County‐Level Factors Associated With Cardiovascular Mortality by Race/Ethnicity

Background Persistent racial/ethnic disparities in cardiovascular disease (CVD) mortality are partially explained by healthcare access and socioeconomic, demographic, and behavioral factors. Little is known about the association between race/ethnicity‐specific CVD mortality and county‐level factors. Methods and Results Using 2017 county‐level data, we studied the association between race/ethnicity‐specific CVD age‐adjusted mortality rate (AAMR) and county‐level factors (demographics, census region, socioeconomics, CVD risk factors, and healthcare access). Univariate and multivariable linear regressions were used to estimate the association between these factors; R 2 values were used to assess the factors that accounted for the greatest variation in CVD AAMR by race/ethnicity (non‐Hispanic White, non‐Hispanic Black, and Hispanic/Latinx individuals). There were 659 740 CVD deaths among non‐Hispanic White individuals in 2698 counties; 100 475 deaths among non‐Hispanic Black individuals in 717 counties; and 49 493 deaths among Hispanic/Latinx individuals across 267 counties. Non‐Hispanic Black individuals had the highest mean CVD AAMR (320.04 deaths per 100 000 individuals), whereas Hispanic/Latinx individuals had the lowest (168.42 deaths per 100 000 individuals). The highest CVD AAMRs across all racial/ethnic groups were observed in the South. In unadjusted analyses, the greatest variation ( R 2 ) in CVD AAMR was explained by physical inactivity for non‐Hispanic White individuals (32.3%), median household income for non‐Hispanic Black individuals (24.7%), and population size for Hispanic/Latinx individuals (28.4%). In multivariable regressions using county‐level factor categories, the greatest variation in CVD AAMR was explained by CVD risk factors for non‐Hispanic White individuals (35.3%), socioeconomic factors for non‐Hispanic Black (25.8%), and demographic factors for Hispanic/Latinx individuals (34.9%). Conclusions The associations between race/ethnicity‐specific age‐adjusted CVD mortality and county‐level factors differ significantly. Interventions to reduce disparities may benefit from being designed accordingly.

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Abstract 15076: County-level Subgroups With Unique Cardiovascular Outcomes: An Unsupervised Clustering Analysis

Circulation ◽

10.1161/circ.142.suppl_3.15076 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Matthew W Segar ◽

Shreya Rao ◽

Amy E Hughes ◽

Ambarish Pandey

Keyword(s):

Machine Learning ◽

Risk Factors ◽

Linear Regression ◽

Healthcare Access ◽

Model Performance ◽

The United States ◽

County Level ◽

Cvd Risk ◽

Unsupervised Machine Learning ◽

Cvd Mortality

Introduction: Regional heterogeneity in cardiovascular disease (CVD) risk has been demonstrated in the United States (US), however associations between county-level social and demographic risk factors and CVD mortality have not previously been described. To address this, we evaluated whether unsupervised machine learning-based clustering could identify distinct US county subgroups with unique CVD outcomes. Methods: The study included 2,676 counties from the 2020 County Health Rankings program. Unsupervised hierarchical clustering of 46 candidate variables encompassing demographic, health behaviors, socioeconomic factors, and healthcare access domains was used to derive phenogroups. The association of phenogroups and age-adjusted CVD mortality was assessed by linear regression. Results: Clustering identified 4 phenogroups based on within-cluster inertia. Cluster 1 (N=924; 24.5%) counties were largely white, suburban households with high income and access to healthcare. Cluster 2 counties (N=451; 16.9%) were large with predominantly Hispanic residents and below average prevalence of CVD risk factors. Cluster 3 (N=951; 35.5%) counties included rural, white residents with the lowest levels of healthcare access. Cluster 4 (350; 13.1%) counties were comprised of predominantly black residents with substantial cardiovascular comorbidities and physical and socioeconomic burdens. Age-adjusted cardiovascular mortality increased in a stepwise fashion from 247 in cluster 1 to 349 per 100,000 residents in cluster 4 (FigA) with the phenogroups demonstrating regionality across the US (FigB). Addition of phenogroup in linear regression improved model performance with a R 2 of 0.70. Conclusions: Unsupervised machine learning clustering based on demographic and behavior data can identify unique county phenogroups with differential risk of CVD mortality and may aid in identifying communities at highest risk for CVD-related adverse events.

