Abstract P013: Cost-Effectiveness of Treating Hypertension in African Americans According to 2014 Guidelines

Circulation ◽  
2015 ◽  
Vol 131 (suppl_1) ◽  
Author(s):  
Eshan Vasudeva ◽  
Nathalie Moise ◽  
Keane Y Tzong ◽  
Joanne Penko ◽  
Lee Goldman ◽  
...  
Keyword(s):  
African American ◽  
Cost Effectiveness ◽  
African Americans ◽  
Cost Saving ◽  
African American Women ◽  
African American Men ◽  
Hypertension Treatment ◽  
Community Based Interventions ◽  
Life Years ◽  
Stage 1

Background: Among U.S. ethnic groups, African Americans have the highest prevalence of hypertension and higher rates of hypertension-related morbidity and mortality. We estimated the cost-effectiveness of improved hypertension control in African Americans. Methods: The populations studied were African Americans and all U.S. adults aged 35-74 years. Using the CVD Policy Model, we simulated CVD events and non-CVD deaths, quality-adjusted life years (QALYs), and hypertension and CVD treatment costs, before and after implementing 2014 U.S. guidelines. African American and overall U.S. CVD incidence, mortality, and risk factor levels were obtained from cohort studies, vital statistics, and the NHANES. Hypertension treatment effects were derived from a meta-analysis of clinical trials. Stage 2 hypertension was defined as BP ≥160/100 mmHg; stage 1 as BP ≥140/90 and <160/100 mmHg. Incremental cost-effectiveness ratios (ICERs) were calculated as change in costs divided by change in QALYs. An ICER <50,000 was cost effective, ≥$50,000 and <$150,000 intermediate value, and >$150,000 low value. Results: Treating hypertension in CVD patients and in stage 2 hypertensives without CVD would be cost-saving in all African Americans and in all but the youngest women overall (Table). Treating stage 1 hypertension would be cost-saving in all African American men except for ages 35-44 without diabetes or CKD, and cost-saving in all women ≥45 years old. Treating the youngest women with stage 1 hypertension was of intermediate or low value in both African Americans and the U.S. overall, but of more value in African American women. Discussion: In a computer simulation of hypertension treatment according to 2014 guidelines, we found that controlling hypertension would be cost-saving in all African American adults age 45 or older. These results suggest that investment in effective clinic and community-based interventions aimed at controlling hypertension in African Americans would yield high value to health system payers and to society.

Abstract MP019: Should Global Cardiovascular Risk Guide Treatment of Stage One Hypertension? A Cost-effectiveness Analysis

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Andrew Moran ◽  
Petra Rasmussen ◽  
Rachel Zhao ◽  
Pamela G Coxson ◽  
David Guzman ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Cost Effectiveness ◽  
Cost Saving ◽  
Risk Function ◽  
Annual Number ◽  
Base Case ◽  
Cvd Risk ◽  
Policy Model ◽  
Life Years ◽  
Stage 1

