scholarly journals Enrolling Incident Caregivers and Matched Controls From a Nationwide Epidemiological Study

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 658-658
Author(s):  
David Roth ◽  
William Haley ◽  
Orla Sheehan ◽  
J David Rhodes ◽  
Virginia Howard
Keyword(s):  
Blood Sample ◽  
Epidemiological Study ◽  
Racial Differences ◽  
Family Caregiving ◽  
Regards Study

Abstract Participants in the national Reasons for Geographic and Racial Differences in Stroke (REGARDS) study were asked about family caregiving responsibilities at enrollment (2003-2007). Among the 88% of participants who were not caregivers at enrollment, 1,229 reported becoming caregivers before a follow-up interview 12 years later. The Caregiving Transitions Study screened these participants and enrolled 251 as incident caregivers. All reported 5 or more hours of care per week, provided assistance with at least one ADL or IADL, and were caregivers for at least 3 months before a 2nd blood sample was obtained in the REGARDS study. A total of 251 noncaregiving control participants who reported no caregiving responsibilities over this 12-year period were also enrolled. Each control was matched to a caregiver on age (+ 5 years), sex, race, other demographics, and baseline (pre-caregiving) health variables. Descriptive analyses confirm the unique comparability of the samples compared to previous caregiving studies.

Abstract P515: Comparison of Dietary Measures Association With Incident Type 2 Diabetes: The Reasons for Geographic and Racial Differences in Stroke (regards) Study

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Stephanie Tison ◽  
April P Carson ◽  
James M Shikany ◽  
Keith Pearson ◽  
George Howard ◽  
...  
Keyword(s):  
Racial Differences ◽  
Mediterranean Diet ◽  
Dietary Patterns ◽  
Dietary Pattern ◽  
A Priori ◽  
Incident Diabetes ◽  
A Posteriori ◽  
Regards Study ◽  
Diet Score

Background: Previous studies have investigated the association of dietary patterns with risk of diabetes, but have not compared a priori and a posteriori dietary scores in the same diverse population. The objective of this study was to evaluate a priori and a posteriori dietary patterns associations with incident diabetes in the REGARDS study. Methods: This study included 8,875 Black and White adults with available dietary data, without diabetes (defined as fasting glucose>=126 mg/dL, random glucose>=200 mg/dL, or use of diabetes medications) at baseline (2003-2007), and with follow-up (2013-2016) status of diabetes. Dietary patterns were examined by quintile and included a posteriori Plant-based and Southern, as well as a priori scores of Mediterranean Diet Score, Dietary Approaches to Stop Hypertension (DASH) Diet Score, Dietary Inflammatory Index (DII) and Dietary Inflammation Score (DIS). Modified Poisson regression was used to obtain risk ratios for incident diabetes with models adjusted for total energy intake, demographics, and lifestyle factors. Results: The mean (SD) age at baseline was 63.2 (8.5) years, 27.1% were Black, 56.2% were female, and 11.7% had incident diabetes at follow-up. Adherence to the Southern dietary pattern was positively associated with incident diabetes for all models (figure). After adjustment for demographic factors, the highest quintiles of DII and DIS were associated with incident diabetes and the highest quintiles of DASH scores were protective of development of incident diabetes. Conclusion: The Southern dietary pattern derived in REGARDS showed the strongest association with incident diabetes of all the dietary scores and of the a priori scores the DIS showed the strongest association with incident diabetes. The lack of association in adjusted models with the Mediterranean Diet and Plant-based pattern show these scores to be less pertinent. The DIS demonstrates food based dietary inflammation as one of the potential pathways for incident diabetes.