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Racial/Ethnic Variability in Hypertension Prevalence and Risk Factors in National Health Interview Survey

ISRN Hypertension ◽

10.5402/2013/257842 ◽

2013 ◽

Vol 2013 ◽

pp. 1-8 ◽

Cited By ~ 12

Author(s):

L. Holmes ◽

J. Hossain ◽

D. Ward ◽

F. Opara

Keyword(s):

Risk Factors ◽

National Health ◽

National Health Interview Survey ◽

Ethnic Disparities ◽

Health Interview Survey ◽

Ethnic Variability ◽

Interview Survey ◽

Race Ethnicity ◽

Racial Ethnic ◽

Hispanic White

Objective. Hypertension is one of the leading causes of death attributed to cardiovascular diseases, and the prevalence varies across racial/ethnic groups, with African Americans being disproportionately affected. The underlying causes of these disparities are not fully understood despite volume of literature in this perspective. We aimed in this current study to examine ethnic/racial disparities in hypertension utilizing Hispanics as the base racial/ethnic group for comparison. Research Design and Methods. We utilized the National Health Interview Survey (NHIS), which is a large cross-sectional survey of the United States non-institutionalized residents to investigate the racial/ethnic disparities in hypertension after the adjustment of other socio-economic, demographic, and prognostic risk factors. The study participants were adults (n = 30,852). Data were analyzed using Chi square statistic, and logistic regression model. Results. There were statistically significant differences by race/ethnicity with respect to income, education, marital status, smoking, alcohol, physical activities, body mass index, and age, P < 0.01, but not insurance coverage, P > 0.01. Hispanic ethnicity (18.9%) compared to either non-Hispanic white (27.7%) or non-Hispanic black (35.5%) was associated with the lowest prevalence of hypertension. Race/ethnicity was a single independent predictor of hypertension, with non-Hispanic black more likely to be hypertensive compare with Hispanic, prevalence odds ratio (POR), 2.38, 99% Confidence Interval (CI), 2.17–2.61 and non-Hispanic white, POR, 1.64, 99% CI, 1.52–1.77. After controlling for the confounding variables, the racial/ethnic differences in hypertension persisted. Conclusions. Racial/ethnic disparities in hypertension persisted after controlling for potential predictors of hypertension in NHIS, implying the inability of known hypertension risk factors to account for racial/ethnic variability in hypertension in US.

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Abstract MP53: Racial Disparities in Predicted Cardiovascular Risk among Young Men and Women in the National Longitudinal Study of Adolescent Health (Add Health) Study

Circulation ◽

10.1161/circ.127.suppl_12.amp53 ◽

2013 ◽

Vol 127 (suppl_12) ◽

Author(s):

Alvaro Alonso ◽

Susan A Everson-Rose ◽

Cari J Clark

Keyword(s):

