University of North Carolina at Chapel HillChapel HillNC
| | | | | | - Mark G. Weiner
- Department of Population Health SciencesWeill Cornell MedicineNew YorkNY
| | - Alyson B. Goodman
- Division of Nutrition, Physical Activity, and ObesityNational Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and PreventionAtlantaGA
| | - Akaki Lekiachvili
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and PreventionAtlantaGA
| | - Tegan K. Boehmer
- Office of Public Health Data, Surveillance, and TechnologyCenters for Disease Control and PreventionAtlantaGA
| | - Jason P. Block
- Division of Chronic Disease Research Across the Lifecourse (CoRAL)Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical SchoolBostonMA
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Zhang Z, Jackson SL, Gillespie C, Merritt R, Yang Q. Depressive Symptoms and Mortality Among US Adults. JAMA Netw Open 2023; 6:e2337011. [PMID: 37812418 PMCID: PMC10562940 DOI: 10.1001/jamanetworkopen.2023.37011] [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: 06/08/2023] [Accepted: 08/19/2023] [Indexed: 10/10/2023] Open
Abstract
Importance Depression is a common mental health disorder in the US. Depressive symptoms have been associated with increased cardiovascular disease incidence and mortality, but studies have largely focused on narrow population subgroups. Objective To examine the association between depressive symptoms and mortality in a large, diverse, nationally representative sample of US adults, and to examine how lifestyle factors mediate this association. Design, Setting, and Participants This was a prospective cohort study of a nationally representative sample of US adults using National Health and Nutrition Examination Survey 2005 to 2018 data linked with the National Death Index through 2019 for adults aged 20 years and older. Data were analyzed between March 1 and May 26, 2023. Main Outcomes and Measures All-cause, cardiovascular disease, and ischemic heart disease mortality. Depressive symptoms were defined by Patient Health Questionnaire-9 scores and were categorized as none or minimal, mild, and moderate to severe. Secondarily, we assessed degree of mediation by lifestyle factors. Results A total of 23 694 participants were included (unweighted n = 11 862 male [weighted 49.8%]; mean [SE] age, 44.7 [0.24] years). Prevalences of mild and moderate to severe depression were 14.9% and 7.2%, respectively. For all-cause mortality, hazard ratios were 1.35 (95% CI, 1.07-1.72) for mild depressive symptoms vs none and 1.62 (95% CI, 1.24-2.12) for moderate to severe depressive symptoms vs none. The corresponding hazard ratios were 1.49 (95% CI, 1.11-2.00) and 1.79 (95% CI, 1.22-2.62) for cardiovascular disease mortality and 0.96 (95% CI, 0.58-1.60) and 2.21 (95% CI, 1.24-3.91) for ischemic heart disease mortality. The associations were largely consistent across subgroups. Approximately 11.0% to 16.1% of the associations between depression and mortality could be explained by lifestyle factors. Feeling tired or having little energy, poor appetite or overeating, and having little interest in doing things were independently associated with all-cause and cardiovascular disease mortality but not with ischemic heart disease mortality. Conclusions and Relevance In this prospective cohort study of a nationally representative sample of US adults, there was a graded positive association between depressive symptoms and mortality. Public health efforts to improve awareness and treatment of depression and associated risk factors could support a comprehensive, nationwide strategy to reduce the burden of depression.
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Affiliation(s)
- Zefeng Zhang
- Division for Heart Disease and Stroke Prevention, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sandra L. Jackson
- Division for Heart Disease and Stroke Prevention, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Cathleen Gillespie
- Division for Heart Disease and Stroke Prevention, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Robert Merritt
- Division for Heart Disease and Stroke Prevention, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Quanhe Yang
- Division for Heart Disease and Stroke Prevention, US Centers for Disease Control and Prevention, Atlanta, Georgia
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19
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Shahi S, Jackson SL, Streeter TE, He S, Wall HK. Cuff Size Variation Across Manufacturers of Home Blood Pressure Devices: A Current Patient Dilemma. Am J Hypertens 2023; 36:532-535. [PMID: 37422909 DOI: 10.1093/ajh/hpad060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 07/06/2023] [Indexed: 07/11/2023] Open
Abstract
BACKGROUND The American Heart Association (AHA) recommends cuff sizes of blood pressure (BP) monitoring devices based on patient arm circumference, which is critical for accurate BP measurement. This study aimed to assess cuff size variation across validated BP devices and to examine the degree of alignment with the AHA recommendations. METHODS Data on home BP devices were obtained from the US BP Validated Device Listing website and listed cuff sizes were compared against AHA recommendations: small adult (22-26 cm), adult (27-34 cm), large (35-44 cm), and extra-large (XL) (45-52 cm). RESULTS There were 42 home validated BP devices from 13 manufacturers, and none offered cuffs that were aligned with the AHA recommendations. Over half of the devices (22, 52.4%) were compatible with only a broad-range cuff, generally excluding arm sizes larger than 44 cm. Only 5 devices from 4 manufacturers offered a cuff labeled "XL," and of these, only 3 devices had sizes that covered the AHA XL range. Terminology lacked consistency with manufacturers using: different labels to describe the same-sized cuffs (e.g., 22-42 cm was labeled "integrated," "standard," "adult," "large," and "wide range"); the same labels to describe differently sized cuffs (e.g., cuffs labeled "large" were sized 22-42 cm, 32-38 cm, 32-42 cm, 36-45 cm). CONCLUSIONS Manufacturers of US home BP devices employ inconsistent terminologies and thresholds for cuff sizes, and sizes were not aligned with AHA recommendations. This lack of standardization could pose challenges for clinicians and patients attempting to select a properly sized cuff to support hypertension diagnosis and management.
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Affiliation(s)
- Shamim Shahi
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sandra L Jackson
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Taylor E Streeter
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Siran He
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Hilary K Wall
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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20
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Hohman KH, Zambarano B, Klompas M, Wall HK, Kraus EM, Carton TW, Jackson SL. Development of a Hypertension Electronic Phenotype for Chronic Disease Surveillance in Electronic Health Records: Key Analytic Decisions and Their Effects. Prev Chronic Dis 2023; 20:E80. [PMID: 37708339 PMCID: PMC10516201 DOI: 10.5888/pcd20.230026] [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] [Subscribe] [Scholar Register] [Indexed: 09/16/2023] Open
Abstract
INTRODUCTION Modernizing chronic disease surveillance with electronic health record (EHR) data may provide better data to improve hypertension prevention and control, but no consensus exists for an EHR-based surveillance definition for hypertension. The Multi-State EHR-Based Network for Disease Surveillance (MENDS) pilot surveillance system was used to develop and test an electronic phenotype for hypertension. METHODS We used MENDS data from 1,671,279 patients in Louisiana to examine the effect of different analytic decisions on estimates of hypertension prevalence. Decisions included 1) whether to restrict surveillance to patients with recent blood pressure measurements, 2) varying the number and recency of encounters to define the population at risk of hypertension, 3) how to define hypertension (diagnosis codes, antihypertensive medication, blood pressure measurements, or combinations of these), and 4) how to handle multiple blood pressure measurements on the same day. Results were compared with independent estimates of hypertension prevalence in Louisiana from the Behavioral Risk Factor Surveillance System (BRFSS). RESULTS Applying varying criteria resulted in hypertension prevalence estimates ranging from 19.7% to 59.3%. A hypertension surveillance strategy that includes a population with at least 1 clinical encounter with measured blood pressure in the previous 2 years and identifies hypertension using all available data (≥1 diagnosis code, ≥1 antihypertensive medication, and ≥2 elevated blood pressure values ≥140/90 mm Hg on separate days) generated estimates in line with population-based survey data. This definition estimated the crude 2019 hypertension prevalence in the state of Louisiana as 43.4% (age-adjusted, 41.0%), comparable with the crude BRFSS estimate of 39.7% (age adjusted, 37.1%). CONCLUSION Applying different criteria to define hypertension using EHR data has a large effect on hypertension prevalence estimates. The proposed electronic phenotype generates hypertension prevalence estimates that align with independent estimates from BRFSS.
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Affiliation(s)
- Katherine H Hohman
- National Association of Chronic Disease Directors, 101 W Ponce de Leon, Decatur, GA 30030
| | | | - Michael Klompas
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Hilary K Wall
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Emily M Kraus
- Independent Consultant to Public Health Informatics Institute, a program of the Task Force for Global Health, Decatur, Georgia
| | | | - Sandra L Jackson
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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21
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Yang PK, Park S, Jackson SL, Attipoe-Dorcoo S, Gray E, Ritchey MD, Sperling LS. Trends and Characteristics of Blood Pressure Prescription Fills Before and During the COVID-19 Pandemic in the United States. Am J Hypertens 2023; 36:439-445. [PMID: 37086191 PMCID: PMC10345475 DOI: 10.1093/ajh/hpad036] [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: 07/14/2022] [Revised: 11/15/2022] [Accepted: 04/18/2023] [Indexed: 04/23/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic disrupted healthcare in the United States and raised concerns about certain antihypertensives, and may have impacted both prescribing practices and access to blood pressure (BP) medications. METHODS We assessed trends in BP prescription fills before and during the first year of the COVID-19 pandemic, using cross-sectional data for BP fills and tablets in the IQVIA (IMS Health) National Prescription Audit® database. Drugs filled via retail (92% coverage), mail-order (78% coverage), and long-term care (72% coverage) channels from January 2018 through December 2020 were included. Data were projected nationally and by state. RESULTS Between 2.9 and 3.4 billion BP tablets were dispensed monthly until February 2020, increasing sharply to 3.8 billion in March 2020 and declining to 3.5 billion in April, then increasing at 3-month intervals until December 2020. The number of tablets per fill increased slightly over time, with the largest increase (from 66.7 to 68.6) during February-March, 2020. Tablets were dispensed through retail channels (99.7 billion), mail-order (14.7 billion), and long-term care (5.3 billion). Rates of patients initiating new medications decreased during 2020 compared to prior years. Fills did not vary significantly by drug class. CONCLUSIONS A sharp increase in BP fills occurred with COVID-19 emergence, suggesting patients may have secured medications in preparation for potential access limitations. A decrease in new fills, indicating decreased initiation and/or modification of treatment regimens, suggests need for efforts to re-engage patients in the healthcare system and provide alternative ways to obtain medication refills and adjustments.
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Affiliation(s)
- Peter K Yang
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
- University of North Carolina, Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - SoYoun Park
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sandra L Jackson
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sharon Attipoe-Dorcoo
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
- The Bizzell Group, Atlanta, Georgia
| | - Elizabeth Gray
- Division of Health Informatics and Surveillance, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Matthew D Ritchey
- Division of Health Informatics and Surveillance, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Laurence S Sperling
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Emory University, School of Medicine, Atlanta, GA, USA
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22
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Koyama AK, Imperatore G, Rolka DB, Lundeen E, Rutkowski RE, Jackson SL, He S, Kuklina EV, Park S, Pavkov ME. Risk of Cardiovascular Disease After COVID-19 Diagnosis Among Adults With and Without Diabetes. J Am Heart Assoc 2023:e029696. [PMID: 37382101 DOI: 10.1161/jaha.123.029696] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
Background Growing evidence suggests incident cardiovascular disease (CVD) may be a long-term outcome of COVID-19 infection, and chronic diseases, such as diabetes, may influence CVD risk associated with COVID-19. We evaluated the postacute risk of CVD >30 days after a COVID-19 diagnosis by diabetes status. Methods and Results We included adults ≥20 years old with a COVID-19 diagnosis from March 1, 2020 through December 31, 2021 in a retrospective cohort study from the IQVIA PharMetrics Plus insurance claims database. A contemporaneous control group comprised adults without recorded diagnoses for COVID-19 or other acute respiratory infections. Two historical control groups comprised patients with or without an acute respiratory infection. Cardiovascular outcomes included cerebrovascular disorders, dysrhythmia, inflammatory heart disease, ischemic heart disease, thrombotic disorders, other cardiac disorders, major adverse cardiovascular events, and any CVD. The total sample comprised 23 824 095 adults (mean age, 48.4 years [SD, 15.7 years]; 51.9% women; mean follow-up, 8.5 months [SD, 5.8 months]). In multivariable Cox regression models, patients with a COVID-19 diagnosis had a significantly greater risk of all cardiovascular outcomes compared with patients without a diagnosis of COVID-19 (hazard ratio [HR], 1.66 [1.62-1.71], with diabetes; HR, 1.75 [1.73-1.78], without diabetes). Risk was attenuated but still significant for the majority of outcomes when comparing patients with COVID-19 to both historical control groups. Conclusions In patients with COVID-19 infection, postacute risk of incident cardiovascular outcomes is significantly higher than among controls without COVID-19, regardless of diabetes status. Therefore, monitoring for incident CVD may be essential beyond the first 30 days after a COVID-19 diagnosis.