Abstract 2535: Urban Versus Rural Differences In Stroke Risk: The CDC Wonder Estimates Of Mortality, And REasons For Geographic And Racial Differences In Stroke (REGARDS) Estimates Of Incidence And Survival After Stroke

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
George Howard ◽  
Michael Mullen ◽  
John Higginbotham ◽  
Dawn O Kleindorfer ◽  
Leslie A McClure ◽  
...  
Keyword(s):  
Racial Differences ◽  
Stroke Risk ◽  
Classification Scheme ◽  
Statistical Significance ◽  
Stroke Mortality ◽  
Stroke Incidence ◽  
Risk Of Death ◽  
Urban Rural ◽  
Regards Study

Introduction: Rural-urban disparities in stroke are poorly understood and incompletely characterized. US stroke incidence, mortality, and survival after stroke have not, to our knowledge, been previously reported by urban-rural status. Methods: Data for US residents over age 45 from the CDC WONDER system were used to describe the age-adjusted stroke mortality rates between 1999 and 2007 for each county in the US, stratified by rurality. Stroke was defined by ICD-10 codes 60-69. Rurality was defined at the county level using the National Center for Health Statistics 6-level classification scheme. Data from the REGARDS Study, a longitudinal cohort study of 30,239 black and white participants aged 45+ from 48 states, were used to estimate the age and sex adjusted hazard ratio for incident stroke, and to assess survival after stroke, using the same urban/rural classification scheme. Results: Between 1999 and 2007, stroke mortality (per 100,000) for those aged 45+ was higher in rural counties for both whites and blacks, with a 20% difference in whites (156.6 for rural versus 131.0 for central metropolitan) and a 32% difference in blacks (237.4 versus 179.6). Among 27,740 REGARDS participants who were stroke-free at baseline with follow-up data, 614 adjudicated stroke events occurred over a mean 4.9 years of follow-up. For whites, incident stroke risk did not change with higher urbanization (HR reported in table ). There was a consistently lower risk of incident stroke with higher urbanization for blacks although this difference did not reach statistical significance (see table ). Follow-up was available on 609 of the stroke events. Risk of death after stroke appeared consistently (although generally non-significantly) lower with greater urbanization (see table ) for both blacks and whites. Discussion: Greater urbanization appears to be associated with lower stroke mortality for both whites and blacks, although differences may be larger for blacks. This difference in mortality may be due to both decreased incidence and survival following stroke for blacks; however, higher mortality for rural whites appears to be only due to decreased survival. Reasons for differences in incidence and survival following stroke may be related to control of vascular risk factors and access to care although further study is required.

Abstract 13: Racial Differences in the Impact of Multiple Social Vulnerabilities to Health Disparities and Hypertension and Death in the Reasons for Geographic and Racial Differences in Stroke (regards) Study

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Jordan B King ◽  
Laura Pinheiro ◽  
Joanna Bryan Ringel ◽  
Adam P Bress ◽  
Daichi Shimbo ◽  
...  
Keyword(s):  
Health Disparities ◽  
Racial Differences ◽  
Economic Education ◽  
Community Context ◽  
Adjusted Relative Risk ◽  
Black Adults ◽  
Regards Study ◽  
Social Vulnerabilities ◽  
The Impact

Background: Individual social vulnerabilities to health disparities increase the risk of developing hypertension and lower life expectancy, but their cumulative effect on these outcomes is unknown. Methods: Using the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, we included participants aged 45 years or older without hypertension at baseline (i.e., systolic/diastolic blood pressure <130/80 mm Hg and no antihypertensive medication use). The exposure was count of vulnerabilities at baseline which were defined across economic, education, health and health care, neighborhood and built environment, and social and community context domains. The primary outcome took on three levels: 1) alive at follow-up without hypertension (reference group), 2) alive at follow-up with hypertension, or 3) deceased prior to follow-up 10-year risk of hypertension or death. Multinomial logistic regression was used to determine associations of the count of vulnerabilities with hypertension and survival status at the second in-home visit, expressed as adjusted relative risk ratios (aRRR). Analyses were stratified by race. Results: Among 5425 participants (mean±SD age of 63±10 years, 24% black, and 54% female), 1785 (33%) participants developed hypertension and 1135 (21%) participants died. A greater proportion of black participants developed hypertension and died than did white participants (hypertension, 38% vs 31%; death, 25% vs 20%). The associations between vulnerability count and both hypertension and death were stronger in white participants than black participants (p-value for vulnerability count*race interaction: hypertension = 0.042, death =0.021; Figure 1). Conclusions: The relative effect of multiple social vulnerabilities on hypertension development may be stronger in white adults than black adults. Nonetheless, black adults experience the highest absolute rates of hypertension in all subpopulations.

