P2778Geographic variability in the decline of the incidence of fatal and non-fatal stroke: a statewide study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J B Kostis ◽  
J Cabrera ◽  
S Zinonos ◽  
W J Kostis
Keyword(s):  
Risk Factors ◽  
Regression Model ◽  
Violent Crime ◽  
Low Income ◽  
Single Parent ◽  
Mixed Effects ◽  
Robert Wood Johnson Foundation ◽  
Stroke Incidence ◽  
Fatal Stroke ◽  
Physically Inactive

Abstract Background/Introduction There is scant information on the geographic variability in the rate of stroke incidence as it relates to the demographics, comorbidities, risk factors, and insurance type. Purpose/Methods County-level data on four modifiable groups of health factors including healthy behaviors, clinical care, physical environment, and socioeconomic conditions were obtained from the Robert Wood Johnson Foundation. The percentage of persons 65 years or older, smokers, physically inactive, obese, diabetics, heavy drinkers, college graduates, low income, unemployed, uninsured heads of single parent households, and residence in areas of violent crime was used in predicting fatal or non-fatal stroke. The counties were lumped into 5 categories based on similarities of the above characteristics. The incidence of fatal and non-fatal stroke was compared among the 5 county clusters using a mixed-effects regression model. Results The incidence of fatal and non-fatal stroke was significantly lower (p<0.0001) in cluster 3, where residents had higher income, were better educated, and were less likely to be unemployed, to live in single parent households, to have diabetes, to be obese, to smoke, to be physically inactive, or to live in communities with violent crime. The percentage of persons older than 65, violent crime rate, and obesity were identified as significant predictors of stroke using a mixed-effects regression model. Conclusions This study indicates that the incidence of stroke is higher in areas with older population, higher rate of obesity, and in regions with more violent crime. In order to improve health outcomes, preventive measures for stroke should address environmental factors in addition to the known cardiovascular risk factors. Acknowledgement/Funding Robert Wood Johnson Foundation

scholarly journals Environmental exposures and systemic hypertension are risk factors for decline in lung function

Thorax ◽  
2018 ◽  
Vol 73 (12) ◽  
pp. 1120-1127 ◽  
Author(s):  
Catherine H Miele ◽  
Matthew R Grigsby ◽  
Trishul Siddharthan ◽  
Robert H Gilman ◽  
J Jaime Miranda ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lung Function ◽  
High Altitude ◽  
Low Income ◽  
Population Based ◽  
Mixed Effects ◽  
Systemic Hypertension ◽  
Lung Function Decline ◽  
Linear Mixed Effects ◽  
Annual Decline

BackgroundChronic lung disease is a leading contributor to the global disease burden; however, beyond tobacco smoke, we do not fully understand what risk factors contribute to lung function decline in low-income and middle-income countries.MethodsWe collected sociodemographic and clinical data in a randomly selected, age-stratified, sex-stratified and site-stratified population-based sample of 3048 adults aged ≥35 years from four resource-poor settings in Peru. We assessed baseline and annual pre-bronchodilator and post-bronchodilator lung function over 3 years. We used linear mixed-effects models to assess biological, socioeconomic and environmental risk factors associated with accelerated lung function decline.ResultsMean±SD enrolment age was 55.4±12.5 years, 49.2% were male and mean follow-up time was 2.36 (SD 0.61) years. Mean annual pre-bronchodilator FEV1 decline was 30.3 mL/year (95% CI 28.6 to 32.0) and pre-bronchodilator FVC decline was 32.2 mL/year (30.0 to 34.4). Using multivariable linear mixed-effects regression, we found that urban living, high-altitude dwelling and having hypertension accounted for 25.9% (95% CI 15.7% to 36.1%), 21.3% (11.1% to 31.5%) and 15.7% (3.7% to 26.9%) of the overall mean annual decline in pre-bronchodilator FEV1/height2, respectively. Corresponding estimates for pre-bronchodilator FVC/height2 were 42.1% (95% CI% 29.8% to 54.4%), 36.0% (23.7% to 48.2%) and 15.8% (2.6% to 28.9%) of the overall mean annual decline, respectively.ConclusionUrbanisation, living at high altitude and hypertension were associated with accelerated lung function decline in a population with low daily smoking prevalence.