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Affiliation(s)
- Alain K Koyama
- Division of Diabetes Translation Centers for Disease Control and Prevention Atlanta GA USA
| | - Giuseppina Imperatore
- Division of Diabetes Translation Centers for Disease Control and Prevention Atlanta GA USA
| | - Deborah B Rolka
- Division of Diabetes Translation Centers for Disease Control and Prevention Atlanta GA USA
| | - Elizabeth Lundeen
- Division of Diabetes Translation Centers for Disease Control and Prevention Atlanta GA USA
| | - Rachel E Rutkowski
- Division of Diabetes Translation Centers for Disease Control and Prevention Atlanta GA USA
| | - Sandra L Jackson
- Division for Heart Disease and Stroke Prevention Centers for Disease Control and Prevention Atlanta GA USA
| | - Siran He
- Division for Heart Disease and Stroke Prevention Centers for Disease Control and Prevention Atlanta GA USA
| | - Elena V Kuklina
- Division for Heart Disease and Stroke Prevention Centers for Disease Control and Prevention Atlanta GA USA
| | - Soyoun Park
- Division for Heart Disease and Stroke Prevention Centers for Disease Control and Prevention Atlanta GA USA
| | - Meda E Pavkov
- Division of Diabetes Translation Centers for Disease Control and Prevention Atlanta GA USA
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23
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Abstract
Introduction Tracking social needs can provide information on barriers to controlling hypertension and the need for wraparound services. No recent studies have examined ICD-10-CM social determinants of health-related Z codes (Z55-Z65) to indicate social needs with a focus on patients with hypertension. Methods Three cohorts were identified with a diagnosis of hypertension during 2016-2017 and continuously enrolled in fee-for-service insurance through June 2021: (1) commercial, age 18-64 years (n=1,024,012); (2) private insurance to supplement Medicare (Medicare Supplement), age ≥65 years (n=296,340); and (3) Medicaid, age ≥18 years (n=146,484). Both the proportion of patients and healthcare encounters or visits with social determinants of health-related Z code were summarized annually. Patient and visit characteristics were summarized for 2019. Results In 2020, the highest annual documentation of social determinants of health-related Z codes was among Medicaid beneficiaries (3.02%, 0.46% commercial, 0.42% Medicare Supplement); documentation was higher among inpatient than among outpatient visits for all insurance types. Z63 (related to primary support group) was more common among commercial and Medicare Supplement beneficiaries, and Z59 (housing and economic circumstances) was more common among Medicaid beneficiaries. The 2019 total unadjusted medical expenditures were 1.85, 1.78, and 1.61 times higher for those with social determinants of health-related Z code than for those without commercial, Medicare Supplement, and Medicaid, respectively. Patients with social determinants of health-related Z code also had higher proportions of diagnosed chronic conditions. Among Medicaid beneficiaries, differences in the presence of social determinants of health-related Z code by race or ethnicity were observed. Conclusions Although currently underreported, social determinants of health-related Z codes provide an opportunity to integrate social and medical data and may help decision makers understand the need for additional services among individuals with hypertension.
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Affiliation(s)
- Jun Soo Lee
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kara E. MacLeod
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
- ASRT, Inc., Atlanta, Georgia
| | - Elena V. Kuklina
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Xin Tong
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sandra L. Jackson
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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24
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Sekkarie A, Park S, Therrien NL, Jackson SL, Woodruff RC, Attipoe-Dorcoo S, Yang PK, Sperling L, Loustalot F, Thompson-Paul AM. Trends in Lipid-Lowering Prescriptions: Increasing Use of Guideline-Concordant Pharmacotherapies, U.S., 2017‒2022. Am J Prev Med 2023; 64:561-566. [PMID: 36464556 PMCID: PMC10033441 DOI: 10.1016/j.amepre.2022.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 10/19/2022] [Accepted: 10/20/2022] [Indexed: 12/04/2022]
Abstract
INTRODUCTION Almost one third of U.S. adults have elevated low-density lipoprotein cholesterol, increasing their risk of atherosclerotic cardiovascular disease. The 2018 American College of Cardiology/American Heart Association Multisociety Cholesterol Management Guideline recommends maximally tolerated statin for those at increased atherosclerotic cardiovascular disease risk and add-on therapies (ezetimibe and PCSK9 inhibitors) in those at very high risk and low-density lipoprotein cholesterol ≥70 mg/dL. Prescription fill trends are unknown. METHODS Using national outpatient retail prescription data from the first quarter of 2017 to the first quarter of 2022, authors determined counts of patients who filled low-, moderate-, or high-intensity statins alone and with add-on therapies. The overall percentage change and joinpoint regression were used to assess trends. Analyses were conducted in March 2022-May 2022. RESULTS During the first quarter of 2017 to the first quarter of 2022, patients filling a statin increased by 25.0%, with the greatest increase in high-intensity statins (64.1%, range=6.6-10.9 million). Low-intensity statins decreased by 29.2% (range=3.3-2.4 million). Concurrent fills of high-intensity statin and ezetimibe rose by 210% to 579,012 patients by the first quarter of 2022, with an increase in slope by the first quarter of 2019 for all statin intensities (p<0.01). Concurrent fills of a statin and PCSK9 inhibitor increased to 2,629, 16,169, and 28,651 by the first quarter of 2022 for low-, moderate-, and high-intensity statins, respectively. For patients on all statin intensities and PCSK9 inhibitor, there were statistically significant increases in slope in the second quarter of 2019 and decreases in the first quarter of 2020. CONCLUSIONS Patients filling moderate- and high-intensity statins and add-on ezetimibe and PCSK9 inhibitors have increased, indicating uptake of guideline-concordant lipid-lowering therapies. Improvements in the initiation and continuity of these therapies are important for atherosclerotic cardiovascular disease prevention.
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Affiliation(s)
- Ahlia Sekkarie
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Soyoun Park
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nicole L Therrien
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sandra L Jackson
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Rebecca C Woodruff
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sharon Attipoe-Dorcoo
- Division for Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Peter K Yang
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Laurence Sperling
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Fleetwood Loustalot
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia; United States Public Health Service Commissioned Corps, Rockville, Maryland
| | - Angela M Thompson-Paul
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia; United States Public Health Service Commissioned Corps, Rockville, Maryland
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25
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Duncan MS, Robbins NN, Wernke SA, Greevy RA, Jackson SL, Beatty AL, Thomas RJ, Whooley MA, Freiberg MS, Bachmann JM. Geographic Variation in Access to Cardiac Rehabilitation. J Am Coll Cardiol 2023; 81:1049-1060. [PMID: 36922091 PMCID: PMC10901160 DOI: 10.1016/j.jacc.2023.01.016] [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: 01/03/2023] [Accepted: 01/10/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND There is marked geographic variation in cardiac rehabilitation (CR) initiation, ranging from 10% to 40% of eligible patients at the state level. The potential causes of this variation, such as patient access to CR centers, are not well studied. OBJECTIVES The authors sought to determine how access to CR centers affects CR initiation in Medicare beneficiaries. METHODS The authors used Medicare files to identify CR-eligible Medicare beneficiaries and calculate CR initiation rates at the hospital referral region (HRR) level. We used linear regression to evaluate the percent variation in CR initiation accounted for by CR access across HRRs. We then employed geospatial hotspot analysis to identify CR deserts, or counties in which patient load per CR center is disproportionately high. RESULTS A total of 1,133,657 Medicare beneficiaries were eligible for CR from 2014 to 2017, of whom 263,310 (23%) initiated CR. The West North Central Census Division had the highest adjusted CR initiation rate (35.4%) and the highest density of CR programs (6.58 per 1,000 CR-eligible Medicare beneficiaries). Density of CR programs accounted for 21.2% of geographic variation in CR initiation at the HRR level. A total of 40 largely urban counties comprising 14% of the United States population age ≥65 years had disproportionately low CR access and were identified as CR deserts. CONCLUSIONS A substantial proportion of geographic variation in CR initiation was related to access to CR programs, with a significant amount of the U.S. population living in CR deserts. These data invite further study on interventions to increase CR access.
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Affiliation(s)
| | - Natalie N. Robbins
- Vanderbilt Institute for Spatial Research, Vanderbilt University, Nashville, Tennessee, USA
| | - Steven A. Wernke
- Department of Anthropology, Vanderbilt University, Nashville, TN, USA
| | - Robert A. Greevy
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Alexis L. Beatty
- Departments of Biostatistics, Epidemiology and Medicine, University of California-San Francisco, San Francisco, California, USA
| | - Randal J. Thomas
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Mary A. Whooley
- San Francisco Veterans Affairs Health Care System and University of California-San Francisco, San Francisco, California, USA
| | - Matthew S. Freiberg
- Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN, USA
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Justin M. Bachmann
- Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN, USA
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
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26
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Hohman KH, Martinez AK, Klompas M, Kraus EM, Li W, Carton TW, Cocoros NM, Jackson SL, Karras BT, Wiltz JL, Wall HK. Leveraging Electronic Health Record Data for Timely Chronic Disease Surveillance: The Multi-State EHR-Based Network for Disease Surveillance. J Public Health Manag Pract 2023; 29:162-173. [PMID: 36715594 PMCID: PMC9897452 DOI: 10.1097/phh.0000000000001693] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
CONTEXT Electronic health record (EHR) data can potentially make chronic disease surveillance more timely, actionable, and sustainable. Although use of EHR data can address numerous limitations of traditional surveillance methods, timely surveillance data with broad population coverage require scalable systems. This report describes implementation, challenges, and lessons learned from the Multi-State EHR-Based Network for Disease Surveillance (MENDS) to help inform how others work with EHR data to develop distributed networks for surveillance. PROGRAM Funded by the Centers for Disease Control and Prevention (CDC), MENDS is a data modernization demonstration project that aims to develop a timely national chronic disease sentinel surveillance system using EHR data. It facilitates partnerships between data contributors (health information exchanges, other data aggregators) and data users (state and local health departments). MENDS uses query and visualization software to track local emerging trends. The program also uses statistical and geospatial methods to generate prevalence estimates of chronic disease risk measures at the national and local levels. Resulting data products are designed to inform public health practice and improve the health of the population. IMPLEMENTATION MENDS includes 5 partner sites that leverage EHR data from 91 health system and clinic partners and represents approximately 10 million patients across the United States. Key areas of implementation include governance, partnerships, technical infrastructure and support, chronic disease algorithms and validation, weighting and modeling, and workforce education for public health data users. DISCUSSION MENDS presents a scalable distributed network model for implementing national chronic disease surveillance that leverages EHR data. Priorities as MENDS matures include producing prevalence estimates at various geographic and subpopulation levels, developing enhanced data sharing and interoperability capacity using international data standards, scaling the network to improve coverage nationally and among underrepresented geographic areas and subpopulations, and expanding surveillance of additional chronic disease measures and social determinants of health.