scholarly journals Association Between HDL Cholesterol and Incident Cognitive Impairment in Black and White Adults in The Reasons For Geographic and Racial Differences in Stroke Study

2021 ◽  
Author(s):  
Robert Rosenson ◽  
Mary Cushman ◽  
Emily C. McKinley ◽  
Paul Muntner ◽  
Zhixin Wang ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Black Women ◽  
Racial Differences ◽  
White Women ◽  
Density Lipoprotein ◽  
Hdl Cholesterol ◽  
Stroke Event ◽  
Low Hdl ◽  
Regards Study

Abstract BACKGROUND: Low levels of high-density lipoprotein cholesterol (HDL-C) have been associated with incident cognitive impairment (ICI) in some, but not all studies. METHODS: We examine the association between HDL-C and ICI among 18,378 Reasons for Geographic and Racial Differences in Stroke (REGARDS) study participants without cognitive impairment or stroke at baseline in 2003 to 2007, and who did not have a stroke event during follow-up. RESULTS: Over a median follow-up of 9.6 years, 1,359 participants developed ICI. In fully adjusted models, the RR for ICI was 1.51 (95% CI 1.06, 2.15) in White women and 1.25 (95% CI 0.95, 1.65) in Black women. The association was not statistically significant afrter adjustment for triglycerides. There was no evidence of an association between HDL-C and ICI among White or Black men. CONCLUSIONS: Low HDL-C was associated with a higher risk of ICI in White and Black women in models not including triglycerides.

Abstract MP102: Family Caregiving is Associated with Increased Stroke Risk Among Strained Spouse Caregivers

Circulation ◽  
2016 ◽  
Vol 133 (suppl_1) ◽  
Author(s):  
Sindhu Lakkur ◽  
Virginia Howard ◽  
Suzanne Judd ◽  
William Haley ◽  
David Roth
Keyword(s):  
Family Caregivers ◽  
Racial Differences ◽  
Family Caregiving ◽  
Cardiovascular Health ◽  
Stroke Risk ◽  
Care Recipient ◽  
Health Concern ◽  
Increased Risk ◽  
Spouse Caregivers ◽  
Regards Study

Background: As the American population ages, the number of family caregivers is expected to increase. Consequently, understanding the effects family caregiving has on the cardiovascular health of caregivers presents an important public health concern. Previous studies have observed associations between family caregiving and adverse cardiovascular health outcomes such as hypertension, coronary heart disease, and an increased Framingham Stroke Risk Score. However, the association between family caregiving and stroke risk is poorly understood. Hypothesis: We examined the association between family caregiving and risk of incident stroke in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study to test the hypotheses that 1) family caregivers have higher risk of stroke compared to noncaregivers and 2) strained caregivers have higher risk of stroke compared to noncaregivers. Methods: The REGARDS study enrolled black and white participants, aged 45 and older, from 2003-2007. Participants were categorized as caregivers if they answered affirmatively to the baseline interview question, “Are you currently providing care on an on-going basis to a family member with a chronic illness or disability?” Caregivers were asked their relationship to the care recipient and the amount of perceived physical and mental strain they associated with care (none, some, a lot). Using a propensity score matching procedure based on 16 demographic, lifestyle, and stroke risk factors, caregivers (n=3,055) were individually matched with noncaregivers (n=3,055). Hazard ratios (HRs) and 95% confidence intervals (95% CIs) for incident stroke risk were calculated using Cox proportional hazards models. Results: During an average 8.5-year follow up period, 114 (3.73%) caregivers and 112 (3.67%) matched noncaregivers had an incident stroke. Caregivers did not have a higher risk of stroke compared to non-caregivers (HR=1.006, 95% CI=0.775, 1.306). The HRs (95% CIs) for incident stroke risk were 1.427 (0.938, 2.171) for caregivers reporting no caregiving strain, 0.918 (0.628, 1.341) for moderate strain, and 1.963 (0.977, 3.946) for high strain. Strained spouse caregivers who reported high or moderate strain had a 95% higher risk of stroke than matched noncaregivers (HR=1.958, 95% CI=1.002, 3.828). Conclusion: We observed that perceived caregiving strain, particularly among spouse caregiviers, is associated with increased risk of stroke. This group of caregivers may need targeted support. Further studies examining the nuanced effects of caregiver burden on cardiovascular health are required.