Housing Relocation Policy and Violence

2016 ◽  
Vol 17 (5) ◽  
pp. 601-610 ◽  
Author(s):  
Andrea Casas ◽  
Jessica Duell ◽  
Teagen O’Malley ◽  
Patricia Documet ◽  
Richard Garland ◽  
...  
Keyword(s):  
Risk Factors ◽  
Public Housing ◽  
Violent Crime ◽  
Low Income ◽  
Housing Assistance ◽  
Housing Policies ◽  
Persistent Problem ◽  
Housing Projects ◽  
Moving To Opportunity ◽  
Comprehensive Picture

This article summarizes and reviews the cross-discipline literature on violent crime in destination neighborhoods postrelocation in order to build a more comprehensive picture of risk factors for violence, as well as how and why housing policies influence risk of violence. High rates of violent crime continue to be a persistent problem in areas of concentrated poverty and public housing. Modern housing programs such as Moving to Opportunity and Housing Opportunities for People Everywhere are popular interventions for reducing the density of low-income people receiving public housing assistance by relocating residents of distressed housing projects. However, evidence suggests that relocated residents may not experience less violence or improved safety in their new communities.

Increasing stroke incidence and prevalence of risk factors in a low-income Chinese population

Neurology ◽  
2014 ◽  
Vol 84 (4) ◽  
pp. 374-381 ◽  
Author(s):  
J. Wang ◽  
Z. An ◽  
B. Li ◽  
L. Yang ◽  
J. Tu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Low Income ◽  
Chinese Population ◽  
Stroke Incidence

A Cross-sectional Study of the Clinical Profile of Children With Cerebral Palsy in Benin, a West African Low-Income Country

2019 ◽  
Vol 34 (13) ◽  
pp. 842-850
Author(s):  
Emmanuel Segnon Sogbossi ◽  
Damienne Houekpetodji ◽  
Toussaint G. Kpadonou ◽  
Yannick Bleyenheuft
Keyword(s):  
Risk Factors ◽  
Cerebral Palsy ◽  
Low Income ◽  
Classification System ◽  
West African ◽  
Low Income Countries ◽  
Cross Sectional ◽  
Common Cause ◽  
Low Income Country ◽  
Children With Cerebral Palsy

Cerebral palsy is a common cause of pediatric motor disability. Although there are increasing amounts of data on the clinical profile of children with cerebral palsy in high-income countries, corresponding information about low-income countries and developing countries is lacking. Therefore, we aimed to describe the clinical spectrum of cerebral palsy in children in Benin, a representative West African low-income country. Our cross-sectional observational study included 114 children with cerebral palsy recruited from community-based rehabilitation centers and teaching hospitals (median age: 7 years, range 2-17; sex: 66% male). Data were collected through review of medical records and interviews with children’s mothers. Assessment included risk factors, clinical subtypes according to the Surveillance of CP in Europe criteria, severity of motor outcome scored by the Gross Motor Function Classification System (GMFCS) and Manual Ability Classification System, comorbidities, and school attendance. We recorded a high prevalence of intrapartum adverse events. Seventeen percent of children had postneonatal cerebral palsy, with cerebral malaria being the most common cause. Most children were severely affected (67.5% as bilateral spastic; 54.4% as GMFCS IV or V), but severity declined substantially with age. Only 23% of the children with cerebral palsy had attended school. Poor motor outcomes and comorbidities were associated with school nonattendance. These results suggest that intrapartum risk factors and postnatal cerebral malaria in infants are opportune targets for prevention of cerebral palsy in Sub-Saharan low-income countries.

scholarly journals Effect of tofogliflozin on arterial stiffness in patients with type 2 diabetes: prespecified sub-analysis of the prospective, randomized, open-label, parallel-group comparative UTOPIA trial

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Naoto Katakami ◽  
◽  
Tomoya Mita ◽  
Hidenori Yoshii ◽  
Toshihiko Shiraiwa ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Conventional Treatment ◽  
Mixed Effects ◽  
Mixed Effects Models ◽  
Open Label ◽  
Parallel Group ◽  
History Of