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Affiliation(s)
- Katherine H. Hohman
- National Association of Chronic Disease Directors (NACDD), Decatur, Georgia (Dr Hohman); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts (Drs Klompas and Cocoros); Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, Massachusetts (Dr Li); Louisiana Public Health Institute, New Orleans, Louisiana (Dr Carton); Division for Heart Disease and Stroke Prevention (Dr Jackson and Ms Wall) and Office of the Director (Dr Wiltz), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia; and Washington State Department of Health, Tumwater, Washington (Dr Karras). Ms Martinez is an independent consultant to NACDD. Dr Kraus is an independent consultant to Public Health Informatics Institute, a program of the Task Force for Global Health
| | - Amanda K. Martinez
- National Association of Chronic Disease Directors (NACDD), Decatur, Georgia (Dr Hohman); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts (Drs Klompas and Cocoros); Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, Massachusetts (Dr Li); Louisiana Public Health Institute, New Orleans, Louisiana (Dr Carton); Division for Heart Disease and Stroke Prevention (Dr Jackson and Ms Wall) and Office of the Director (Dr Wiltz), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia; and Washington State Department of Health, Tumwater, Washington (Dr Karras). Ms Martinez is an independent consultant to NACDD. Dr Kraus is an independent consultant to Public Health Informatics Institute, a program of the Task Force for Global Health
| | - Michael Klompas
- National Association of Chronic Disease Directors (NACDD), Decatur, Georgia (Dr Hohman); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts (Drs Klompas and Cocoros); Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, Massachusetts (Dr Li); Louisiana Public Health Institute, New Orleans, Louisiana (Dr Carton); Division for Heart Disease and Stroke Prevention (Dr Jackson and Ms Wall) and Office of the Director (Dr Wiltz), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia; and Washington State Department of Health, Tumwater, Washington (Dr Karras). Ms Martinez is an independent consultant to NACDD. Dr Kraus is an independent consultant to Public Health Informatics Institute, a program of the Task Force for Global Health
| | - Emily M. Kraus
- National Association of Chronic Disease Directors (NACDD), Decatur, Georgia (Dr Hohman); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts (Drs Klompas and Cocoros); Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, Massachusetts (Dr Li); Louisiana Public Health Institute, New Orleans, Louisiana (Dr Carton); Division for Heart Disease and Stroke Prevention (Dr Jackson and Ms Wall) and Office of the Director (Dr Wiltz), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia; and Washington State Department of Health, Tumwater, Washington (Dr Karras). Ms Martinez is an independent consultant to NACDD. Dr Kraus is an independent consultant to Public Health Informatics Institute, a program of the Task Force for Global Health
| | - Wenjun Li
- National Association of Chronic Disease Directors (NACDD), Decatur, Georgia (Dr Hohman); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts (Drs Klompas and Cocoros); Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, Massachusetts (Dr Li); Louisiana Public Health Institute, New Orleans, Louisiana (Dr Carton); Division for Heart Disease and Stroke Prevention (Dr Jackson and Ms Wall) and Office of the Director (Dr Wiltz), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia; and Washington State Department of Health, Tumwater, Washington (Dr Karras). Ms Martinez is an independent consultant to NACDD. Dr Kraus is an independent consultant to Public Health Informatics Institute, a program of the Task Force for Global Health
| | - Thomas W. Carton
- National Association of Chronic Disease Directors (NACDD), Decatur, Georgia (Dr Hohman); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts (Drs Klompas and Cocoros); Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, Massachusetts (Dr Li); Louisiana Public Health Institute, New Orleans, Louisiana (Dr Carton); Division for Heart Disease and Stroke Prevention (Dr Jackson and Ms Wall) and Office of the Director (Dr Wiltz), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia; and Washington State Department of Health, Tumwater, Washington (Dr Karras). Ms Martinez is an independent consultant to NACDD. Dr Kraus is an independent consultant to Public Health Informatics Institute, a program of the Task Force for Global Health
| | - Noelle M. Cocoros
- National Association of Chronic Disease Directors (NACDD), Decatur, Georgia (Dr Hohman); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts (Drs Klompas and Cocoros); Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, Massachusetts (Dr Li); Louisiana Public Health Institute, New Orleans, Louisiana (Dr Carton); Division for Heart Disease and Stroke Prevention (Dr Jackson and Ms Wall) and Office of the Director (Dr Wiltz), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia; and Washington State Department of Health, Tumwater, Washington (Dr Karras). Ms Martinez is an independent consultant to NACDD. Dr Kraus is an independent consultant to Public Health Informatics Institute, a program of the Task Force for Global Health
| | - Sandra L. Jackson
- National Association of Chronic Disease Directors (NACDD), Decatur, Georgia (Dr Hohman); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts (Drs Klompas and Cocoros); Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, Massachusetts (Dr Li); Louisiana Public Health Institute, New Orleans, Louisiana (Dr Carton); Division for Heart Disease and Stroke Prevention (Dr Jackson and Ms Wall) and Office of the Director (Dr Wiltz), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia; and Washington State Department of Health, Tumwater, Washington (Dr Karras). Ms Martinez is an independent consultant to NACDD. Dr Kraus is an independent consultant to Public Health Informatics Institute, a program of the Task Force for Global Health
| | - Bryant Thomas Karras
- National Association of Chronic Disease Directors (NACDD), Decatur, Georgia (Dr Hohman); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts (Drs Klompas and Cocoros); Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, Massachusetts (Dr Li); Louisiana Public Health Institute, New Orleans, Louisiana (Dr Carton); Division for Heart Disease and Stroke Prevention (Dr Jackson and Ms Wall) and Office of the Director (Dr Wiltz), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia; and Washington State Department of Health, Tumwater, Washington (Dr Karras). Ms Martinez is an independent consultant to NACDD. Dr Kraus is an independent consultant to Public Health Informatics Institute, a program of the Task Force for Global Health
| | - Jennifer L. Wiltz
- National Association of Chronic Disease Directors (NACDD), Decatur, Georgia (Dr Hohman); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts (Drs Klompas and Cocoros); Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, Massachusetts (Dr Li); Louisiana Public Health Institute, New Orleans, Louisiana (Dr Carton); Division for Heart Disease and Stroke Prevention (Dr Jackson and Ms Wall) and Office of the Director (Dr Wiltz), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia; and Washington State Department of Health, Tumwater, Washington (Dr Karras). Ms Martinez is an independent consultant to NACDD. Dr Kraus is an independent consultant to Public Health Informatics Institute, a program of the Task Force for Global Health
| | - Hilary K. Wall
- National Association of Chronic Disease Directors (NACDD), Decatur, Georgia (Dr Hohman); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts (Drs Klompas and Cocoros); Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, Massachusetts (Dr Li); Louisiana Public Health Institute, New Orleans, Louisiana (Dr Carton); Division for Heart Disease and Stroke Prevention (Dr Jackson and Ms Wall) and Office of the Director (Dr Wiltz), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia; and Washington State Department of Health, Tumwater, Washington (Dr Karras). Ms Martinez is an independent consultant to NACDD. Dr Kraus is an independent consultant to Public Health Informatics Institute, a program of the Task Force for Global Health
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Abstract
IMPORTANCE Current estimates of productivity losses associated with heart disease and stroke in the US include income losses from premature mortality but do not include income losses from morbidity. OBJECTIVE To estimate labor income losses associated with morbidity of heart disease and stroke in the US due to missed or lower labor force participation. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used 2019 Panel Study of Income Dynamics data to estimate labor income losses associated with heart disease and stroke by comparing labor income between persons with and without heart disease or stroke, after controlling for sociodemographic characteristics and other chronic conditions and considering the situation of zero labor income (eg, withdrawal from the labor market). The study sample included individuals aged 18 to 64 years who were reference persons or spouses or partners. Data analysis was conducted from June 2021 to October 2022. EXPOSURE The key exposure was heart disease or stroke. MAIN OUTCOMES AND MEASURES The main outcome was labor income, measured for the year 2018. Covariates included sociodemographic characteristics and other chronic conditions. Labor income losses associated with heart disease and stroke were estimated using the 2-part model, in which part 1 is to model the probability that labor income is greater than zero and part 2 is to regress positive labor income, with both parts having the same set of explanatory variables. RESULTS In the study sample consisting of 12 166 individuals (6721 [52.4%] females) representing a weighted mean income of $48 299 (95% CI, $45 712-$50 885), the prevalence of heart disease was 3.7% and the prevalence of stroke was 1.7%, and there were 1610 Hispanic persons (17.3%), 220 non-Hispanic Asian or Pacific Islander persons (6.0%), 3963 non-Hispanic Black persons (11.0%), and 5688 non-Hispanic White persons (60.2%). The age distribution was largely even, from 21.9% for the age 25 to 34 years group to 25.8% for the age 55 to 64 years group, except for young adults (age 18-24 years), who made up 4.4% of the sample. After adjustment for sociodemographic characteristics and other chronic conditions, persons with heart disease would receive an estimated $13 463 (95% CI, $6993-$19 933) less in annual labor income than those without heart disease (P < .001), and persons with stroke would receive an estimated $18 716 (95% CI, $10 356-$27 077) less in annual labor income than those without stroke (P < .001). Total labor income losses associated with morbidity were estimated at $203.3 billion for heart disease and $63.6 billion for stroke. CONCLUSIONS AND RELEVANCE These findings suggest that total labor income losses associated with morbidity of heart disease and stroke were far greater than those from premature mortality. Comprehensive estimation of total costs of CVD may assist decision-makers in assessing benefits from averted premature mortality and morbidity and allocating resources to the prevention, management, and control of CVD.
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Affiliation(s)
- Feijun Luo
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Grace Chapel
- Department of Economics, Tulane University, New Orleans, Louisiana
| | - Zhiqiu Ye
- Center for Healthcare Delivery Science and Innovation, University of Chicago Medicine, Chicago, Illinois
| | - Sandra L. Jackson
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kakoli Roy
- Office of the Director, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Thompson-Paul AM, Kraus E, Porter RM, Pierce SL, Kompaniyets L, Sekkarie A, Goodman AB, Jackson SL. Abstract 61: Frequency of Pediatric Lipid Screening Using a Large National Electronic Health Record System. Circulation 2023. [DOI: 10.1161/circ.147.suppl_1.61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
Background:
Universal lipid screening is recommended for U.S. youth aged 9-11 and 17-21 years. Our objective was to describe the prevalence of pediatric lipid screening and elevated lipid measurements among those screened, by patient characteristics.
Methods:
IQVIA’s Ambulatory Electronic Medical Records (version 5, release: October 2021) database, containing medical records from 100,000 physicians in the U.S., was used for this analysis. The study population included 3,131,956 patients aged 9-21 years with ≥1 valid measure of height and weight during our observation period (01/01/2018-11/30/2021). Lipid screening was defined as ≥1 valid measurement any time during the observation period. Body mass index (BMI) was calculated and categorized using pediatric percentiles (ages 9-20 years) and adult interpretations (age ≥21 years) (
Table
). After excluding biologically implausible values, lipid measurements were considered elevated if ≥1 of the following was identified: low density lipoprotein ≥130 mg/dL, very low-density lipoprotein ≥31 mg/dL, non-high-density lipoprotein ≥145 mg/dL, triglycerides ≥130 mg/dL, or total cholesterol ≥200 mg/dL.