scholarly journals Risk for cardiovascular events following ‘microsize’ versus usual myocardial infarctions

Heart ◽  
2020 ◽  
pp. heartjnl-2020-317852
Author(s):  
Zaid I Almarzooq ◽  
Lisandro D Colantonio ◽  
Peter M Okin ◽  
Joshua S Richman ◽  
Todd M Brown ◽  
...  
Keyword(s):  
Racial Differences ◽  
Cardiovascular Events ◽  
Cohort Analysis ◽  
Myocardial Infarctions ◽  
Prevention Strategies ◽  
All Cause Mortality ◽  
History Of ◽  
Regards Study ◽  
Study Participants

BackgroundMicrosize myocardial infarction (MI) is a recently described phenomenon that meets rigorous criteria for MI with very low peak troponin elevations. We aim to compare the risk for cardiovascular events and mortality following microsize versus usual MIs.Methods and resultsProspective cohort analysis of REasons for Geographic And Racial Differences in Stroke (REGARDS) study participants without a history of coronary heart disease (CHD) who had an incident MI between 2003 and 2015. Incident MIs were classified as microsize MI (peak troponin <0.5 ng/mL) or usual MI (peak troponin ≥0.5 ng/mL). Participants were followed for a composite of cardiovascular events that included recurrent MI, coronary revascularisation, fatal CHD and heart failure, and all-cause mortality. Overall, 1024 participants with an incident MI were included in the analysis (328 with microsize MI and 696 with usual MI). Participants with microsize MI were more likely to be older and black. The multivariable-adjusted adjustment HR for cardiovascular events among participants with microsize versus usual MI after a median follow-up of 1.7 years was 1.11 (95% CI 0.86 to 1.44). The multivariable-adjusted HR for all-cause mortality after 28 days from incident MI among participants with microsize versus usual MI after a median follow-up of 3.6 years was 1.09 (95% CI 0.81 to 1.45).ConclusionMicrosize MIs have a prognostic value for future cardiovascular events and mortality comparable to usual MIs. These findings should encourage clinicians to initiate secondary prevention strategies in patients with microsize MI until this emerging clinical entity is better understood.

scholarly journals DEMENTIA CAREGIVING NEGATIVELY AFFECTS THE HEALTH OF CAREGIVER AND CARE RECIPIENT. CAREGIVING TRANSITIONS STUDY

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S219-S219
Author(s):  
Orla C Sheehan ◽  
William E Haley ◽  
Virginia Howard ◽  
Jin Huang ◽  
J David Rhodes ◽  
...  
Keyword(s):  
Racial Differences ◽  
Family Caregiving ◽  
Population Based ◽  
Care Recipient ◽  
Eligibility Criteria ◽  
Dementia Caregivers ◽  
Cross Sectional ◽  
Regards Study ◽  
Caregiving Roles ◽  
Person With Dementia