Introduction: Current U.S. hypertension guidelines base treatment on clinic blood pressure (BP) alone. International guidelines recommend adding global cardiovascular disease (CVD) risk to guide treatment. We projected incremental effectiveness and costs of treating stage 1 hypertension based on CVD risk assessment. Methods: We used the Coronary Heart Disease (CHD) Policy Model, a validated state-transition simulation of the CVD epidemic in the US, to model CHD and stroke events, costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness (ICE) of increasingly aggressive treatment of hypertensive patients. Census and national survey data were used to estimate joint distributions of risk factors by age and sex; the CVD risk function was based on Framingham. We modeled treatment of BP to an approximate target <140/90 mmHg using standard dose medications, including averaged annual drug costs (e.g., $253 for a systolic BP reduction of 11.5 mmHg; $1,036 for reduction of 36.7 mmHg) and monitoring costs (2 or 4 visits/year for stage 1 or 2 plus 1 lab test/year for all). We compared a strategy in which only stage 2 hypertensives (≥160/≥100 mmHg) were treated to increasingly aggressive strategies in which stage 1 hypertensives (140-159/90-99 mmHg) with successively lower global CVD risk (15%, 10%, 5% risk, then all of stage 1) were also treated. Results: Reaching hypertension treatment targets with any policy simulated would prevent between 389,000 and 478,000 CVD events annually ( Table ). Treating all stage 2 and ≥15% CVD risk stage 1 hypertensives would be cost-saving and treating stage 1 with ≥10% or ≥5% CVD risk would incur modest costs. Treating all stage 1 would cost $161,000/QALY more than treating only ≥5% CVD risk. Conclusions: Treatment of low risk stage 1 hypertensives appears to come at high cost and limited added benefit unless treatment costs can be minimized. Using global CVD risk assessment might allow re-allocation of resources toward controlling hypertension in the highest risk patients. Table Simulated CVD outcomes, costs, and cost-effectiveness, 2010-2011, the CHD Policy Model Scenario Annual number hypertensives treated Annual CVD events Annual QALYs (millions) Annual costs (millions, $US) ICER * Base case, no intervention - 2,387,000 127.67 $827,313 reference Treat only stage 2 23,364,180 1,997,000 128.78 $825,264 cost saving Treat stage 2 + stage 1 >=15% CVD risk 30,654,361 1,943,000 128.93 $824,541 cost saving Treat stage 2 + stage 1 >=10% CVD risk 34,947,200 1,928,000 128.97 $824,898 $9,381 Treat stage 2 + stage 1 >= 5% CVD risk 44,321,985 1,913,000 129.02 $826,433 $28,931 Treat stage 2 + all stage 1 50,863,390 1,909,000 129.04 $828,290 $160,630 *ICER = difference in cost/difference in QALY in comparison with the next less effective strategy

Age Differences in Knowledge about HIV Transmission among African-American Men and Women

2007 ◽  
Vol 101 (3_suppl) ◽  
pp. 1133-1140 ◽  
Author(s):  
Ann Kathleen Burlew
Keyword(s):  
African American ◽  
African Americans ◽  
African American Women ◽  
Hiv Transmission ◽  
African American Men ◽  
Hiv And Aids ◽  
Men And Women ◽  
Younger Women ◽  
Older African Americans ◽  
The Difference

To test whether knowledge about HIV transmission may be one contributing factor to the disproportionately high rates of HIV and AIDS cases among older African Americans, this study examined data from 448 African-American men and women, who completed the AIDS Knowledge and Awareness Scale. Overall the findings supported the hypothesis that older African Americans were not as knowledgeable as their younger counterparts. However, the analyses also indicated older (age 61+) African-American women were significantly less knowledgeable about HIV transmission than the younger women. However, the difference between older and younger men was not significant. One implication is that older African Americans, especially women, should be targets of educational efforts.

scholarly journals Dietary vitamin D and risk of non-Hodgkin lymphoma: the multiethnic cohort

2009 ◽  
Vol 103 (4) ◽  
pp. 581-584 ◽  
Author(s):  
Eva Erber ◽  
Gertraud Maskarinec ◽  
Unhee Lim ◽  
Laurence N. Kolonel
Keyword(s):  
Vitamin D ◽  
African American ◽  
African Americans ◽  
African American Women ◽  
Disease Risk ◽  
African American Men ◽  
B Cell Lymphoma ◽  
Dietary Vitamin ◽  
Multiethnic Cohort ◽  
Dietary Vitamin D

The present study explored the association between dietary vitamin D and non-Hodgkin's lymphoma (NHL) risk. The multiethnic cohort (MEC) includes more than 215 000 Caucasians, African Americans, Native Hawaiians, Japanese Americans and Latinos, aged 45–75. After 10 years of follow-up, 939 incident NHL cases were identified. Risk was estimated using proportional hazards' models adjusted for possible confounders. Vitamin D intake was not associated with NHL risk in the entire cohort (Ptrend = 0·72 for men and Ptrend = 0·83 for women), but significantly lowered disease risk in African American women (hazard ratio (HR) = 0·50, 95 % CI: 0·28, 0·90, Ptrend = 0·03) and was borderline protective in African American men (HR = 0·68; 95 % CI: 0·39, 1·19; Ptrend = 0·31) when the highest to the lowest tertile was compared. In NHL subtype analyses, a 19, 36 and 32 % lowered risk, although not significant, was observed for diffuse large B-cell lymphoma, follicular lymphoma and small lymphocytic lymphoma/chronic lymphocytic leukemia in women, respectively. High dietary intake of vitamin D did not show a protective effect against NHL within the MEC except among African Americans, possibly because vitamin D production due to sun exposure is limited in this population.