Results:
A total of 354,764 (11.3%) youth had documented lipid screening. The frequency of lipid screening increased by age group (9-11 years: 9.1%; 12-16 years: 11.0%,17-21 years: 12.9%) and BMI category (underweight and healthy weight: 9.5%; overweight: 11.0%; obesity: 16.7%; severe obesity: 19.6%). Frequency of screening varied across race/ethnicity (White: 10.8%; Black 14.5%; Asian: 18.0%). Among those screened, 30.2% had ≥1 elevated measure with highest prevalence among those with obesity (44.8%) or severe obesity (48.1%).
Conclusions:
Our findings indicate that among youth aged 9-11y and 17-21y, lipid screening is suboptimal, and prevalence of elevated lipid levels is high among those screened. Increased pediatric lipid screening could lead to improvements in treatment, management, and prevention of adverse, long-term cardiovascular outcomes.
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Affiliation(s)
| | - Emily Kraus
- Cntrs for Disease Control and Prevention (CDC), Atlanta, GA
| | - Renee M Porter
- Cntrs for Disease Control and Prevention (CDC), Atlanta, GA
| | | | | | - Ahlia Sekkarie
- Cntrs for Disease Control and Prevention (CDC), Atlanta, GA
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Jackson SL, Gillespie C, Shimbo D, Rakotz M, Wall HK. Blood Pressure Cuff Sizes for Adults in the United States: National Health and Nutrition Examination Survey, 2015-2020. Am J Hypertens 2022; 35:923-928. [PMID: 36066190 PMCID: PMC10851131 DOI: 10.1093/ajh/hpac104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 08/31/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Hypertension, defined as blood pressure (BP) ≥130/80 mm Hg or antihypertensive medication use, affects approximately half of US adults, and appropriately sized BP cuffs are important for accurate BP measurement and hypertension management. METHODS This cross-sectional study analyzed 13,038 US adults (≥18 years) in the National Health and Nutrition Examination Survey 2015-March 2020 cycles. Recommended BP cuff sizes were categorized based on mid-arm circumference: small adult (≤26 cm), adult (>26 to ≤34 cm), large adult (>34 to ≤44 cm), and extra-large adult (>44 cm). Analyses were weighted and proportions were extrapolated to the US population. RESULTS Among US adults (246 million), recommended cuff sizes were: 6% (16 million) small adult, 51% adult (125 million), 40% large adult (98 million), and 3% extra-large adult (8 million). Among adults with hypertension (116 million), large or extra-large cuffs were needed by over half (51%) overall, including 65% of those aged 18-34 years and 84% of those with obesity (BMI ≥30 kg/m2). By race/ethnicity, the proportion needing a large or extra-large cuff was 57% of non-Hispanic Black adults, 54% of Hispanic adults, 51% of non-Hispanic White adults, and 23% of non-Hispanic Asian adults. Approximately 40% of adults with hypertension in Medicare needed a large or extra-large cuff, compared to 54% for private insurance and 53% for Medicaid. CONCLUSIONS Over half of US adults with hypertension need a large or extra-large BP cuff.
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Affiliation(s)
- Sandra L Jackson
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Cathleen Gillespie
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Daichi Shimbo
- Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Michael Rakotz
- American Medical Association, Improving Health Outcomes, Chicago, IL
| | - Hilary K Wall
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
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Zhang Z, Kahn HS, Jackson SL, Steele EM, Gillespie C, Yang Q. Associations between ultra- or minimally processed food intake and three adiposity indicators among US adults: NHANES 2011 to 2016. Obesity (Silver Spring) 2022; 30:1887-1897. [PMID: 35924441 PMCID: PMC10083896 DOI: 10.1002/oby.23507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 05/16/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Ultraprocessed food (UPF) intake is associated with BMI, but effects on regional adipose depots or related to minimally processed food (MPF) intake are unknown. METHODS Data included 12,297 adults in the National Health and Nutrition Examination Survey (NHANES), 2011 to 2016. This study analyzed associations between usual percentage of kilocalories from UPFs and MPFs and three adiposity indicators: supine sagittal abdominal diameter to height ratio (SADHtR, estimates visceral adiposity); waist circumference to height ratio (WHtR, estimates abdominal adiposity); and BMI, using linear and multinomial logistic regression. RESULTS Standardized β coefficients per 10% increase in UPF intake were 0.0926, 0.0846, and 0.0791 for SADHtR, WHtR, and BMI, respectively (all p < 0.001; p > 0.26 for pairwise differences). For MPF intake, the β coefficients were -0.0901, -0.0806, and -0.0688 (all p < 0.001; p > 0.18 pairwise). Adjusted odds ratios (95% CI) for adiposity tertile 3 versus tertile 1 (comparing UPF intake quartiles 2, 3, and 4 to quartile 1) were 1.33 (1.22-1.45), 1.67 (1.43-1.95), and 2.24 (1.76-2.86), respectively, for SADHtR; 1.31 (1.19-1.44), 1.62 (1.37-1.91), and 2.13 (1.63-2.78), respectively, for WHtR; and 1.27 (1.16-1.39), 1.53 (1.31-1.79), and 1.96 (1.53-2.51), respectively, for BMI. MPF intake showed inverse associations with similar trends in association strength. CONCLUSIONS Among US adults, abdominal and visceral adiposity indictors were positively associated with UPFs and inversely associated with MPFs.
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Affiliation(s)
- Zefeng Zhang
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Henry S Kahn
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Sandra L Jackson
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Euridice Martinez Steele
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
- Center for Epidemiological Studies in Health and Nutrition, University of São Paulo, São Paulo, Brazil
| | - Cathleen Gillespie
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Quanhe Yang
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Jackson SL, Block JP, Rolka DB, Pavkov ME, Chevinsky JR, Lekiachvili A, Carton TW, Thacker D, Denson JL, Paranjape A, Kappelman MD, Boehmer TK, Twentyman E. COVID-19 Outcomes Stratified by Control Status of Hypertension and Diabetes: Preliminary Findings From PCORnet, U.S. AJPM Focus 2022; 1:100012. [PMID: 36942020 PMCID: PMC9271352 DOI: 10.1016/j.focus.2022.100012] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Introduction Hypertension and diabetes are associated with increased COVID-19 severity, yet less is known about COVID-19 outcomes across levels of disease control for these conditions. Methods All adults aged ≥20 years with COVID-19 between March 1, 2020 and March 15, 2021 in 42 healthcare systems in National Patient-Centered Clinical Research Network were identified. Results Among 656,049 adults with COVID-19, 41% had hypertension, and 13% had diabetes. Of patients with classifiable hypertension, 35% had blood pressure <130/80 mmHg, 40% had blood pressure of 130‒139/80‒89 mmHg, 21% had blood pressure of 140‒159/90‒99 mmHg, and 6% had blood pressure ≥160/100 mmHg. Severe COVID-19 outcomes were more prevalent among those with blood pressure of ≥160/100 than among those with blood pressure of 130-139/80-89, including hospitalization (23.7% [95% CI=23.0, 24.4] vs 11.7% [95% CI=11.5, 11.9]), receipt of critical care (5.5% [95% CI=5.0, 5.8] vs 2.4% [95% CI=2.3, 2.5]), receipt of mechanical ventilation (3.0% [95% CI=2.7, 3.3] vs 1.2% [95% CI=1.1, 1.3]), and 60-day mortality (4.6% [95% CI=4.2, 4.9] vs 1.8% [95% CI=1.7, 1.9]). Of patients with classifiable diabetes, 44% had HbA1c <7%, 35% had HbA1c 7% to <9%, and 21% had HbA1c ≥9%. Hospitalization prevalence was 31.3% (95% CI=30.7, 31.9) among those with HbA1c <7% vs 40.2% (95% CI=39.4, 41.1) among those with HbA1c ≥9%; other outcomes did not differ substantially by HbA1c. Conclusions These findings highlight the importance of appropriate management of hypertension and diabetes, including during public health emergencies such as the COVID-19 pandemic.
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Affiliation(s)
- Sandra L Jackson
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jason P Block
- Division of Chronic Disease Research Across the Lifecourse (CoRAL), Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, Massachusetts
| | - Deborah B Rolka
- Division for Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Meda E Pavkov
- Division for Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jennifer R Chevinsky
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Akaki Lekiachvili
- National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Deepika Thacker
- Nemours Cardiac Center, Nemours Children's Health, Jacksonville, Florida
| | - Joshua L Denson
- Section of Pulmonary, Critical Care, and Environmental Medicine, Tulane University School of Medicine, New Orleans, Louisiana
| | | | - Michael D Kappelman
- Department of Pediatrics, UNC School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Tegan K Boehmer
- Center for Surveillance, Epidemiology, and Laboratory Services (CSELS), Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Evelyn Twentyman
- National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Centers for Disease Control and Prevention, Atlanta, Georgia
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Jackson SL, Nair PR, Chang A, Schieb L, Loustalot F, Wall HK, Sperling LS, Ritchey MD. Antihypertensive and Statin Medication Adherence Among Medicare Beneficiaries. Am J Prev Med 2022; 63:313-323. [PMID: 35987557 PMCID: PMC10851130 DOI: 10.1016/j.amepre.2022.02.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 12/02/2021] [Revised: 02/04/2022] [Accepted: 02/28/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Medication adherence is important for optimal management of chronic conditions, including hypertension and hypercholesterolemia. This study describes adherence to antihypertensive and statin medications, individually and collectively, and examines variation in adherence by demographic and geographic characteristics. METHODS The 2017 prescription drug event data for beneficiaries with Medicare Part D coverage were assessed. Beneficiaries with a proportion of days covered ≥80% were considered adherent. Adjusted prevalence ratios were estimated to quantify the associations between demographic and geographic characteristics and adherence. Adherence estimates were mapped by county of residence using a spatial empirical Bayesian smoothing technique to enhance stability. Analyses were conducted in 2019‒2021. RESULTS Among the 22.5 million beneficiaries prescribed antihypertensive medications, 77.1% were adherent; among the 16.1 million prescribed statin medications, 81.9% were adherent; and among the 13.5 million prescribed antihypertensive and statin medications, 70.3% were adherent to both. Adherence varied by race/ethnicity: American Indian/Alaska Native (adjusted prevalence ratio=0.83, 95% confidence limit=0.82, 0.842), Hispanic (adjusted prevalence ratio=0.90, 95% confidence limit=0.90, 0.91), and non-Hispanic Black (adjusted prevalence ratio=0.87, 95% confidence limit=0.86, 0.87) beneficiaries were less likely to be adherent than non-Hispanic White beneficiaries. County-level adherence ranged across the U.S. from 25.7% to 88.5% for antihypertensive medications, from 36.0% to 93.8% for statin medications, and from 20.8% to 92.9% for both medications combined and tended to be the lowest in the southern U.S. CONCLUSIONS This study highlights opportunities for efforts to remove barriers and support medication adherence, especially among racial/ethnic minority groups and within the regions at greatest risk for adverse cardiovascular outcomes.