Risk Factors ◽

Cardiovascular Risk ◽

Education Level ◽

Cvd Risk Factors ◽

Cvd Risk ◽

P Values ◽

Men And Women ◽

National Longitudinal Study ◽

Race Ethnicity ◽

Racial Ethnic

Background: We used data from a nationally representative sample of young adults to examine sex-specific disparities in global cardiovascular risk across racial/ethnic groups, which have not previously been examined. Methods: Data were from National Longitudinal Study of Adolescent Health subjects who participated in wave 4 (2007-08) and who had valid weights and non-missing data (7270 women; 6499 men). Age, race/ethnicity, educational attainment, and cardiovascular disease (CVD) risk factors (body mass index, smoking status, diabetes, systolic blood pressure, and use of antihypertensive medication) were collected via an in-home exam. We calculated the 30-Year risk for hard CVD endpoints (coronary death, myocardial infarction, stroke) using a Framingham-based prediction model including data on age, sex, and CVD risk factors. Gender-specific differences in 30-year risk of CVD by race were calculated with weighted age- and education-adjusted linear models. Interactions between race/ethnicity and education were tested. Results: Mean age was 28.9 ± 1.7 years; participants were 69% non-Hispanic white (NHW), 15% non-Hispanic black (NHB), 12% Hispanic (HIS), 3% Asian/Pacific-Islander (API), 1% Native American (NA). Average 30-year risk of CVD was 10.3 ± 7.4% in men and 4.3 ± 4.1% in women. Compared to NHW men, NA and NHB had higher (p-values<0.05) and HIS and API had similar (p-values>0.05) 30-year risk of CVD. API and HIS women had lower risk and NHB and NA women had higher risk (all p-values<=0.05), compared to NHW women. A significant race/ethnicity by education interaction was observed (p-value=0.01), with racial/ethnic differences in women greatly reduced at the highest education level (Figure). Conclusion: Disparities in global CVD risk were observed for young men and women, though mostly attenuated among women with higher education level. Strategies to reduce disparities in CVD should start early in life, consider gender differences, and focus on educationally disadvantaged groups.

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The Association between Maternal Race and Ethnicity and Risk Factors for Primary Cesarean Delivery in Nulliparous Women

American Journal of Perinatology ◽

10.1055/s-0039-1697587 ◽

2019 ◽

Author(s):

Elisabeth L. Stark ◽

William A. Grobman ◽

Emily S. Miller

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Black Women ◽

Cesarean Delivery ◽

White Women ◽

Ethnic Disparities ◽

Nulliparous Women ◽

Race Ethnicity ◽

Racial Ethnic ◽

Hispanic White

Abstract Objective To understand whether maternal, perinatal, and systems-level factors can be identified to explain racial/ethnic disparities in cesarean delivery rates. Study Design This retrospective cohort study included nulliparous women with singleton gestations who delivered at a tertiary care center from 2015 to 2017. Maternal, perinatal, and systems-level factors were compared by race/ethnicity. Multilevel multivariable logistic regression was used to identify whether race/ethnicity was independently associated with cesarean. Effect modification was evaluated using interaction terms. Bivariable analyses and multinomial logistic regression were used to determine differences in indication for cesarean. Results Of 9,865 eligible women, 2,126 (21.5%) delivered via cesarean. The frequency of cesarean was lowest in non-Hispanic white women (19.2%) and highest in non-Hispanic black women (28.2%; p < 0.001). Accounting for factors associated with cesarean delivery did not lessen the odds of cesarean associated with non-Hispanic black race (aOR: 1.58, 95% CI: 1.31–1.91). Compared with non-Hispanic white women, non-Hispanic black women were more likely to undergo cesarean for nonreassuring fetal status (aOR: 2.73, 95% CI: 2.06–3.61). Conclusion Examined maternal, perinatal, and systems-level risk factors for cesarean delivery did not explain the racial/ethnic disparities observed in cesarean delivery rates. Increased cesarean delivery for nonreassuring fetal status contributed substantially to this disparity.

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Abstract P052: Circulating Natural Killer Cells and Subclinical Cardiovascular Disease in the Multi-Ethnic Study of Atherosclerosis (MESA)

Circulation ◽

10.1161/circ.137.suppl_1.p052 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Nancy S Jenny ◽

Nels C Olson ◽

Alicia M Ellis ◽

Margaret F Doyle ◽

Sally A Huber ◽

...

