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 Multiple Social Vulnerabilities to Health Disparities and Hypertension and Death in the REGARDS Study

Hypertension ◽  
2021 ◽  
Author(s):  
Jordan B. King ◽  
Laura C. Pinheiro ◽  
Joanna Bryan Ringel ◽  
Adam P. Bress ◽  
Daichi Shimbo ◽  
...  
Keyword(s):  
Relative Risk ◽  
Racial Differences ◽  
Risk Ratio ◽  
Social Vulnerability ◽  
Economic Education ◽  
Community Context ◽  
Relative Risk Ratio ◽  
Adjusted Relative Risk ◽  
Regards Study ◽  
Social Vulnerabilities

Social vulnerabilities increase the risk of developing hypertension and lower life expectancy, but the effect of an individual’s overall vulnerability burden is unknown. Our objective was to determine the association of social vulnerability count and the risk of developing hypertension or dying over 10 years and whether these associations vary by race. We used the REGARDS study (Reasons for Geographic and Racial Differences in Stroke) and included participants without baseline hypertension. The primary exposure was the count of social vulnerabilities defined across economic, education, health and health care, neighborhood and built environment, and social and community context domains. Among 5425 participants of mean age 64±10 SD years of which 24% were Black participants, 1468 (31%) had 1 vulnerability and 717 (15%) had ≥2 vulnerabilities. Compared with participants without vulnerabilities, the adjusted relative risk ratio for developing hypertension was 1.16 (95% CI, 0.99–1.36) and 1.49 (95% CI, 1.20–1.85) for individuals with 1 and ≥2 vulnerabilities, respectively. The adjusted relative risk ratio for death was 1.55 (95% CI, 1.24–1.93) and 2.30 (95% CI, 1.75–3.04) for individuals with 1 and ≥2 vulnerabilities, respectively. A greater proportion of Black participants developed hypertension and died than did White participants (hypertension, 38% versus 31%; death, 25% versus 20%). The vulnerability count association was strongest in White participants ( P value for vulnerability count×race interaction: hypertension=0.046, death=0.015). Overall, a greater number of socially determined vulnerabilities was associated with progressively higher risk of developing hypertension, and an even higher risk of dying over 10 years.

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 P316: Multiple Vulnerabilities to Health Disparities and Incident Coronary Heart Disease in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Monika M Safford ◽  
Laura Pinheiro ◽  
Madeline Sterling ◽  
Joshua Richman ◽  
Paul Muntner ◽  
...  
Keyword(s):  
Health Disparities ◽  
Racial Differences ◽  
Low Income ◽  
Proportional Hazards ◽  
Health Management ◽  
Cox Proportional Hazards ◽  
Southeastern Us ◽  
Cox Proportional Hazards Models ◽  
Increased Risk ◽  
Regards Study

Social determinants contribute to disparities in incident CHD but it is not known if they have an additive effect. We hypothesized that having more socially determined vulnerabilities to health disparities is associated with increased risk of incident CHD in the REGARDS study, a large biracial prospective cohort with physiological and survey measures. Experts adjudicated incident fatal and nonfatal CHD over 10 years of follow-up. Vulnerabilities included black race, low education, low income, and Southeastern US residence. The risks for CHD outcomes associated with 1, 2, and 3+ vs 0 vulnerabilities were calculated with Cox proportional hazards models adjusted for medical conditions, functional status, health behaviors, and physiologic variables. Of the 19,645 participants free of CHD at baseline (mean age 64 years, 57% women), 16% had 0 vulnerabilities, 36% had 1, 29% had 2, and 18% had 3+. Increasing numbers of vulnerabilities were associated with higher incidence (Figure) and risk of CHD that attenuated somewhat after multivariable adjustment (Table). These findings may provide a method of risk stratification useful for population health management.

Abstract P370: Obesity and Incident Coronary Heart Disease in the Million Women Study: A Prospective, Population-based Cohort Study

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Dexter Canoy ◽  
Benjamin J Cairns ◽  
Angela Balkwill ◽  
Jayne Green ◽  
Lucy Wright ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Cumulative Risk ◽  
Excess Weight ◽  
Adjusted Relative Risk ◽  
Chd Risk ◽  
Wide Range ◽  
Chd Risk Factors ◽  
The Impact

Background: Higher body-mass index (BMI) has been associated with increased risk for coronary heart disease (CHD) mortality but its association with incident CHD is less investigated, and data for women are limited. Methods: We examined the prospective relation between BMI and incident CHD (first CHD hospitalization or death) in 1.2 million women aged ≥50 years without prior CHD, who were recruited through a national breast screening programme in 1996 to 2001 and followed for an average of 9 years (48,842 events with 10.7 million person-years of follow-up). Absolute and relative risks (using Cox regression) associated with higher BMI were estimated. Results: After excluding the first 4 years of follow-up, there were 32,465 events (5.9 million person-years) including 3,345 CHD deaths. The adjusted relative risk per 5 kg/m 2 BMI difference was 1.24 [95% confidence interval (CI) 1.22 to 1.25]. CHD risk increased linearly across a wide range of BMI, with no apparent excess risk in the lower end of BMI distribution. The relation persisted after excluding current smokers or limiting cases to myocardial infarction only. For women in this cohort, the 20-year cumulative risk of CHD from age 55 to 74 years (95% CI) ranged from 9% (8 to10) to 18% (16 to 20) for women with BMI of 20 to 22.5 kg/m 2 and ≥35 kg/m 2 , respectively. Never smokers with BMI ≥35 kg/m 2 had comparable cumulative risk to current smokers with BMI of 20 to 22.5 kg/m 2 . Conclusion: In this large cohort of women, the impact of excess weight on CHD morbidity and mortality is substantial. Measures to prevent and control excess weight and other CHD risk factors are needed to help reduce CHD burden in women.