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Affiliation(s)
- Sandra L Jackson
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Priya R Nair
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Anping Chang
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Linda Schieb
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Fleetwood Loustalot
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Hilary K Wall
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Laurence S Sperling
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Matthew D Ritchey
- Division of Health Informatics and Surveillance, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia
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Staimez LR, Kipling LM, Nina Ham J, Legvold BT, Jackson SL, Wilson PWF, Rhee MK, Phillips LS. Potential misclassification of diabetes and prediabetes in the U.S.: Mismatched HbA1c and glucose in NHANES 2005-2016. Diabetes Res Clin Pract 2022; 189:109935. [PMID: 35662612 PMCID: PMC10148706 DOI: 10.1016/j.diabres.2022.109935] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/13/2022] [Accepted: 05/27/2022] [Indexed: 11/28/2022]
Abstract
AIMS To assess the prevalence and clinical implications of "mismatches" between HbA1c and glucose levels in the United States across the life course. METHODS Participants ages 12-79 years from U.S. National Health and Nutrition Examination Survey (NHANES) 2005-2016 without known diagnosis of diabetes and who had a 75 g oral glucose tolerance test were included. Previously undiagnosed diabetes (DM), prediabetes, and normal glucose metabolism (NGM) were defined using American Diabetes Association cut-points. Mismatches were defined by the hemoglobin glycation index (HGI). RESULTS In 10,361 participants, 5% and 41% had diabetes and prediabetes, respectively, by fasting or 2-hour glucose criteria. By HbA1c criteria, the high HGI tertile consisted of mostly abnormal classification (3% DM, 52% prediabetes) and the low HGI tertile contained mostly normal classification (78% NGM). Across all ages, 15% (weighted: 30 million individuals) had clinically significant mismatches of HGI magnitude ≥+0.5% (i.e., high mismatch) or ≤-0.5% (low mismatch). Mismatch was most common in older adults and non-Hispanic Black participants. CONCLUSIONS Mismatches of clinically significant magnitude could lead to HbA1c-related misdiagnosis or inappropriate management in up to 30 million Americans. Older adults, non-Hispanic Black individuals, and others with high mismatches may benefit from complementing HbA1c with additional diagnostic and management strategies.
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Affiliation(s)
- Lisa R Staimez
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322, USA.
| | - Lauren M Kipling
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322, USA
| | - J Nina Ham
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Emory University School of Medicine, Emory University, 100 Woodruff Circle, Atlanta, GA 30322, USA; Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Brian T Legvold
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322, USA
| | - Sandra L Jackson
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Atlanta, GA 30341, USA
| | - Peter W F Wilson
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322, USA; Division of Cardiology, Department of Medicine, School of Medicine, Emory University, 100 Woodruff Circle, Atlanta, GA 30322, USA; Atlanta Veterans Affairs Health Care System, 1670 Clairmont Rd, Decatur, GA 30033, USA
| | - Mary K Rhee
- Atlanta Veterans Affairs Health Care System, 1670 Clairmont Rd, Decatur, GA 30033, USA; Division of Endocrinology and Metabolism, Department of Medicine, Emory University School of Medicine, Emory University, 100 Woodruff Circle, Atlanta, GA 30322, USA
| | - Lawrence S Phillips
- Atlanta Veterans Affairs Health Care System, 1670 Clairmont Rd, Decatur, GA 30033, USA; Division of Endocrinology and Metabolism, Department of Medicine, Emory University School of Medicine, Emory University, 100 Woodruff Circle, Atlanta, GA 30322, USA
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Keteyian SJ, Jackson SL, Chang A, Brawner CA, Wall HK, Forman DE, Sukul D, Ritchey MD, Sperling LS. Tracking Cardiac Rehabilitation Utilization in Medicare Beneficiaries: 2017 UPDATE. J Cardiopulm Rehabil Prev 2022; 42:235-245. [PMID: 35135961 PMCID: PMC10865223 DOI: 10.1097/hcr.0000000000000675] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [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] [Indexed: 11/26/2022]
Abstract
PURPOSE This study updates cardiac rehabilitation (CR) utilization data in a cohort of Medicare beneficiaries hospitalized for CR-eligible events in 2017, including stratification by select patient demographics and state of residence. METHODS We identified Medicare fee-for-service beneficiaries who experienced a CR-eligible event and assessed their CR participation (≥1 CR sessions in 365 d), engagement, and completion (≥36 sessions) rates through September 7, 2019. Measures were assessed overall, by beneficiary characteristics and state of residence, and by primary (myocardial infarction; coronary artery bypass surgery; heart valve repair/replacement; percutaneous coronary intervention; or heart/heart-lung transplant) and secondary (angina; heart failure) qualifying event type. RESULTS In 2017, 412 080 Medicare beneficiaries had a primary CR-eligible event and 28.6% completed ≥1 session of CR within 365 d after discharge from a qualifying event. Among beneficiaries who completed ≥1 CR session, the mean total number of sessions was 25 ± 12 and 27.6% completed ≥36 sessions. Nebraska had the highest enrollment rate (56.1%), with four other states also achieving an enrollment rate >50% and 23 states falling below the overall rate for the United States. CONCLUSIONS The absolute enrollment, engagement, and program completion rates remain low among Medicare beneficiaries, indicating that many patients did not benefit or fully benefit from a class I guideline-recommended therapy. Additional research and continued widespread adoption of successful enrollment and engagement initiatives are needed, especially among identified populations.
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Affiliation(s)
- Steven J. Keteyian
- Division of Cardiovascular Medicine, Henry Ford Health System, Detroit, MI
| | | | - Anping Chang
- Centers for Disease Control and Prevention, Atlanta, GA
| | - Clinton A. Brawner
- Division of Cardiovascular Medicine, Henry Ford Health System, Detroit, MI
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI
| | | | - Daniel E. Forman
- Divisions of Geriatrics and Cardiology, University of Pittsburgh and the VA Pittsburgh GRECC, Pittsburgh, PA
| | - Devraj Sukul
- Division of Cardiovascular Diseases, University of Michigan, Ann Arbor, MI
| | | | - Laurence S. Sperling
- Centers for Disease Control and Prevention, Atlanta, GA
- Emory University School of Medicine, Center for Heart Disease Prevention, Atlanta, GA
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Jackson SL, Tsipas S, Yang PK, Ritchey MD, Loustalot F, Wozniak G, Wang X. Prescription Smoking-Cessation Medication Fills and Spending, 2009-2019. Am J Prev Med 2022; 62:e351-e355. [PMID: 35597571 PMCID: PMC9186091 DOI: 10.1016/j.amepre.2021.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 11/19/2021] [Accepted: 11/29/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Smoking is the leading cause of preventable disease and death. However, effective medicines, including prescription medications often covered by health insurance, are available to aid cessation. METHODS Trends of 7 U.S. Food and Drug Administration-approved prescription medications for smoking cessation during 2009-2019 (before and during Affordable Care Act implementation), including fill counts and spending (total and patient, adjusted to 2019 U.S. dollars), were assessed among U.S. adults aged ≥18 years. Symphony Health's Integrated Dataverse combines data on >90% of outpatient prescription fills with market purchasing data to create national estimates. Analyses were conducted in 2021. RESULTS Annually, total fills (spending) decreased from 3.7 million ($577 million) in 2009 to 2.5 million ($465 million) in 2013 and increased to 4.5 million ($1.279 billion) in 2019; patient spending decreased from $174 million (30% of total annual spending) in 2009 to $54 million (4%) in 2019. Comparing 2009 with 2019, the total spending per fill increased by 80% (from $157 to $282), whereas patient spending per fill decreased by 75% (from $47 to $12). The total spending per fill for branded products increased by 175% (from $166 to $459) and decreased by 41% (from $75 to $44) for generic products. Branded product percentage decreased from 89% to 57%. CONCLUSIONS Total fills and spending decreased from 2009 to 2013 and then increased through 2019, whereas patient spending decreased. Earlier studies suggest possible reasons for these trends, such as gradual implementation of federal requirements for insurance coverage of cessation medications and reduced cost sharing and financial barriers.
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Affiliation(s)
- Sandra L Jackson
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | | | - Peter K Yang
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Matthew D Ritchey
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Fleetwood Loustalot
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Xu Wang
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Hayes DK, Jackson SL, Li Y, Wozniak G, Tsipas S, Hong Y, Thompson-Paul AM, Wall HK, Gillespie C, Egan BM, Ritchey MD, Loustalot F. Blood Pressure Control Among Non-Hispanic Black Adults Is Lower Than Non-Hispanic White Adults Despite Similar Treatment With Antihypertensive Medication: NHANES 2013-2018. Am J Hypertens 2022; 35:514-525. [PMID: 35380626 PMCID: PMC9233145 DOI: 10.1093/ajh/hpac011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 10/19/2021] [Accepted: 01/26/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Controlled blood pressure can prevent or reduce adverse health outcomes. Social and structural determinants may contribute to the disparity that despite equivalent proportions on antihypertensive medication, non-Hispanic Black (Black) adults have lower blood pressure control and more cardiovascular events than non-Hispanic White (White) adults. METHODS Data from 2013 to 2018 National Health and Nutrition Examination Survey were pooled to assess control among Black and White adults by antihypertensive medication use and selected characteristics using the 2017 American College of Cardiology/American Heart Association (ACC/AHA) Blood Pressure Guideline definition (systolic blood pressure <130 mm Hg and diastolic blood pressure <80 mm Hg) among 4,739 adults. RESULTS Among those treated with antihypertensive medication, an estimated 34.9% of Black and 45.0% of White adults had controlled blood pressure. Control was lower for Black and White adults among most subgroups of age, sex, education, insurance status, usual source of care, and poverty-income ratio. Black adults had higher use of diuretics (28.5%-Black adults vs. 23.5%-White adults) and calcium channel blockers (24.2%-Black adults vs. 14.7%-White adults) compared with White adults. Control among Black adults was lower than White adults across all medication classes including diuretics (36.1%-Black adults vs. 47.3%-White adults), calcium channel blockers (30.2%-Black adults vs. 40.1%-White adults), and number of medication classes used. CONCLUSIONS Suboptimal blood pressure control rates and disparities warrant increased efforts to improve control, which could include addressing social and structural determinants along with emphasizing implementation of the 2017 ACC/AHA Blood Pressure Guideline into clinical practice.
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Affiliation(s)
| | - Sandra L Jackson
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Yanfeng Li
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Gregory Wozniak
- Improving Health Outcomes, American Medical Association, Chicago, Illinois, USA
| | - Stavros Tsipas
- Improving Health Outcomes, American Medical Association, Chicago, Illinois, USA
| | - Yuling Hong
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Angela M Thompson-Paul
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Hilary K Wall
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Cathleen Gillespie
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Brent M Egan
- Improving Health Outcomes, American Medical Association, Chicago, Illinois, USA
| | - Matthew D Ritchey
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Fleetwood Loustalot
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Wall HK, Wright JS, Jackson SL, Daussat L, Ramkissoon N, Schieb LJ, Stolp H, Tong X, Loustalot F. How Do We Jump-Start Self-measured Blood Pressure Monitoring in the United States? Addressing Barriers Beyond the Published Literature. Am J Hypertens 2022; 35:244-255. [PMID: 35259238 PMCID: PMC10061272 DOI: 10.1093/ajh/hpab170] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/15/2021] [Accepted: 10/21/2021] [Indexed: 01/07/2023] Open
Abstract
Hypertension is highly prevalent in the United States, and many persons with hypertension do not have controlled blood pressure. Self-measured blood pressure monitoring (SMBP), when combined with clinical support, is an evidence-based strategy for lowering blood pressure and improving control in persons with hypertension. For years, there has been support for widespread implementation of SMBP by national organizations and the federal government, and SMBP was highlighted as a primary intervention in the 2020 Surgeon General's Call to Action to Control Hypertension, yet optimal SMBP use remains low. There are well-known patient and clinician barriers to optimal SMBP documented in the literature. We explore additional high-level barriers that have been encountered, as broad policy and systems-level changes have been attempted, and offer potential solutions. Collective efforts could modernize data transfer and processing, improve broadband access, expand device coverage and increase affordability, integrate SMBP into routine care and reimbursement practices, and strengthen patient engagement, trust, and access.
