Cardiovascular Health Disparities in Racial and Other Underrepresented Groups: Initial Results From the All of Us Research Program

Background All of Us is a novel research program that aims to accelerate research in populations traditionally underrepresented in biomedical research. Our objective was to evaluate the burden of cardiovascular disease (CVD) in broadly defined underrepresented groups. Methods and Results We evaluated the latest data release of All of Us. We conducted a cross‐sectional analysis combining survey and electronic health record data to estimate the prevalence of CVD upon enrollment in underrepresented groups defined by race, ethnicity, age (>75 years), disability (not able to carry out everyday physical activities), sexual orientation and gender identity lesbian, gay, bisexual, transgender, queer, intersex, and asexual (LGBTQIA+), income (annual household income <$35 000 US dollars) and education (less than a high school degree). We used multivariate logistic regression to estimate the adjusted odds ratio (OR) and product terms to test for interaction. The latest All of Us data release includes 315 297 participants. Of these, 230 577 (73%) had information on CVD and 17 958 had CVD (overall prevalence, 7.8%; 95% CI, 7.7–7.9). Multivariate analyses adjusted by hypertension, hyperlipidemia, type 2 diabetes mellitus, body mass index, and smoking indicated that, compared with White participants, Black participants had a higher adjusted odds of CVD (OR, 1.21; 95% CI, 1.16–1.27). Higher adjusted odds of CVD were also observed in underrepresented groups defined by other factors, including age >75 years (OR, 1.90; 95% CI, 1.81–1.99), disability (OR, 1.60; 95% CI, 1.53–1.68), and income <$35 000 US dollars (OR, 1.22; 95% CI, 1.17–1.27). Sex significantly modified the odds of CVD in several of the evaluated groups. Conclusions Among participants enrolled in All of Us, underrepresented groups defined based on race, ethnicity and other factors have a disproportionately high burden of CVD. The All of Us research program constitutes a powerful platform to accelerate research focused on individuals in underrepresented groups.

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Abstract P113: The Probability of Maintaining Ideal Levels of Glucose in US Populations: The Hispanic Community Health Study/Study of Latinos (HCHS/SOL) and the National Health and Nutrition Examination Survey (NHANES)

Circulation ◽

10.1161/circ.129.suppl_1.p113 ◽

2014 ◽

Vol 129 (suppl_1) ◽

Author(s):

Christy L Avery ◽

Donglin Zeng ◽

Sujatro Chakladar ◽

Katelyn M Holliday ◽

Dan Yu Lin ◽

...

Keyword(s):

Ethnic Groups ◽

Cardiovascular Health ◽

Markov Models ◽

Fasting Glucose ◽

Heart Association ◽

Health Study ◽

Cross Sectional ◽

Ideal Cardiovascular Health ◽

Glucose Levels ◽

Race Ethnicity

Ideal cardiovascular health is a novel concept adopted by the American Heart Association (AHA) that is operationalized through measurement and classification (ideal; intermediate; poor) of seven health metrics, including fasting glucose. Declines in the prevalence of ideal fasting glucose levels have been consistently associated with higher rates of cardiovascular disease, yet few studies have examined the ages at which such declines begin. We used cross-sectional data from NHANES (2007-2010, n=5,961) and the HCHS/SOL (n=14,357) to estimate the age-specific prevalence of ideal (<100 mg/dl without medication), intermediate (100-125 mg/dl or treated to <100 mg/dl) and poor (≥126 mg/dl) fasting glucose levels defined per AHA criteria among European American (EA), African American (AA), and Hispanic/Latino (H/L) participants ≥16 years of age. Race/ethnicity-stratified age-specific net probabilities of transitioning between ideal, intermediate and poor glucose levels were then calculated from cross-sectional estimates using state-of-the-art Markov models that accommodated complex sampling under the assumption that transitions remained stable across time. In all race/ethnic groups, approximately 80% of participants ≤20 years of age had ideal glucose levels. However, the estimated probability of maintaining ideal glucose levels after age 20 varied by race/ethnicity. For example, by the age of 40, the estimated probability of maintaining ideal levels of glucose over the next five years was approximately 90% for EAs and AAs and slightly higher for H/Ls (five-year probability: 92.1%, 95% CI: 91.1%, 93.1%). Among individuals with intermediate glucose levels at age 40, the estimated five-year probability of transitioning to poor levels of glucose was twice as high for AAs (five-year probability: 8.1%, 95% CI: 4.3%, 11.9%) and H/Ls (five-year probability: 9.8%, 95% CI: 8.0%, 11.6%) compared to EAs (five-year probability = 3.9%, 95% CI: 2.7%, 5.3%). Unfortunately, among participants with poor glucose levels, the estimated probability of transitioning to ideal glucose levels remained 0% for all race/ethnic groups and across all ages. Our results suggest that efforts to maintain ideal glucose levels should target young adults and extend through 40 years of age, given the sizeable prevalence of intermediate and poor levels of glucose observed by age 20, the estimated acceleration in the transition to intermediate and poor glucose levels that occurs between the second and fourth decade of life, and the negligible estimated probability of successfully re-attaining ideal glucose levels among those with intermediate or poor glucose levels. Enhanced efforts to identify and treat populations with poor glucose levels also are needed, since these populations would include persons with undiagnosed and therefore untreated type 2 diabetes.