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Confidence Interval ◽

Systolic Blood Pressure ◽

Nk Cells ◽

Nk Cell ◽

Agatston Score ◽

Cvd Risk Factors ◽

Cvd Risk ◽

Race Ethnicity

Introduction: Clinically, natural killer (NK) cells are important in inflammatory and autoimmune diseases. As part of innate immunity, NK cells produce chemokines and inflammatory cytokines, potentially linking them to cardiovascular disease (CVD) development and progression as well. However, their role in human CVD is not clear. Hypothesis: NK cells are proatherogenic in humans and are associated with CVD risk factors and subclinical CVD measures. Methods: We examined cross-sectional associations of circulating NK cell levels with CVD risk factors, subclinical CVD measures and coronary artery calcium (CAC) in 891 White, Black, Chinese and Hispanic men and women (mean age 66 y) in the Multi-Ethnic Study of Atherosclerosis (MESA) at Exam 4 (2005-07). NK cell percent, percent of circulating lymphocytes that were CD3 - CD56 + CD16 + , was measured in whole blood by flow cytometry. CAC presence was defined as Agatston score > 0. Results: Mean (standard deviation) NK percent differed by race/ethnicity; 8.2% (4.7) in Whites, 11.3% (7.5) in Chinese (p<0.001 compared to Whites), 7.1 (4.2) in Blacks (p=0.007) and 8.4 (5.2) in Hispanics (p=0.6). NK cell percent was positively associated with age (p<0.001) and systolic blood pressure (P=0.003) in the full group. However, NK cell percent was lower in current smokers than in never smokers (p=0.002). Adjusting for age, sex, race/ethnicity, smoking, body mass index, systolic blood pressure, diabetes and dyslipidemia, NK cell percent was negatively associated with common carotid intima media thickness (IMT; β coefficient -0.01; 95% confidence interval -0.03, -0.003) but was not associated with internal carotid IMT (-0.002; -0.037, 0.033). Likewise, NK cell percent was not associated with the presence of CAC (compared those with no detectable CAC; relative risk 1.02; 95% confidence interval 0.96, 1.08) or continuous Agatston score in those with a positive score (β coefficient 0.16, 95% confidence interval -0.003, 0.32) in the full group (models adjusted as above). Results were similar across race/ethnic groups. Conclusions: Of clinical interest, CD3 - CD56 + CD16 + NK cell percent varied significantly by race/ethnicity in these men and women from MESA. However, NK cell percent was inconsistently associated with CVD risk factors; positively with age and systolic blood pressure, and negatively with smoking. NK cell percent was also negatively associated with common carotid IMT. Larger sample sizes and longitudinal analyses will be required to clarify the potential relationship between NK cells and atherosclerosis in humans.

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Trends in breast cancer survival by race-ethnicity in Florida.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e18556 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e18556-e18556

Author(s):

Robert Brooks Hines ◽

Asal Johnson ◽

Eunkyung Lee ◽

Stephanie Erickson ◽

Saleh M.M. Rahman

Keyword(s):

Breast Cancer ◽

Ethnic Disparities ◽

Cancer Death ◽

Cancer Outcomes ◽

Subdistribution Hazard ◽

Breast Cancer Death ◽

Breast Cancer Outcomes ◽

Race Ethnicity ◽

Racial Ethnic ◽

Hispanic White

e18556 Background: Considerable efforts to improve disparities in breast cancer outcomes for underserved women have occurred over the past 3 decades. This study was conducted to evaluate trends in survival, by race-ethnicity, for women diagnosed with breast cancer in Florida over a 26-year period to assess potential improvement in racial-ethnic disparities. Methods: This was a retrospective cohort study of women diagnosed with invasive breast cancer in Florida between 1990-2015. Data were obtained from the Florida Cancer Data System. Women in the study were categorized according to race (white/black) and Hispanic ethnicity (yes/no) as non-Hispanic white (NHW), non-Hispanic black (NHB), Hispanic white (HW), and Hispanic black (HB). Cumulative incidence estimates of 5- and 10-year breast cancer death with 95% confidence intervals (CI) were obtained by race-ethnicity, according to diagnosis year. Subdistribution hazard models were used to obtain subdistribution hazard ratios (sHR) for the relative rate of breast cancer death accounting for competing causes. Results: Compared to NHW women, minority women were more likely to be younger, be uninsured or have Medicaid as health insurance, live in high poverty neighborhoods, have more advanced disease at diagnosis, have high grade tumors, have hormone receptor negative tumors, and receive chemotherapy as treatment. Minority women were less likely to receive surgery. Over the course of the study, breast cancer mortality decreased for all racial-ethnic groups, and racial-ethnic minorities had greater absolute and relative improvement in breast cancer survival for nearly all metrics compared to non-Hispanic white (NHW) women. However, for the most recent time period (2010-2015), black women still experienced significant survival disparities with non-Hispanic black (NHB) women having twice the rate of 5-year (sHR = 2.04: 95% CI; 1.91-2.19) and 10-year (sHR = 2.02: 95% CI; 1.89-2.16) breast cancer death. Conclusions: Despite efforts to improve disparities in breast cancer outcomes for underserved women in Florida, additional targeted approaches are needed to reduce the poorer survival in black (especially NHB) women. Our next step is to conduct a mediation analysis of the most important factors driving racial/ethnic disparities in breast cancer outcomes for women in Florida.