Abstract Background Tofogliflozin, an SGLT2 inhibitor, is associated with favorable metabolic effects, including improved glycemic control and serum lipid profile and decreased body weight, visceral adipose tissue, and blood pressure (BP). This study evaluated the effects of tofogliflozin on the brachial-ankle pulse wave velocity (baPWV) in patients with type 2 diabetes (T2DM) without a history of apparent cardiovascular disease. Methods The using tofogliflozin for possible better intervention against atherosclerosis for type 2 diabetes patients (UTOPIA) trial is a prospective, randomized, open-label, multicenter, parallel-group, comparative study. As one of the prespecified secondary outcomes, changes in baPWV over 104 weeks were evaluated in 154 individuals (80 in the tofogliflozin group and 74 in the conventional treatment group) who completed baPWV measurement at baseline. Results In a mixed-effects model, the progression in the right, left, and mean baPWV over 104 weeks was significantly attenuated with tofogliflozin compared to that with conventional treatment (– 109.3 [– 184.3, – 34.3] (mean change [95% CI] cm/s, p = 0.005; – 98.3 [– 172.6, – 24.1] cm/s, p = 0.010; – 104.7 [– 177.0, – 32.4] cm/s, p = 0.005, respectively). Similar findings were obtained even after adjusting the mixed-effects models for traditional cardiovascular risk factors, including body mass index (BMI), glycated hemoglobin (HbA1c), total cholesterol, high-density lipoprotein (HDL)-cholesterol, triglyceride, systolic blood pressure (SBP), hypertension, smoking, and/or administration of drugs, including hypoglycemic agents, antihypertensive agents, statins, and anti-platelets, at baseline. The findings of the analysis of covariance (ANCOVA) models, which included the treatment group, baseline baPWV, and traditional cardiovascular risk factors, resembled those generated by the mixed-effects models. Conclusions Tofogliflozin significantly inhibited the increased baPWV in patients with T2DM without a history of apparent cardiovascular disease, suggesting that tofogliflozin suppressed the progression of arterial stiffness. Trial Registration UMIN000017607. Registered 18 May 2015. (https://www.umin.ac.jp/icdr/index.html)

scholarly journals A comprehensive, contemporary assessment of the association between hepatosteatosis and coronary artery calcium scoring

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
T Heseltine ◽  
SW Murray ◽  
RL Jones ◽  
M Fisher ◽  
B Ruzsics
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Coronary Artery ◽  
Regression Model ◽  
Coronary Artery Calcium ◽  
Logistic Regression Model ◽  
Prediction Models ◽  
Multinomial Logistic Regression ◽  
Cvd Risk ◽  
Male Sex

Abstract Funding Acknowledgements Type of funding sources: None. onbehalf Liverpool Multiparametric Imaging Collaboration Background Coronary artery calcium (CAC) score is a well-established technique for stratifying an individual’s cardiovascular disease (CVD) risk. Several well-established registries have incorporated CAC scoring into CVD risk prediction models to enhance accuracy. Hepatosteatosis (HS) has been shown to be an independent predictor of CVD events and can be measured on non-contrast computed tomography (CT). We sought to undertake a contemporary, comprehensive assessment of the influence of HS on CAC score alongside traditional CVD risk factors. In patients with HS it may be beneficial to offer routine CAC screening to evaluate CVD risk to enhance opportunities for earlier primary prevention strategies. Methods We performed a retrospective, observational analysis at a high-volume cardiac CT centre analysing consecutive CT coronary angiography (CTCA) studies. All patients referred for investigation of chest pain over a 28-month period (June 2014 to November 2016) were included. Patients with established CVD were excluded. The cardiac findings were reported by a cardiologist and retrospectively analysed by two independent radiologists for the presence of HS. Those with CAC of zero and those with CAC greater than zero were compared for demographic and cardiac risks. A multivariate analysis comparing the risk factors was performed to adjust for the presence of established risk factors. A binomial logistic regression model was developed to assess the association between the presence of HS and increasing strata of CAC. Results In total there were 1499 patients referred for CTCA without prior evidence of CVD. The assessment of HS was completed in 1195 (79.7%) and CAC score was performed in 1103 (92.3%). There were 466 with CVD and 637 without CVD. The prevalence of HS was significantly higher in those with CVD versus those without CVD on CTCA (51.3% versus 39.9%, p = 0.007). Male sex (50.7% versus 36.1% p= &lt;0.001), age (59.4 ± 13.7 versus 48.1 ± 13.6, p= &lt;0.001) and diabetes (12.4% versus 6.9%, p = 0.04) were also significantly higher in the CAC group compared to the CAC score of zero. HS was associated with increasing strata of CAC score compared with CAC of zero (CAC score 1-100 OR1.47, p = 0.01, CAC score 101-400 OR:1.68, p = 0.02, CAC score &gt;400 OR 1.42, p = 0.14). This association became non-significant in the highest strata of CAC score. Conclusion We found a significant association between the increasing age, male sex, diabetes and HS with the presence of CAC. HS was also associated with a more severe phenotype of CVD based on the multinomial logistic regression model. Although the association reduced for the highest strata of CAC (CAC score &gt;400) this likely reflects the overall low numbers of patients within this group and is likely a type II error. Based on these findings it may be appropriate to offer routine CVD risk stratification techniques in all those diagnosed with HS.

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