scholarly journals Race and other sociodemographic categories are differentially linked to multiple dimensions of interpersonal-level discrimination: Implications for intersectional, health research

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0251174
Author(s):  
Danielle L. Beatty Moody ◽  
Shari R. Waldstein ◽  
Daniel K. Leibel ◽  
Lori S. Hoggard ◽  
Gilbert C. Gee ◽  
...  
Keyword(s):  
African American ◽  
African Americans ◽  
Social Status ◽  
African American Women ◽  
African American Men ◽  
Multiple Dimensions ◽  
Older African Americans ◽  
Poverty Status ◽  
Interpersonal Level ◽  
Everyday Discrimination

Objectives To examine whether intersections of race with other key sociodemographic categories contribute to variations in multiple dimensions of race- and non-race-related, interpersonal-level discrimination and burden in urban-dwelling African Americans and Whites. Methods Data from 2,958 participants aged 30–64 in the population-based Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study were used to estimate up to four-way interactions of race, age, gender, and poverty status with reports of racial and everyday discrimination, discrimination across multiple social statuses, and related lifetime discrimination burden in multiple regression models. Results We observed that: 1) African Americans experienced all forms of discrimination more frequently than Whites, but this finding was qualified by interactions of race with age, gender, and/or poverty status; 2) older African Americans, particularly African American men, and African American men living in poverty reported the greatest lifetime discrimination burden; 3) older African Americans reported greater racial discrimination and greater frequency of multiple social status-based discrimination than younger African Americans; 4) African American men reported greater racial and everyday discrimination and a greater frequency of social status discrimination than African American women; and, 5) White women reported greater frequency of discrimination than White men. All p’s < .05. Conclusions Within African Americans, older, male individuals with lower SES experienced greater racial, lifetime, and multiple social status-based discrimination, but this pattern was not observed in Whites. Among Whites, women reported greater frequency of discrimination across multiple social statuses and other factors (i.e., gender, income, appearance, and health status) than men. Efforts to reduce discrimination-related health disparities should concurrently assess dimensions of interpersonal-level discrimination across multiple sociodemographic categories, while simultaneously considering the broader socioecological context shaping these factors.

African American men who become mental health advocates

2021 ◽  
pp. 002076402110127
Author(s):  
Sandra Yaklin ◽  
Miyong Kim ◽  
Jacklyn Hecht
Keyword(s):  
Mental Health ◽  
African American ◽  
African Americans ◽  
Intervention Program ◽  
African American Men ◽  
Working Relationships ◽  
Major Theme ◽  
Community Based ◽  
Tailored Messages ◽  
Promote Mental Health

Using a narrative approach, this study explored how African American men became mental health advocates. This ancillary study is part of a formative within an ongoing community based intervention program that was designed to promote mental health of African Americans (AMEN) project within an ongoing community based intervention program that was designed to promote mental health of African Americans (AMEN) project. Narrative research techniques were used to analyze and synthesize the data. Analysis generated one major theme (interdependence) with four supporting sub-themes (credibility, social depression, stigma, and calling). These findings and insights through this qualitative study guided the AMEN project team to formulate effective communication strategies in establishing working relationships with community partners and wider stakeholders as well as crafting culturally tailored messages for African American participants.