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Do Women with Diabetes Need More Intensive Action for Cardiovascular Reduction than Men with Diabetes?

Current Diabetes Reports ◽

10.1007/s11892-020-01348-2 ◽

2020 ◽

Vol 20 (11) ◽

Author(s):

Jürgen Harreiter ◽

Helena Fadl ◽

Alexandra Kautzky-Willer ◽

David Simmons

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Meta Analysis ◽

Cvd Risk Factors ◽

Cvd Risk ◽

Risk Factor Management ◽

High Risk Women ◽

Background Population ◽

Cvd Mortality

Abstract Purpose of Review This narrative review makes the case for greater efforts to reduce cardiovascular disease (CVD) risk in women with diabetes. Recent Findings In a recent meta-analysis including five CVOTs of diabetes medications with 46,606 subjects, women (vs men) with type 2 diabetes had a higher relative risk for stroke (RR 1.28; 95% CI 1.09, 1.50) and heart failure (1.30; 1.21, 1.40). Prior studies found higher “within-gender” RR for CVD mortality in women with diabetes although men have an absolute higher risk. Women with prior gestational diabetes mellitus (GDM) have a 2-fold higher CVD risk than the background population. Worse CVD and CVD risk factor management in women, as well as lower female therapy adherence, contribute further to these disparities. Summary The mechanism behind this excess risk includes biological, hormonal, socioeconomic, clinical, and behavioral factors that still require further investigation. The need for more intensive CVD reduction in women now includes more attention to screening for both incident diabetes and CVD risk factors among high-risk women.

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Racial and Ethnic Disparities in Health

10.31235/osf.io/eq4y3 ◽

2019 ◽

Author(s):

Samia Tasmim ◽

Sarah Collins

Keyword(s):

Health Disparities ◽

Healthcare Access ◽

Ethnic Disparities ◽

Well Being ◽

Racial And Ethnic Disparities ◽

Individual Level ◽

Fundamental Cause ◽

Race Ethnicity ◽

Unequal Opportunities ◽

Racial Ethnic

Racial and ethnic disparities in health stem from the historical legacy and continued patterns of unequal resources and treatment on the basis of race/ethnicity in society (Hummer and Hamilton 2019; Williams and Sternthal 2010). Health disparities encompass differences in physical health, mental health, all-cause and cause-specific mortality risk, activity limitations, healthcare access and utilization, and other metrics of well-being. Researchers have identified a variety of explanations for racial/ethnic health disparities, including socioeconomic inequality, institutional- and individual-level discrimination, residential segregation, early-life circumstances, and health behaviors, among others. However, unequal opportunities on the basis of race/ethnicity remain the fundamental cause of health disparities (Hummer 1996; Phelan and Link 2015).