Abstract 183: Depressive Symptoms and Incident Stroke in Black and White Participants in the REGARDS Study

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Audrey L Austin ◽  
Michael G Crowe ◽  
Martha R Crowther ◽  
Virginia J Howard ◽  
Abraham J Letter ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Depressive Symptoms ◽  
Racial Differences ◽  
Stroke Risk ◽  
Depression Scale ◽  
Stroke Incidence ◽  
Blacks And Whites ◽  
The Impact

Background and Purpose: Research suggests that depression may contribute to stroke risk independent of other known risk factors. Most studies examining the impact of depression on stroke have been conducted with predominantly white cohorts, though blacks are known to have higher stroke incidence than whites. The purpose of this study was to examine depressive symptoms as a risk factor for incident stroke in blacks and whites, and determine whether depressive symptomatology was differentially predictive of stroke among blacks and whites. Methods: The REasons for Geographic and Racial Differences in Stroke (REGARDS), is a national, population-based longitudinal study designed to examine risk factors associated with black-white and regional disparities in stroke incidence. Among 30,239 participants (42% black) accrued from 2003-2007, excluding those lacking follow-up or data on depressive symptoms, 27,557 were stroke-free at baseline. As of the January 2011 data closure, over an average follow-up of 4.6 years, 548 incident stroke cases were verified by study physicians based on medical records review. The association between baseline depressive symptoms (assessed via the Center for Epidemiological Studies Depression scale, 4-item version) and incident stroke was analyzed with Cox proportional hazards models adjusted for demographic factors (age, race, and sex), stroke risk factors (hypertension, diabetes, smoking, atrial fibrillation, and history of heart disease), and social factors (education, income, and social network). Results: For the total sample, depressive symptoms were predictive of incident stroke. The association between depressive symptoms and stroke did not differ significantly based on race (Wald X 2 = 2.38, p = .1229). However, race-stratified analyses indicated that the association between depressive symptoms and stroke was stronger among whites and non-significant among blacks. Conclusions: Depressive symptoms were an independent risk factor for incident stroke among a national sample of blacks and whites. These findings suggest that assessment of depressive symptoms may warrant inclusion in stroke risk scales. The potential for a stronger association in whites than blacks requires further study.

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.

The weight change impact on metabolic syndrome: a 17-year follow-up study

Open Medicine ◽  
2011 ◽  
Vol 6 (6) ◽  
pp. 788-794 ◽  
Author(s):  
Magdalena Kwaśniewska ◽  
Dorota Kaleta ◽  
Anna Jegier ◽  
Tomasz Kostka ◽  
Elżbieta Dziankowska-Zaborszczyk ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Weight Loss ◽  
Weight Gain ◽  
Weight Change ◽  
Metabolic Risk ◽  
Adjusted Relative Risk ◽  
Prospective Longitudinal ◽  
The Impact

AbstractIntroduction: Data on long-term patterns of weight change in relation to the development of metabolic syndrome (MetS) are scarce. The aim of the study was to evaluate the impact of weight change on the risk of MetS in men. Material and Methods: Prospective longitudinal observation (17.9 ± 8.1 years) of apparently healthy 324 men aged 18–64 years. Metabolic risk was assessed in weight gain (⩾ 2.5 kg), stable weight (> −2.5 kg and < 2.5 kg) and weight loss (⩽ −2.5 kg) groups. Adjusted relative risk (RR) of MetS was analyzed using multivariate logistic regression. Results: The prevalence of MetS over follow-up was 22.5%. There was a strong relationship between weight gain and worsening of MetS components among baseline overweight men. Long-term increase in weight was most strongly related with the risk of abdominal obesity (RR=7.26; 95% CI 2.98–18.98), regardless of baseline body mass index (BMI). Weight loss was protective against most metabolic disorders. Leisure-time physical activity (LTPA) with energy expenditure > 2000 metabolic equivalent/min/week was associated with a significantly lower risk of MetS. Conclusions: Reducing weight among overweight and maintaining stable weight among normal-weight men lower the risk of MetS. High LTPA level may additionally decrease the metabolic risk regardless of BMI.

Does race affect outcomes in triple negative breast cancer (TNBC)?