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Affiliation(s)
- Hilary K Wall
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Janet S Wright
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sandra L Jackson
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lura Daussat
- Practice Support Unit, Public Health Informatics Institute, Decatur, Georgia, USA
| | - Nar Ramkissoon
- Improving Health Outcomes, American Medical Association, Chicago, Illinois, USA
| | - Linda J Schieb
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Haley Stolp
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- ASRT, Inc., Atlanta, Georgia, USA
| | - Xin Tong
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Fleetwood Loustalot
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Zhang Z, Jackson SL, Steele EM, Gillespie C, Yang Q. Relationship Between Ultraprocessed Food Intake and Cardiovascular Health Among U.S. Adolescents: Results From the National Health and Nutrition Examination Survey 2007-2018. J Adolesc Health 2022; 70:249-257. [PMID: 34716093 PMCID: PMC10063320 DOI: 10.1016/j.jadohealth.2021.09.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/14/2021] [Accepted: 09/22/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Studies of the association between ultraprocessed foods (UPF) and cardiovascular disease risk factors have been mainly focused on the adult population. This study examined the association between usual percentage of calories (%kcal) from UPF and the American Heart Association's seven cardiovascular health (CVH) metrics among U.S. adolescents aged 12-19 years. METHODS We used data from the National Health and Nutrition Examination Survey 2007-2018 (n = 5,565). The NOVA food system was used to classify UPF according to the extent and purpose of food processing. Each CVH metric was given a score of 0, 1, or 2 (poor, intermediate, or ideal health, respectively). Scores of six metrics were summed (excluding diet) to categorize CVH as low (0-7), moderate (8-10), or high (11-12). The National Cancer Institute's methods were used to estimate usual %kcal from UPF. Multivariable linear regression and multinomial logistic regression were used to evaluate the association between UPF and CVH. RESULTS Among youth, 12.1% had low CVH, 56.3% moderate, and 31.6% high. The mean usual %kcal from UPF was 65.7%. Every 5% increase in calories from UPF was associated with .13 points lower CVH scores (p < .001). Comparing Q2, Q3, and Q4 to Q1 of UPF intake, the adjusted odds ratios for low versus high CVH were 1.43 (95% confidence interval 1.16-1.76), 1.86 (1.29-2.66), and 2.59 (1.49-4.55), respectively. The pattern of association was largely consistent across subgroups. CONCLUSIONS U.S. adolescents consume about two thirds of daily calorie from UPF. There was a graded inverse association between %kcal from UPF and CVH score.
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Affiliation(s)
- Zefeng Zhang
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Sandra L Jackson
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Euridice Martinez Steele
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil; Center for Epidemiological Studies in Health and Nutrition, University of São Paulo, São Paulo, Brazil
| | - Cathleen Gillespie
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Quanhe Yang
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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Jackson SL, Park S, Loustalot F, Thompson-Paul AM, Hong Y, Ritchey MD. Characteristics of US Adults Who Would Be Recommended for Lifestyle Modification Without Antihypertensive Medication to Manage Blood Pressure. Am J Hypertens 2021; 34:348-358. [PMID: 33120415 DOI: 10.1093/ajh/hpaa173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/11/2020] [Accepted: 10/27/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The 2017 American College of Cardiology / American Heart Association Guideline for blood pressure (BP) management newly classifies millions of Americans with elevated BP or stage 1 hypertension for recommended lifestyle modification alone (without pharmacotherapy). This study characterized these adults, including their cardiovascular disease risk factors, barriers to lifestyle modification, and healthcare access. METHODS This cross-sectional study examined nationally representative National Health and Nutrition Examination Survey data, 2013-2016, on 10,205 US adults aged ≥18, among whom 2,081 had elevated BP or stage 1 hypertension and met 2017 ACC/AHA BP Guideline criteria for lifestyle modification alone. RESULTS An estimated 22% of US adults (52 million) would be recommended for lifestyle modification alone. Among these, 58% were men, 43% had obesity, 52% had low-quality diet, 95% consumed excess sodium, 43% were physically inactive, and 8% consumed excess alcohol. Many reported attempting lifestyle changes (range: 39%-60%). Those who reported receiving health professional advice to lose weight (adjusted prevalence ratio 1.21, 95% confidence interval 1.06-1.38), reduce sodium intake (2.33, 2.00-2.72), or exercise more (1.60, 1.32-1.95) were significantly more likely to report attempting changes. However, potential barriers to lifestyle modification included 28% of adults reporting disability, asthma, or arthritis. Additionally, 20% had no health insurance and 22% had no healthcare visits in the last year. CONCLUSIONS One-fifth of US adults met 2017 ACC/AHA BP Guideline criteria for lifestyle modification alone, and many reported attempting behavior change. However, barriers exist such as insurance gaps, limited access to care, and physical impairment.
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Affiliation(s)
- Sandra L Jackson
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Soyoun Park
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Fleetwood Loustalot
- U.S. Public Health Service, Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Angela M Thompson-Paul
- U.S. Public Health Service, Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Yuling Hong
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Matthew D Ritchey
- U.S. Public Health Service, Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Zhao L, Ogden CL, Yang Q, Jackson SL, Loria CM, Galuska DA, Wiltz JL, Merritt R, Cogswell ME. Association of Usual Sodium Intake with Obesity Among US Children and Adolescents, NHANES 2009-2016. Obesity (Silver Spring) 2021; 29:587-594. [PMID: 33528899 PMCID: PMC9134125 DOI: 10.1002/oby.23102] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 11/26/2020] [Accepted: 12/01/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the association of sodium intake with obesity in US children and adolescents. METHODS Cross-sectional data were analyzed for 9,026 children and adolescents in the National Health and Nutrition Examination Survey (NHANES) 2009-2016. Usual sodium intake was estimated from 24-hour dietary recalls using a measurement error model. Logistic regression was used to assess the association of sodium intake with overweight/obesity, obesity, and central obesity (waist to height ratio [WtHR] ≥ 0.5; waist circumferences (WC) ≥ age- and sex-specific 90th percentile). RESULTS Mean (SE) sodium intake was 3,010 (9) and 3,404 (20) mg/d for children and adolescents, respectively. The adjusted odds ratio (AOR) comparing Q4 versus Q1 (87.5th vs. 12.5th percentile of sodium intake) among children was 1.98 (95% CI: 1.19-3.28) for overweight/obesity, 2.20 (1.30-3.73) for obesity, 2.10 (1.12-3.95) for WC ≥ 90th percentile, and 1.68 (0.95-2.97) for WtHR ≥ 0.5, adjusting for demographics, energy, and sugar-sweetened beverage intake. Among adolescents, AOR was 1.81 (0.98-3.37) for overweight/obesity, 1.71 (0.82-3.56) for obesity, 1.62 (0.71-3.66) for WC ≥ 90th percentile, and 1.73 (0.85-3.50) for WtHR ≥ 0.5. CONCLUSIONS Sodium intake was positively associated with overweight/obesity, obesity, and central obesity among US children independent of energy and SSB intake, but the association did not reach significance among adolescents.
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Affiliation(s)
- Lixia Zhao
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- IHRC, Inc., Atlanta, Georgia, USA
| | - Cynthia L. Ogden
- National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland, USA
| | - Quanhe Yang
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sandra L. Jackson
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Catherine M. Loria
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Deborah A. Galuska
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jennifer L. Wiltz
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- United States Public Health Service, Atlanta, Georgia, USA
| | - Robert Merritt
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mary E. Cogswell
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Abstract
Background Amid recently rising heart failure (HF) death rates in the United States, we describe county‐level trends in HF mortality from 1999 to 2018 by racial/ethnic group and sex for ages 35 to 64 years and 65 years and older. Methods and Results Applying a hierarchical Bayesian model to National Vital Statistics data representing all US deaths, ages 35 years and older, we estimated annual age‐standardized county‐level HF death rates and percent change by age group, racial/ethnic group, and sex from 1999 through 2018. During 1999 to 2011, ~30% of counties experienced increasing HF death rates among adults ages 35 to 64 years. However, during 2011 to 2018, 86.9% (95% CI, 85.2–88.2) of counties experienced increasing mortality. Likewise, for ages 65 years and older, during 1999 to 2005 and 2005 to 2011, 27.8% (95% CI, 25.8–29.8) and 12.6% (95% CI, 11.2–13.9) of counties, respectively, experienced increasing mortality. However, during 2011 to 2018, most counties (67.4% [95% CI, 65.4–69.5]) experienced increasing mortality. These temporal patterns by age group held across racial/ethnic group and sex. Conclusions These results provide local context to previously documented recent national increases in HF death rates. Although county‐level declines were most common before 2011, some counties and demographic groups experienced increasing HF death rates during this period of national declines. However, recent county‐level increases were pervasive, occurring across counties, racial/ethnic group, and sex, particularly among ages 35 to 64 years. These spatiotemporal patterns highlight the need to identify and address underlying clinical risk factors and social determinants of health contributing to these increasing trends.
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Affiliation(s)
- Adam S Vaughan
- From the Division for Heart Disease and Stroke Prevention Centers for Disease Control and Prevention Atlanta GA
| | - Mary G George
- From the Division for Heart Disease and Stroke Prevention Centers for Disease Control and Prevention Atlanta GA
| | - Sandra L Jackson
- From the Division for Heart Disease and Stroke Prevention Centers for Disease Control and Prevention Atlanta GA
| | - Linda Schieb
- From the Division for Heart Disease and Stroke Prevention Centers for Disease Control and Prevention Atlanta GA
| | - Michele Casper
- From the Division for Heart Disease and Stroke Prevention Centers for Disease Control and Prevention Atlanta GA
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Zhang Z, Jackson SL, Martinez E, Gillespie C, Yang Q. Association between ultraprocessed food intake and cardiovascular health in US adults: a cross-sectional analysis of the NHANES 2011-2016. Am J Clin Nutr 2021; 113:428-436. [PMID: 33021623 PMCID: PMC10097423 DOI: 10.1093/ajcn/nqaa276] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [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: 06/18/2020] [Accepted: 09/04/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Higher intake of ultraprocessed foods (UPFs) might be associated with increased risk of cardiovascular disease. OBJECTIVES Our objective was to examine the association between usual percentage of calories (%kcal) from UPFs and the American Heart Association's "Life's Simple 7" cardiovascular health (CVH) metrics in US adults. METHODS We analyzed data from 11,246 adults aged ≥20 y from the NHANES 2011-2016 (a cross-sectional, nationally representative survey). UPF designation was assigned on the basis of the NOVA classification system, according to the extent and purpose of food processing. Each CVH metric was given a score of 0, 1, or 2 representing poor, intermediate, or ideal health, respectively. Scores of the 6 metrics (excluding diet) were summed, and CVH was categorized as inadequate (0-4), average (5-8), or optimum (9-12). We used the National Cancer Institute's methods to estimate the usual %kcal from UPFs, and multivariable linear and multinomial logistic regression to assess the association between UPFs and CVH, adjusted for age, sex, race and Hispanic origin, education, and poverty. RESULTS The weighted prevalence of inadequate, average, and optimum CVH was 8.0%, 51.7%, and 40.3%, respectively. The mean usual %kcal from UPFs was 55.4%, and midpoint of quartiles of intake ranged from 40.4% (quartile 1) to 70.5% (quartile 4). Every 5% increase in calories from UPFs was associated with 0.14 points lower CVH score (P < 0.001). The adjusted ORs for inadequate CVH were 1.40 (95% CI: 1.23, 1.60), 1.82 (1.45, 2.29), and 2.57 (1.79, 3.70), respectively, comparing quartiles 2, 3, and 4 with quartile 1 of UPF intake. The pattern of association was largely consistent across subgroups. CONCLUSIONS Usual %kcal from UPFs represented more than half of total calorie intake in US adults. A graded inverse association between %kcal from UPFs and CVH was observed.