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Trends in Cardiovascular Disease by Asian American, Native Hawaiian, and Pacific Islander Ethnicity, Medicare Health Outcomes Survey 2011–2015

The Journals of Gerontology Series A ◽

10.1093/gerona/glab262 ◽

2021 ◽

Author(s):

Lan N Đoàn ◽

Yumie Takata ◽

Karen Hooker ◽

Carolyn Mendez-Luck ◽

Veronica L Irvin

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Health Outcomes ◽

Asian American ◽

Native Hawaiian ◽

Pacific Islander ◽

Cvd Risk Factors ◽

Cvd Risk ◽

White Adults ◽

Racial Ethnic

Abstract Background The burden of cardiovascular disease (CVD) is increasing in the aging population. However, little is known about CVD risk factors and outcomes for Asian American, Native Hawaiian, and Other Pacific Islander (NH/PI) older adults by disaggregated subgroups. Methods Data were from the Centers for Medicare and Medicaid Services 2011–2015 Health Outcomes Survey, which started collecting expanded racial/ethnic data in 2011. Guided by Andersen and Newman’s theoretical framework, multivariable logistic regression analyses were conducted to examine the prevalence and determinants of CVD risk factors (obesity, diabetes, smoking status, hypertension) and CVD conditions (coronary artery disease [CAD], congestive heart failure [CHF], myocardial infarction [MI], other heart conditions, stroke) for 10 Asian American and NH/PI subgroups and White adults. Results Among the 639 862 respondents, including 26 853 Asian American and 4 926 NH/PI adults, 13% reported CAD, 7% reported CHF, 10% reported MI, 22% reported other heart conditions, and 7% reported stroke. CVD risk factors varied by Asian American and NH/PI subgroup. The prevalence of overweight, obesity, diabetes, and hypertension was higher among most Asian American and NH/PI subgroups than White adults. After adjustment, Native Hawaiians had significantly greater odds of reporting stroke than White adults. Conclusions More attention should focus on NH/PIs as a priority population based on the disproportionate burden of CVD risk factors compared with their White and Asian American counterparts. Future research should disaggregate racial/ethnic data to provide accurate depictions of CVD and investigate the development of CVD risk factors in Asian Americans and NH/PIs over the life course.

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Birthweight in offspring and cardiovascular mortality in their parents, aunts and uncles: a family-based cohort study of 1.35 million births

International Journal of Epidemiology ◽

10.1093/ije/dyz156 ◽

2019 ◽

Vol 49 (1) ◽

pp. 205-215

Author(s):

Fareeha Shaikh ◽

Marte Karoline Kjølllesdal ◽

David Carslake ◽

Camilla Stoltenberg ◽

George Davey Smith ◽

...

Keyword(s):

Risk Factors ◽

Cvd Risk Factors ◽

Cvd Risk ◽

Birth Registry ◽

Nuclear Families ◽

Hazard Ratios ◽

Increased Risk ◽

Paternal Aunt ◽

Family Based ◽

Cvd Mortality

Abstract Background A link between suboptimal fetal growth and higher risk of cardiovascular disease (CVD) is well documented. It has been difficult to assess the contribution of environmental versus genetic factors to the association, as these factors are closely connected in nuclear families. We investigated the association between offspring birthweight and CVD mortality in parents, aunts and uncles, and examined whether these associations are explained by CVD risk factors. Methods We linked Norwegian data from the Medical Birth Registry, the Cause of Death Registry and cardiovascular surveys. A total of 1 353 956 births (1967–2012) were linked to parents and one maternal and one paternal aunt/uncle. Offspring birthweight and CVD mortality association among all relationships was assessed by hazard ratios (HR) from Cox regressions. The influence of CVD risk factors on the associations was examined in a subgroup. Results Offspring birthweight was inversely associated with CVD mortality among parents and aunts/uncles. HR of CVD mortality for one standard deviation (SD) increase in offspring birthweight was 0.72 (0.69–0.75) in mothers and 0.89 (0.86–0.92) in fathers. In aunts/uncles, the HRs were between 0.90 (0.86–0.95) and 0.93 (0.91–0.95). Adjustment for CVD risk factors in a subgroup attenuated all the associations. Conclusions Birthweight was associated with increased risk of CVD in parents and in aunts/uncles. These associations were largely explained by CVD risk factors. Our findings suggest that associations between offspring birthweight and CVD in adult relatives involve both behavioural variables (especially smoking) and shared genetics relating to established CVD risk factors.

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