Abstract Dementia is one of the most common reasons for needing a caregiver (CG). Few studies have compared dementia and non-dementia caregivers who have transitioned into family caregiving roles. Participants in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study who transitioned into a significant caregiving role were recruited to participate in the Caregiving Transitions Study (CTS). Of 11,483 REGARDS participants who were not caregivers at baseline, 1229 (11%) transitioned into a family caregiving role. Eligibility criteria were met by 251 and they were enrolled along with 251 demographically-matched noncaregiving controls. Enrolled caregivers are 65% female; 36% African American; 71.8 + 8.1 years of age; caring for a spouse/partner (51%), parent (25%), or another person (24%). 47% are caring for a person with dementia. Dementia CGs provide more hours of care per day (9.3 hours versus 6.7 hours), report being under more stress and twice as much strain as non-dementia CGs (p&lt;0.03 for all). They feel more burdened by the care recipient’s treatment (p=0.01) and report that the burden leads to delays in the care recipient receiving medical care (p&lt;0.007). Dementia CGs are more than twice as likely as non-caregivers to report that their caregiving makes them worse at taking care of their own health (33.9% versus 15.4%, p=0.003). This prospective, population-based study confirms previous cross-sectional findings from convenience samples on the greater care burden experienced by dementia caregivers and extends this work to new measures of treatment burden and treatment delay.

Abstract P395: Low Neighborhood Income is Associated With Increased Hypertension Incidence in the Reasons for Geographic and Racial Differences in Stroke Study

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Insu Koh ◽  
Leslie A McClure ◽  
Suzanne E Judd ◽  
Gina S Lovasi ◽  
Natalie Colabianchi ◽  
...  
Keyword(s):  
Racial Differences ◽  
Low Income ◽  
Middle Income ◽  
Incident Hypertension ◽  
Individual Level ◽  
Neighborhood Income ◽  
Regards Study ◽  
Incident Rate ◽  
The Relationship

Introduction: Prior studies have investigated the relationship between neighborhood income and incident hypertension but have lacked participant-level details or studied specific subpopulations. We assessed the relationship between neighborhood income and incident hypertension accounting for individual level factors in the racially and geographically diverse REasons for Geographic And Racial Differences in Stroke (REGARDS) study. Hypothesis: Low neighborhood income is associated with increased hypertension incidence. Methods: REGARDS recruited 30,239 white and black adults aged ≥45y from the contiguous US in 2003-7 with follow-up between 2013-6. We excluded individuals with baseline hypertension (≥130/80 mm Hg or using antihypertension medications, n=22,325), missing follow-up (n=3,365) and not residing at the same address for ≥5 years (n=1,075). Neighborhood income was measured within 1 and 5 km buffers around the participant’s home using a spatial overlay of census tract-level median household income, and then classified into tertiles. We used Poisson regression to calculate risk ratio for incident hypertension adjusting for demographic, socioeconomic, and health habit factors. Results: Among the 3,474 individuals (58% women, 24% black, mean age 62y), 1,499 individuals (43%) developed hypertension. After adjusting for individual-level risk factors, the incident rate ratio of hypertension for individuals living in low-income neighborhoods was 1.16 (95% CI 1.04, 1.31) and middle-income was 1.12 (95% CI 1.01, 1.25) as compared to high income, when neighborhood was defined as a 1 km buffer. The result was similar but not significant in middle-income for the 5 km buffer neighborhoods (Table 1). There were no significant interactions with age, gender, or race (p-interaction > 0.1). Conclusions: In REGARDS, neighborhood income was associated with incident hypertension. Understanding the specific social and environmental inequities associated with hypertension will require further study.

Abstract W MP64: Incident Stroke and Alcohol Consumption among Older Adults

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Solveig A Cunningham ◽  
Aleena Mosher ◽  
Suzanne E Judd ◽  
Lisa M Matz ◽  
Edmond K Kabagambe ◽  
...  
Keyword(s):  
Alcohol Consumption ◽  
Racial Differences ◽  
Medical Records ◽  
Stroke Risk ◽  
Proportional Hazard ◽  
Black And White ◽  
Stroke Risk Factors ◽  
Regards Study ◽  
White Adults