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Affiliation(s)
- Zefeng Zhang
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sandra L Jackson
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Euridice Martinez
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil.,Center for Epidemiological Studies in Health and Nutrition, University of São Paulo, São Paulo, Brazil
| | - Cathleen Gillespie
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Quanhe Yang
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Jackson SL, Legvold B, Vahratian A, Blackwell DL, Fang J, Gillespie C, Hayes D, Loustalot F. Sociodemographic and Geographic Variation in Awareness of Stroke Signs and Symptoms Among Adults - United States, 2017. MMWR Morb Mortal Wkly Rep 2020; 69:1617-1621. [PMID: 33151923 PMCID: PMC7643899 DOI: 10.15585/mmwr.mm6944a1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Yang Q, Zhang Z, Steele EM, Moore LV, Jackson SL. Ultra-Processed Foods and Excess Heart Age Among U.S. Adults. Am J Prev Med 2020; 59:e197-e206. [PMID: 33012621 PMCID: PMC10924299 DOI: 10.1016/j.amepre.2020.06.013] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 06/15/2020] [Accepted: 06/17/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION A high percentage of total calories from ultra-processed foods has been associated with several cardiovascular disease risk factors. No study has examined the association between ultra-processed foods and heart age. This study examines the association between ultra-processed foods and excess heart age (difference between estimated heart age and chronological age) among U.S. adults. METHODS The National Health and Nutrition Examination Survey (2009-2016) data for participants aged 30-74 years without cardiovascular disease or stroke (n=12,640) was used. Ultra-processed food was assigned based on NOVA classification of food processing, with ultra-processed food being the highest level. This study estimated the usual percentage of calories from ultra-processed foods and used sex-specific Framingham heart age algorithms to calculate heart age. The multivariable linear or logistic regression was used to examine the association between ultra-processed foods and excess heart age or likelihood of excess heart age being ≥10 years. Data analyses were conducted in 2020. RESULTS The median usual percentage of calories from ultra-processed foods was 54.5% (IQR=45.8%‒63.1%). Adjusted excess heart age increased from 7.0 years (95% CI=6.4, 7.6) in the lowest quintile (Q1) to 9.9 years (95% CI=9.2, 10.5) in the highest quintile (Q5) (p<0.001). Compared with Q1, AORs for excess heart age of ≥10 years were 1.16 (95% CI=1.08, 1.25) in Q2, 1.29 (95% CI=1.14, 1.46) in Q3, 1.43 (95% CI=1.20, 1.71) in Q4, and 1.66 (95% CI=1.29, 2.14) in Q5 (p<0.001). The pattern of association was largely consistent across subgroups. CONCLUSIONS U.S. adults consumed more than half of total daily calories from ultra-processed foods. A higher percentage of calories from ultra-processed foods was associated with higher excess heart age and likelihood of excess heart age of ≥10 years.
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Affiliation(s)
- Quanhe Yang
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Zefeng Zhang
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Euridice Martinez Steele
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil; Center for Epidemiological Studies in Health and Nutrition, University of São Paulo, São Paulo, Brazil
| | - 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, Georgia
| | - Sandra L Jackson
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Woodruff RC, Zhao L, Ahuja JK, Gillespie C, Goldman J, Harris DM, Jackson SL, Moshfegh A, Rhodes D, Sebastian RS, Terry A, Cogswell ME. Top Food Category Contributors to Sodium and Potassium Intake - United States, 2015-2016. MMWR Morb Mortal Wkly Rep 2020; 69:1064-1069. [PMID: 32790654 PMCID: PMC7440115 DOI: 10.15585/mmwr.mm6932a3] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
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Staimez LR, Rhee MK, Deng Y, Safo SE, Butler SM, Legvold BT, Jackson SL, Ford CN, Wilson PWF, Long Q, Phillips LS. Retinopathy develops at similar glucose levels but higher HbA 1c levels in people with black African ancestry compared to white European ancestry: evidence for the need to individualize HbA 1c interpretation. Diabet Med 2020; 37:1049-1057. [PMID: 32125000 DOI: 10.1111/dme.14289] [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] [Accepted: 02/26/2020] [Indexed: 11/29/2022]
Abstract
AIMS To examine the association of HbA1c and glucose levels with incident diabetic retinopathy according to black African or white European ancestry. METHODS In this retrospective cohort study of 202 500 US Veterans with diabetes (2000-2014), measures included HbA1c , outpatient random serum/plasma glucose, and incident retinopathy [conversion from negative to ≥2 positive evaluations (ICD-9 codes), without a subsequent negative]. RESULTS At baseline, the study population had a mean age of 59.3 years, their mean BMI was 31.9 kg/m2 , HbA1c level was 57 mmol/mol (7.4%) and glucose level was 8.8 mmol/l, and 77% were of white European ancestry (white individuals) and 21% of black African ancestry (black individuals). HbA1c was 0.3% higher in black vs white individuals (P < 0.001), adjusting for baseline age, sex, BMI, estimated glomerular filtration rate (eGFR), haemoglobin, and average systolic blood pressure and glucose. Over 11 years, incident retinopathy occurred in 9% of black and 7% of white individuals, but black individuals had higher HbA1c , glucose, and systolic blood pressure (all P < 0.001); adjusted for these factors, incident retinopathy was reduced in black vs white individuals (P < 0.001). The population incidence of retinopathy (7%) was associated with higher mean baseline HbA1c in individuals with black vs white ancestry [63 mmol/mol (7.9%) vs 58 mmol/mol (7.5%); P < 0.001)], but with similar baseline glucose levels (9.0 vs 9.0 mmol/l; P = 0.660, all adjusted for baseline age, sex and BMI). CONCLUSIONS Since retinopathy occurs at higher HbA1c levels in black people for a given level of average plasma glucose, strategies may be needed to individualize the interpretation of HbA1c measurements.
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Affiliation(s)
- L R Staimez
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - M K Rhee
- Atlanta Veterans Affairs Medical Centre, Decatur, GA, USA
- Division of Endocrinology and Metabolism, Department of Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| | - Y Deng
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - S E Safo
- Division of Biostatistics, University of Minnesota, Minneapolis, MN, USA
| | - S M Butler
- Department of Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| | - B T Legvold
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - S L Jackson
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - C N Ford
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - P W F Wilson
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Atlanta Veterans Affairs Medical Centre, Decatur, GA, USA
- Cardiology Division, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Q Long
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - L S Phillips
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Atlanta Veterans Affairs Medical Centre, Decatur, GA, USA
- Division of Endocrinology and Metabolism, Department of Medicine, School of Medicine, Emory University, Atlanta, GA, USA
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Xu A, Ma J, Guo X, Wang L, Wu J, Zhang J, Bai Y, Xu J, Lu Z, Xu Z, Zhang X, Ding G, Hong Y, Du F, Wu Y, Yan L, Tang J, Cai X, Dong J, Xu C, Ren J, Chen X, Gao C, Zhang B, Yang Q, Moolenaar R, Cai Y, Jackson SL, Xie G, Yu S, Cui J, Wang Z, Zhao L, Ju L, Shen D, Yun S, Liang X, Bi Z, Wang Y. Association of a Province-Wide Intervention With Salt Intake and Hypertension in Shandong Province, China, 2011-2016. JAMA Intern Med 2020; 180:877-886. [PMID: 32338717 PMCID: PMC7186913 DOI: 10.1001/jamainternmed.2020.0904] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
IMPORTANCE High salt intake is associated with hypertension, which is a leading modifiable risk factor for cardiovascular disease. OBJECTIVE To assess the association of a government-led, multisectoral, and population-based intervention with reduced salt intake and blood pressure in Shandong Province, China. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used data from the Shandong-Ministry of Health Action on Salt and Hypertension (SMASH) program, a 5-year intervention to reduce sodium consumption in Shandong Province, China. Two representative samples of adults (aged 18-69 years) were surveyed in 2011 (15 350 preintervention participants) and 2016 (16 490 postintervention participants) to examine changes in blood pressure, and knowledge, attitudes, and behaviors related to sodium intake. Urine samples were collected from random subsamples (2024 preintervention participants and 1675 postintervention participants) for measuring sodium and potassium excretion. Data were analyzed from January 20, 2017, to April 9, 2019. INTERVENTIONS Media campaigns, distribution of scaled salt spoons, promotion of low-sodium products in markets and restaurants, and activities to support household sodium reduction and school-based sodium reduction education. MAIN OUTCOMES AND MEASURES The primary outcome was change in urinary sodium excretion. Secondary outcomes were changes in potassium excretion, blood pressure, and knowledge, attitudes, and behaviors. Outcomes were adjusted for likely confounders. Means (95% CIs) and percentages were weighted. RESULTS Among 15 350 participants in 2011, 7683 (50.4%) were men and the mean age was 40.7 years (95% CI, 40.2-41.2 years); among 16 490 participants in 2016, 8077 (50.7%) were men and the mean age was 42.8 years (95% CI, 42.5-43.1 years). Among participants with 24-hour urine samples, 1060 (51.8%) were men and the mean age was 40.9 years (95% CI, 40.5-41.3 years) in 2011 and 836 (50.7%) were men and the mean age was 40.7 years (95% CI, 40.1-41.4 years) in 2016. The 24-hour urinary sodium excretion decreased 25% from 5338 mg per day (95% CI, 5065-5612 mg per day) in 2011 to 4013 mg per day (95% CI, 3837-4190 mg per day) in 2016 (P < .001), and potassium excretion increased 15% from 1607 mg per day (95% CI, 1511-1704 mg per day) to 1850 mg per day (95% CI, 1771-1929 mg per day) (P < .001). Adjusted mean systolic blood pressure among all participants decreased from 131.8 mm Hg (95% CI, 129.8-133.8 mm Hg) to 130.0 mm Hg (95% CI, 127.7-132.4 mm Hg) (P = .04), and diastolic blood pressure decreased from 83.9 mm Hg (95% CI, 82.6-85.1 mm Hg) to 80.8 mm Hg (95% CI, 79.4-82.1 mm Hg) (P < .001). Knowledge, attitudes, and behaviors associated with dietary sodium reduction and hypertension improved significantly. CONCLUSIONS AND RELEVANCE The findings suggest that a government-led and population-based intervention in Shandong, China, was associated with significant decreases in dietary sodium intake and a modest reduction in blood pressure. The results of SMASH may have implications for sodium reduction and blood pressure control in other regions of China and worldwide.