Consequences of a match made in hell: the harm caused by menthol smoking to the African American population over 1980–2018

2021 ◽  
pp. tobaccocontrol-2021-056748 ◽  
Author(s):  
David Mendez ◽  
Thuy T T Le
Keyword(s):  
Public Health ◽  
African American ◽  
African Americans ◽  
Smoking Initiation ◽  
African American Community ◽  
American Population ◽  
The Public ◽  
African American Population ◽  
Menthol Cigarettes ◽  
Life Years

BackgroundFor many years, national surveys have shown a consistently disproportionately high prevalence of menthol smokers among African Americans compared with the general population. However, to our knowledge, no prior study has quantified the harm that menthol smoking has caused on that population. In this work, we estimate the public health harm that menthol cigarettes have caused to the African American community over the last four decades.MethodsUsing National Health Interview Survey data, we employed a well-established simulation model to reproduce the observed smoking trajectory over 1980–2018 in the African American population. Then, we repeat the experiment, removing the effects of menthol on the smoking initiation and cessation rates over that period, obtaining a new hypothetical smoking trajectory. Finally, we compared both scenarios to calculate the public health harm attributable to menthol cigarettes over 1980–2018.ResultsOur results show that menthol cigarettes were responsible for 1.5 million new smokers, 157 000 smoking-related premature deaths and 1.5 million life-years lost among African Americans over 1980–2018. While African Americans constitute 12% of the total US population, these figures represent, respectively, a staggering 15%, 41% and 50% of the total menthol-related harm.DiscussionOur results show that menthol cigarettes disproportionally harmed African Americans significantly over the last 38 years and are responsible for exacerbating health disparities among that population. Removing menthol cigarettes from the market would benefit the overall US population but, particularly, the African American community.

Sociodemographic Influences in the Prediction of Attitudes toward Transracial Adoption

2000 ◽  
Vol 81 (1) ◽  
pp. 92-100 ◽  
Author(s):  
Leslie Doty Hollingsworth
Keyword(s):  
African American ◽  
African American Women ◽  
African American Men ◽  
Policy Research ◽  
Transracial Adoption ◽  
Opinion Survey ◽  
Research And Practice ◽  
Caucasian Men ◽  
Using Data ◽  
Age Category

An exploratory study of attitudes toward transracial adoption was conducted, using data from a 1991 national telephone opinion survey of 916 respondents. Seventy-one percent of those surveyed believed that race should not be a factor in who should be allowed to adopt a child. However, in a logistic regression analysis, respondents in the highest age category (i.e., those older than 64 years) were 63% less likely to approve of transracial adoption, compared with 18- to 29-year-olds. There was also an interaction of race and sex. African-American women were 84% less likely than African-American men to approve of transracial adoption. Compared with African-American men, Caucasian men were 72% less likely to approve. The importance of considering subpopulation differences in applying such findings to adoption policy, research, and practice is discussed.

JOB AUTHORITY AND EMERGING RACIAL INCOME INEQUALITIES IN THE PUBLIC SECTOR

2016 ◽  
Vol 14 (1) ◽  
pp. 349-373
Author(s):  
George Wilson ◽  
Vincent J. Roscigno
Keyword(s):  
African American ◽  
Public Sector ◽  
African Americans ◽  
African American Men ◽  
Work Organization ◽  
General Social Survey ◽  
Negative Consequences ◽  
New Governance ◽  
Social Survey ◽  
The Public

AbstractHas the adoption of “new governance” reforms over the last two decades eroded the public sector as a long-standing occupational niche for African Americans? Utilizing data from the General Social Survey, we address this issue in the context of earnings “returns” to three levels of job authority for African American men and women relative to their White counterparts. Findings, derived from analyses of three waves of the General Social Survey, indicate that the acceleration of this “business model” of work organization in the public sector has had relatively profound and negative consequences for African American income. Specifically, racial parity in earnings returns at all levels of authority in the “pre-reform” period (1992–1994) progressively eroded during “early reform” (2000–2002) and then even more so during the “late reform” (2010–2012) period. Much of this growing public sector disadvantage—a disadvantage that is approaching that seen in the private sector—is driven largely by income gaps between White and African American men, although a similar (though smaller) racial gap is witnessed among women. We conclude by discussing the occupational niche status of public sector work for African Americans, calling for further analyses of the growing inequality patterns identified in our analyses, and drawing attention to the implications for contemporary racial disadvantages.