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e17543-e17543
Author(s):  
S. Ahmed ◽  
M. M. Mirza ◽  
A. Farooq ◽  
L. Kronish ◽  
M. Jahanzeb ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Racial Differences ◽  
Statistical Significance ◽  
Menopausal Status ◽  
Cox Proportional Hazards ◽  
Rank Test ◽  
Stage At Diagnosis ◽  
Cancer Specific Survival ◽  
The Impact

e17543 Background: TNBC is associated with a worse prognosis than luminal subtypes. There is discordance among studies assessing the impact of race on outcomes of TNBC. Our objective was to assess whether African American (AA) vs. Caucasian (CA) race predicted survival outcomes for women with TNBC treated at a single institution in Memphis, TN. Secondary objectives were to examine the association of race with patient and tumor characteristics. Methods: Patients with stage I-III TNBC were identified from our breast cancer database and confirmed by review of pathology reports. Event free survival (EFS) was measured from the date of surgery to the date of first recurrence (locoregional, distant, or contralateral), death from breast cancer or last follow-up. Breast cancer specific survival (BCSS) was measured from the date of surgery to the date of death from breast cancer or last follow-up. Fisher's exact test was used for association between variables, Kaplan Meier method for survival estimates, and log rank test for survival comparison between groups (p < 0.05: significant). Cox proportional hazards models with patient, tumor and treatment variables were fitted for EFS and BCSS. Results: Of the 105 patients with TNBC, 71% were AA. There was no significant association between race and stage at diagnosis (p = 0.68). 71% of AA women were < 55 years old and 43% were pre-menopausal vs. 50% and 23% of CA women respectively. There was a trend towards association of race with age and menopausal status (p = 0.08). Ninety three percent of the patients received neo/adjuvant chemotherapy. With a median follow up of 26 months, 26% of AA vs. 20% of CA women had an event (p = 0.62). Overall 3 year EFS and BCSS estimates were 69% and 82% respectively. Racial differences in EFS and BCSS for AA vs. CA (65% vs. 80% and 78% vs. 89%, respectively) did not achieve statistical significance (log rank p = 0.22 for EFS and 0.26 for BCSS). Race was not a significant predictor of EFS or BCSS on uni-variable or multi-variable analysis. Stage at diagnosis retained significance for EFS and BCSS on uni-variable and multi-variable testing. Conclusions: Race did not affect outcomes in our cohort of TNBC patients treated similarly. The high event rate underscores the poor prognosis of TNBC and the need for more effective therapies. No significant financial relationships to disclose.

scholarly journals P109 Impact of ethnicity on colorectal cancer incidence in a cohort of colitis-associated dysplasia patients

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S201-S202
Author(s):  
M Kabir ◽  
K Curtius ◽  
P Kalia ◽  
I Al Bakir ◽  
C H R Choi ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Racial Differences ◽  
Proportional Hazards ◽  
Hazard Analysis ◽  
Cox Proportional Hazards ◽  
Time Interval ◽  
Low Grade ◽  
Kaplan Meier ◽  
The Impact

Abstract Background Racial disparities in inflammatory bowel disease (IBD) phenotypic presentations and outcomes are recognised. However, there are conflicting data from Western population-based cohort studies as to whether racial differences in colitis-associated colorectal cancer (CRC) incidence exists. To our knowledge this is the first study to investigate the impact of ethnicity on the natural history of dysplasia in ulcerative colitis (UC). Methods We performed a retrospective multi-centre cohort study of adult patients with UC whose first low-grade dysplasia (LGD) diagnosis within the extent of colitis was made between 1 January 2001 and 30 December 2018. Only patients with at least one follow-up colonoscopy or colectomy by 30 August 2019 were included. The study end point was time to CRC or end of follow-up. Statistical differences between groups were evaluated using Mann-Whitney U tests and Chi-squared tests. Survival analyses were performed using Kaplan-Meier estimation and multivariate Cox proportional hazards models. Results 408 patients met the inclusion criteria (see Figure 1 for patient and clinical demographics). More patients from a Black or Asian (BAME) background progressed to CRC [13.4% vs. 6.4%; p=0.036] compared to their White Caucasian counterparts, despite having surveillance follow-up. Figure 2 displays Kaplan-Meier curves demonstrating the probability of remaining CRC-free after LGD diagnosis and categorised by ethnicity. BAME patients were more likely to have moderate-severe inflammatory activity on colonic biopsy within the 5 preceding years [42.0% vs. 28.9%; p=0.023], but no significant differences in medication use and a longer median time interval from LGD diagnosis to colectomy date [32 months vs. 11 months; p=0.021]. After adjusting for sex, age and UC duration at time of LGD diagnosis and presence of moderate-severe histological inflammation, being Black or Asian was a predictive factor for CRC progression on multivariate Cox proportional hazard analysis [HR 2.97 (95% CI 1.22 – 7.20); p = 0.016]. However, ethnicity was no longer predictive of CRC progression on sub-analysis of the 317 patients who did not have a colectomy during the follow-up period. Conclusion In this UK multi-centre cohort of UC surveillance patients diagnosed with LGD, delays in receiving cancer preventative colectomy may contribute to an increased CRC incidence in certain ethnic groups. Further work is required to elucidate whether these delays are related to institutional factors (e.g. inequity in the content of decision-making support given or access to healthcare) or cultural factors.

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.

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