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Affiliation(s)
- Aiqiang Xu
- Shandong Center for Disease Control and Prevention, and Academy of Preventive Medicine, Shandong University, Jinan, China
| | - Jixiang Ma
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiaolei Guo
- Shandong Center for Disease Control and Prevention, and Academy of Preventive Medicine, Shandong University, Jinan, China
| | - Linhong Wang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jing Wu
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jiyu Zhang
- Shandong Center for Disease Control and Prevention, and Academy of Preventive Medicine, Shandong University, Jinan, China
| | - Yamin Bai
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jianwei Xu
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zilong Lu
- Shandong Center for Disease Control and Prevention, and Academy of Preventive Medicine, Shandong University, Jinan, China
| | - Zhongji Xu
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiaochang Zhang
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Gangqiang Ding
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yuling Hong
- Division for Heart Disease and Stroke Prevention Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Fengjun Du
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yangfeng Wu
- Peking University Clinical Research Institute, Beijing, China
| | - Liuxia Yan
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Junli Tang
- Shandong Center for Disease Control and Prevention, and Academy of Preventive Medicine, Shandong University, Jinan, China
| | - Xiaoning Cai
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jing Dong
- Shandong Center for Disease Control and Prevention, and Academy of Preventive Medicine, Shandong University, Jinan, China
| | - Chunxiao Xu
- Shandong Center for Disease Control and Prevention, and Academy of Preventive Medicine, Shandong University, Jinan, China
| | - Jie Ren
- Shandong Center for Disease Control and Prevention, and Academy of Preventive Medicine, Shandong University, Jinan, China
| | - Xi Chen
- Shandong Center for Disease Control and Prevention, and Academy of Preventive Medicine, Shandong University, Jinan, China
| | - Congcong Gao
- Shandong Center for Disease Control and Prevention, and Academy of Preventive Medicine, Shandong University, Jinan, China
| | - Bingyin Zhang
- Shandong Center for Disease Control and Prevention, and Academy of Preventive Medicine, Shandong University, Jinan, China
| | - Quanhe Yang
- Division for Heart Disease and Stroke Prevention Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ronald Moolenaar
- Division of Global Health Protection Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ying Cai
- Division of Global Health Protection Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sandra L Jackson
- Division for Heart Disease and Stroke Prevention Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Gaoqiang Xie
- Peking University Clinical Research Institute, Beijing, China
| | - Shicheng Yu
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jing Cui
- China National Salt Industry Company Limited, Beijing, China
| | - Zengwu Wang
- Division of Preventive and Community Health, National Center for Cardiovascular Disease, The State Key Laboratory of Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Liyun Zhao
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Lahong Ju
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Danyang Shen
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Shumei Yun
- Missouri Department of Mental Health, Jefferson City
| | - Xiaofeng Liang
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zhenqiang Bi
- Shandong Center for Disease Control and Prevention, and Academy of Preventive Medicine, Shandong University, Jinan, China
| | - Yu Wang
- Chinese Center for Disease Control and Prevention, Beijing, China
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Ritchey MD, Maresh S, McNeely J, Shaffer T, Jackson SL, Keteyian SJ, Brawner CA, Whooley MA, Chang T, Stolp H, Schieb L, Wright J. Tracking Cardiac Rehabilitation Participation and Completion Among Medicare Beneficiaries to Inform the Efforts of a National Initiative. Circ Cardiovasc Qual Outcomes 2020; 13:e005902. [PMID: 31931615 DOI: 10.1161/circoutcomes.119.005902] [Citation(s) in RCA: 167] [Impact Index Per Article: 41.8] [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: 12/28/2022]
Abstract
BACKGROUND Despite cardiac rehabilitation (CR) being shown to improve health outcomes among patients with heart disease, its use has been suboptimal. In response, the Million Hearts Cardiac Rehabilitation Collaborative developed a road map to improve CR use, including increasing participation rates to ≥70% by 2022. This observational study provides current estimates to measure progress and identifies the populations and regions most at risk for CR service underutilization. METHODS AND RESULTS We identified Medicare fee-for-service beneficiaries who were CR eligible in 2016, and assessed CR participation (≥1 CR session attended), timely initiation (participation within 21 days of event), and completion (≥36 sessions attended) through 2017. Measures were assessed overall, by beneficiary characteristics and geography, and by primary CR-qualifying event type (acute myocardial infarction hospitalization; coronary artery bypass surgery; heart valve repair/replacement; percutaneous coronary intervention; or heart/heart-lung transplant). Among 366 103 CR-eligible beneficiaries, 89 327 (24.4%) participated in CR, of whom 24.3% initiated within 21 days and 26.9% completed CR. Eligibility was highest in the East South Central Census Division (14.8 per 1000). Participation decreased with increasing age, was lower among women (18.9%) compared with men (28.6%; adjusted prevalence ratio: 0.91 [95% CI, 0.90-0.93]) was lower among Hispanics (13.2%) and non-Hispanic blacks (13.6%) compared with non-Hispanic whites (25.8%; adjusted prevalence ratio: 0.63 [0.61-0.66] and 0.70 [0.67-0.72], respectively), and varied by hospital referral region and Census Division (range: 18.6% [East South Central] to 39.1% [West North Central]) and by qualifying event type (range: 7.1% [acute myocardial infarction without procedure] to 55.3% [coronary artery bypass surgery only]). Timely initiation varied by geography and qualifying event type; completion varied by geography. CONCLUSIONS Only 1 in 4 CR-eligible Medicare beneficiaries participated in CR and marked disparities were observed. Reinforcement of current effective strategies and development of new strategies will be critical to address the noted disparities and achieve the 70% participation goal.
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Affiliation(s)
- Matthew D Ritchey
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA (M.D.R., S.L.J., T.C., H.S., L.S.)
| | - Sha Maresh
- Center for Medicare and Medicaid Innovation, Centers for Medicare and Medicaid Services, Baltimore, MD (S.M., J.M., T.S.)
| | - Jessica McNeely
- Center for Medicare and Medicaid Innovation, Centers for Medicare and Medicaid Services, Baltimore, MD (S.M., J.M., T.S.)
| | - Thomas Shaffer
- Center for Medicare and Medicaid Innovation, Centers for Medicare and Medicaid Services, Baltimore, MD (S.M., J.M., T.S.)
| | - Sandra L Jackson
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA (M.D.R., S.L.J., T.C., H.S., L.S.)
| | - Steven J Keteyian
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, Michigan (S.J.K., C.A.B.)
| | - Clinton A Brawner
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, Michigan (S.J.K., C.A.B.)
| | - Mary A Whooley
- School of Medicine, University of California, San Francisco (M.W.)
| | - Tiffany Chang
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA (M.D.R., S.L.J., T.C., H.S., L.S.).,IHRC, Inc. (T.C., H.S.)
| | - Haley Stolp
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA (M.D.R., S.L.J., T.C., H.S., L.S.).,IHRC, Inc. (T.C., H.S.)
| | - Linda Schieb
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA (M.D.R., S.L.J., T.C., H.S., L.S.)
| | - Janet Wright
- Office of the Surgeon General, US Department of Health and Human Services, Washington, DC (J.W.)
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Chang TE, Ritchey MD, Park S, Chang A, Odom EC, Durthaler J, Jackson SL, Loustalot F. National Rates of Nonadherence to Antihypertensive Medications Among Insured Adults With Hypertension, 2015. Hypertension 2019; 74:1324-1332. [DOI: 10.1161/hypertensionaha.119.13616] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Despite the importance of antihypertensive medication therapy for blood pressure control, no single data system provides estimates of medication nonadherence rates across age groups and health insurance plans types. Using multiple administrative datasets and national survey data, we determined health insurance plan-specific and overall weighted national rates of nonadherence to antihypertensive medications among insured hypertensive US adults in 2015. We used 2015 prescription claims data from Medicare Part D and 3 IBM MarketScan databases (Commercial, Medicaid, Medicare Supplemental) to calculate medication nonadherence rates among hypertensive adults aged ≥18 years with public or private health insurance using the proportion of days covered algorithm. These findings, in combination with National Health Interview Survey findings, were used to project national weighted estimates of nonadherence. We included 23.8 million hypertensive adults who filled 265.8 million prescriptions for antihypertensive medications. Nonadherence differed by health insurance plan type (highest for Medicaid members, 55.4%; lowest for Medicare Part D members, 25.2%). The overall weighted national nonadherence rate was 31.0%, with greater nonadherence among women versus men, younger versus older adults (aged 18–34 years, 58.1%; aged 65–74 years, 24.4%), fixed-dose combination medication nonusers (31.2%) versus users (29.4%), and by pharmacy outlet type (retail only, 30.7%; any mail order, 19.8%). In 2015, almost one-third (≈16.3 million) of insured US adults with diagnosed hypertension were considered nonadherent to their antihypertensive medication regimen, and considerable disparities were evident. Public health and healthcare professionals can use available evidence-based interventions to address nonadherence and improve blood pressure control.
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Affiliation(s)
- Tiffany E. Chang
- From the Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA (T.E.C., M.D.R., S.P., A.C., E.C.O., J.D., S.L.J., F.L.)
- IHRC, Inc, Atlanta, GA (T.E.C., A.C., J.D.)
| | - Matthew D. Ritchey
- From the Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA (T.E.C., M.D.R., S.P., A.C., E.C.O., J.D., S.L.J., F.L.)
| | - Soyoun Park
- From the Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA (T.E.C., M.D.R., S.P., A.C., E.C.O., J.D., S.L.J., F.L.)
| | - Anping Chang
- From the Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA (T.E.C., M.D.R., S.P., A.C., E.C.O., J.D., S.L.J., F.L.)
- IHRC, Inc, Atlanta, GA (T.E.C., A.C., J.D.)
| | - Erika C. Odom
- From the Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA (T.E.C., M.D.R., S.P., A.C., E.C.O., J.D., S.L.J., F.L.)
| | - Jeffrey Durthaler
- From the Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA (T.E.C., M.D.R., S.P., A.C., E.C.O., J.D., S.L.J., F.L.)
- IHRC, Inc, Atlanta, GA (T.E.C., A.C., J.D.)
| | - Sandra L. Jackson
- From the Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA (T.E.C., M.D.R., S.P., A.C., E.C.O., J.D., S.L.J., F.L.)
| | - Fleetwood Loustalot
- From the Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA (T.E.C., M.D.R., S.P., A.C., E.C.O., J.D., S.L.J., F.L.)
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50
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Ford CN, Leet RW, Kipling LM, Rhee MK, Jackson SL, Wilson PWF, Phillips LS, Staimez LR. Racial differences in performance of HbA 1c for the classification of diabetes and prediabetes among US adults of non-Hispanic black and white race. Diabet Med 2019; 36:1234-1242. [PMID: 31187544 PMCID: PMC7282707 DOI: 10.1111/dme.13979] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/18/2019] [Indexed: 01/21/2023]
Abstract
AIM To characterize differences between black and white people in optimal HbA1c thresholds for diagnoses of diabetes and prediabetes. METHODS Data were included from the National Health and Nutrition Examination Survey, 2005-2014. Black and white adults (age 18-70 years) who underwent an oral glucose tolerance test and had available fasting plasma glucose, 2-h plasma glucose and HbA1c measurements were eligible for inclusion. Diabetes or prediabetes status was defined by fasting plasma glucose and 2-h plasma glucose using American Diabetes Association criteria. Classification of diabetes, prediabetes and dysglycaemia by HbA1c was evaluated for a range of HbA1c thresholds, with optimal thresholds defined as those values that maximized the sum of sensitivity and specificity (Youden's index). RESULTS In 5324 black (32.3%) and white (67.7%) individuals, Youden's index (optimal) thresholds for HbA1c were ≥42 mmol/mol (6.0%) and ≥39 mmol/mol (5.7%) for discriminating diabetes vs non-diabetes, ≥ 44 mmol/mol (6.2%) and ≥39 mmol/mol (5.7%) for discriminating diabetes vs prediabetes (excluding normoglycaemia), ≥39 mmol/mol (5.7%) and ≥37 mmol/mol (5.5%) for discriminating dysglycaemia vs normoglycaemia, and ≥39 mmol/mol (5.7%) and ≥37 mmol/mol (5.5%) for discriminating prediabetes vs normoglycaemia (excluding diabetes), in black and white people, respectively. CONCLUSIONS Consistently higher optimal HbA1c thresholds in black people than in white people suggest a need to individualize HbA1c relative to glucose levels if HbA1c is used to diagnose diabetes and prediabetes.
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Affiliation(s)
- C N Ford
- Emory Global Diabetes Research Centre, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - R W Leet
- Emory Global Diabetes Research Centre, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Nutrition and Health Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - L M Kipling
- Emory Global Diabetes Research Centre, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - M K Rhee
- Atlanta VA Medical Centre, Decatur, GA, USA
- Division of Endocrinology and Metabolism, Department of Medicine, Emory University, Atlanta, GA, USA
| | - S L Jackson
- Division for Heart Disease and Stroke Prevention, National Centre for Chronic Disease Prevention and Health Promotion, Centres for Disease Control and Prevention, Atlanta, GA, USA
| | - P W F Wilson
- Atlanta VA Medical Centre, Decatur, GA, USA
- Division of Endocrinology and Metabolism, Department of Medicine, Emory University, Atlanta, GA, USA
- Division of Cardiology, Department of Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| | - L S Phillips
- Atlanta VA Medical Centre, Decatur, GA, USA
- Division of Endocrinology and Metabolism, Department of Medicine, Emory University, Atlanta, GA, USA
| | - L R Staimez
- Emory Global Diabetes Research Centre, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Nutrition and Health Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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