Background: Alcohol consumption may reduce the risk of stroke. While both stroke and alcohol consumption patterns differ by race and sex, it is not known to what extent alcohol consumption contributes to the elevated risk of stroke in some groups, particularly in men and blacks in general. Methods: Risk of stroke was studied in 25,162 black and white adults aged 45+, in the REasons for Geographic And Racial Differences in Stroke (REGARDS) study. Information on alcohol consumption was obtained by telephone interview at baseline. Participants are contacted every 6 months by telephone for self- or proxy-reported stroke; medical records are retrieved and adjudicated by physicians Proportional hazard models, adjusted for demographic, socioeconomic, and stroke risk factors , were used. Results: Participants’ mean age was 64.7 years; 40% were black and 56% were women with 867 stroke events and a median follow-up time of 7.6 years. Compared to current drinkers, non-drinkers had 36% higher hazards of incident stroke which was significantly higher consistent across all race-sex groups except black men. Risks were particularly high among past drinkers (50% higher than among current drinkers), as would be expected since many may have stopped drinking due to health problems. However, risks were also elevated among lifetime abstainers. Differences in stroke risks were explained by demographic and socioeconomic differences between drinkers and non-drinkers. Among those who are current drinkers, those who consumed <1 drink per week had significantly lower hazards of stroke than moderate drinkers, and these protective factors remained marginally significant after accounting for demographic, socioeconomic, behavioral and health characteristics. Conclusions: Results suggest that individuals who do not currently consume alcohol may experience higher risks of stroke, which may be due in part due to socio-demographic and other characteristics associated with consuming alcohol.

Pro-Neurotensin/Neuromedin N and Risk of Incident Metabolic Syndrome and Diabetes Mellitus in the REGARDS Cohort

2021 ◽  
Author(s):  
Charles D Nicoli ◽  
April P Carson ◽  
Timothy B Plante ◽  
D Leann Long ◽  
Leslie A McClure ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Insulin Resistance ◽  
Metabolic Syndrome ◽  
Racial Differences ◽  
Regression Models ◽  
Logistic Regression Models ◽  
Low Hdl ◽  
Regards Study ◽  
Neuromedin N

Abstract Context The peptide neurotensin is implicated in insulin resistance, diabetes mellitus (DM), and cardiovascular disease. Objective We studied the association of neurotensin’s stable precursor, pro-neurotensin/neuromedin N (pro-NT/NMN) with incident metabolic syndrome (MetS) and DM. Design/Setting/Participants We included 3,772 participants from the REasons for Geographic And Racial Differences in Stroke (REGARDS) study who completed the baseline exam (2003-2007), the follow-up exam (2013-2016), and had pro-NT/NMN measured by immunoassay. Weighted logistic regression models were fitted to incident DM, incident MetS, and each MetS component, separately, incorporating demographics, metabolic risk factors, HOMA-IR, and diet scores. Main Outcome Measures Incident MetS was defined by ≥3 harmonized criteria at follow-up in those with &lt;3 at baseline. Incident DM was defined by use of hypoglycemic drugs/insulin, fasting glucose ≥126 mg/dL, or random glucose ≥200 mg/dL, in those without these at baseline. Results Median [IQR] plasma pro-NT/NMN was 160 [118-218] pmol/L. 564 (of 2,770 without baseline MetS) participants developed MetS and 407 (of 3,030 without baseline DM) developed DM. Per standard deviation (SD) higher log-Pro-NT/NMN, the demographic-adjusted odds ratio (OR) and 95% confidence interval (CI) of incident MetS was 1.22 (1.11-1.35); 1.16 (1.00-1.35) for incident low HDL, and 1.25 (1.11-1.40) for incident dysglycemia. The association of pro-NT/NMN with MetS was attenuated in the model adding HOMA-IR (OR per SD log-pro-NT/NMN 1.14, 95% CI 1.00-1.30). There was no association with incident DM (OR per SD log-pro-NT/NMN 1.06, 95% CI 0.94-1.19). Conclusions Pro-NT/NMN was associated with MetS and two components, dysglycemia and low HDL, likely explained by insulin resistance.

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