scholarly journals Economic Evaluation of Posaconazole Versus Standard Azole Therapy as Prophylaxis against Invasive Fungal Infections in Patients with Prolonged Neutropenia in Canada

2012 ◽  
Vol 23 (2) ◽  
pp. 59-64 ◽  
Author(s):  
Amir A Tahami Monfared ◽  
Amy K O’Sullivan ◽  
Coleman Rotstein ◽  
George Papadopoulos
Keyword(s):  
Cost Effectiveness ◽  
High Risk ◽  
Cost Saving ◽  
Incremental Cost ◽  
Incremental Cost Effectiveness Ratio ◽  
Cost Effectiveness Ratio ◽  
Lifetime Horizon ◽  
System Perspective ◽  
Life Years ◽  
Neutropenic Patients

INTRODUCTION: Posaconazole prophylaxis in high-risk neutropenic patients prevents invasive fungal infection (IFI). An economic model was used to assess the cost effectiveness of posaconazole from a Canadian health care system perspective.METHODS: A decision-analytic model was developed based on data from a randomized trial comparing posaconazole with standard azole (fluconazole or itraconazole) therapy. The model was extrapolated to a lifetime horizon using one-month Markov cycles; lifetime survival was specific to the underlying disease. Drug and treatment costs associated with IFI were estimated using published literature. The model was used to estimate total costs, IFIs avoided, life-years gained and the incremental cost-effectiveness ratio of posaconazole versus standard azole therapy, in 2007 Canadian dollars.RESULTS: Based on the clinical trial data, posaconazole was associated with fewer cases of IFI (0.05 versus 0.11; P=0.003), increased life-years (2.52 years versus 2.43 years) and slightly lower costs ($6,601 versus $7,045) per patient relative to standard azole therapy over a lifetime horizon. Higher acquisition costs for posaconazole were offset by IFI-associated inpatient costs for those prophylaxed with standard azoles. Probabilistic sensitivity analysis indicated a 59% probability that posaconazole was cost-saving versus standard azole therapy and a 96% probability that the incremental cost-effectiveness ratio for posaconazole was at or below the $50,000 per life-year saved threshold.DISCUSSION: In Canada, posaconazole appears to be cost-saving relative to standard azole therapy in IFI prevention among high-risk neutropenic patients.

scholarly journals Africultural Coping Systems Inventory: Psychometrics in a Clinical Sample of African American Women

2020 ◽  
Vol 46 (6-7) ◽  
pp. 457-481
Author(s):  
Natalie N. Watson-Singleton ◽  
Devon LoParo ◽  
Yara Mekawi ◽  
Joya N. Hampton-Anderson ◽  
Nadine J. Kaslow
Keyword(s):  
African American ◽  
African Americans ◽  
African American Women ◽  
Low Income ◽  
Clinical Sample ◽  
Reliability And Validity ◽  
General Factor ◽  
American Women ◽  
Structure Reliability ◽  
Clinical Counseling

The Africultural Coping Systems Inventory (ACSI) assesses African Americans’ culturally relevant stress coping strategies. Although its factor structure, reliability, and validity of the scores have been examined across ethnic groups of African descent, psychometric properties have not been investigated in an African American clinical sample. Thus, it is unclear if the ACSI is useful for research with African Americans with distress. To assess the ACSI’s psychometrics, we used data from 193 low-income African American women who in the past year encountered interpersonal trauma and attempted suicide. We tested four models: one-factor, four-factor, four-factor hierarchical, and bifactor. None of the models were optimal, suggesting possible revisions to ACSI items. Yet the bifactor model provided a better fit than other models with items loading onto a general factor and onto specific factors. Internal consistency of the scores was above the recommended criterion (i.e., .70), and the ACSI general factor was related to depressive symptoms, suicidal ideation (but not alcohol abuse), providing some support for its concurrent validity. Future directions, limitations, and clinical-counseling implications are discussed.

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