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Abstract 053: Association Of Pre-pregnancy Cardiovascular Health With Adverse Maternal And Fetal Outcomes

Circulation ◽

10.1161/circ.143.suppl_1.053 ◽

2021 ◽

Vol 143 (Suppl_1) ◽

Author(s):

Michael C Wang ◽

Priya M Freaney ◽

Amanda M Perak ◽

Norrina B Allen ◽

Philip Greenland ◽

...

Keyword(s):

Low Birthweight ◽

Cardiovascular Health ◽

Fetal Death ◽

Cross Sectional Study ◽

Fetal Outcomes ◽

Pregnancy Risk ◽

Cross Sectional ◽

Icu Admission ◽

Race Ethnicity ◽

Obesity Hypertension

Introduction: Individual pre-pregnancy risk factors such as obesity, hypertension, and diabetes disproportionately affect minority women and are associated with adverse maternal and offspring outcomes. However, quantification of pre-pregnancy cardiovascular health (CVH) and association with pregnancy outcomes is lacking and can help identify at-risk women and children. Hypothesis: Suboptimal pre-pregnancy CVH is associated with higher risk of adverse maternal and fetal outcomes. Methods: We conducted a cross-sectional study using the CDC Natality files, which include all pregnancies in the US that resulted in live birth or fetal death after 20 weeks. Our study sample consisted of data from singleton live births or fetal deaths to women aged 15-44 years in 2018. Four maternal metrics (body mass index, smoking, diabetes, and hypertension) were assigned 1 point each for pre-pregnancy BMI < 25.0 kg/m 2 , non-smoking, and absence of hypertension or diabetes to construct a pre-pregnancy clinical CVH score ranging from 0-4. We examined the distribution of CVH by race/ethnicity. We then quantified associations of CVH with maternal ICU admission, preterm birth (PTB), low birthweight (LBW), and fetal death using logistic regression (CVH = 4 as the referent) adjusted for maternal age, race/ethnicity, education, prenatal care, and parity. Results: Of 3,582,832 pregnancies in 2018, more than half of women had a suboptimal CVH score (CVH = 3: 51.8%; CVH = 2: 6.7%; CVH = 0/1: 0.4%). Suboptimal CVH score (<4) was more prevalent in non-Hispanic Black (67.8%) and Hispanic (63.1%) than in non-Hispanic White (57.2%) and Asian (36.8%) women ( Figure) . There were consistent and inverse graded associations between CVH score of 3, 2, and 0/1 (compared with 4 as the referent) and maternal ICU admission, PTB, LBW, and fetal death (p<0.001). Conclusions: Pre-pregnancy clinical CVH score has strong, graded associations with adverse maternal and fetal outcomes, with disproportionate impact of suboptimal CVH in non-Hispanic Black and Hispanic women.

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Does College Education Pay? Evidence From The NLSY-79 Data

Contemporary Issues in Education Research (CIER) ◽

10.19030/cier.v3i1.168 ◽

2010 ◽

Vol 3 (1) ◽

pp. 119 ◽

Cited By ~ 1

Author(s):

Diamando Afxentiou ◽

Paul Kutasovic

Keyword(s):

High School ◽

Regression Model ◽

College Graduates ◽

College Education ◽

Cross Sectional ◽

Income Gap ◽

High School Degree ◽

And Gender ◽

College Educated ◽

Over Time

This study examines if the college wage premium favoring college graduates still exists. The NLSY-79 data is employed. The sample includes individuals who received their high school degree and college degree in 1980 and 1981. These individuals were followed until the year 2004. A cross sectional regression model was estimated for the years 1982, 1994, and 2004 and found that education, occupation, and gender were the primary determinants of wages. The income gap between college educated workers and high school educated workers has widen over time. Most interestingly, it is the stagnation of high school educated workers that accounts for the gap.

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Taxation reduces smoking but may not reduce smoking disparities in youth

Tobacco Control ◽

10.1136/tobaccocontrol-2019-055478 ◽

2020 ◽

pp. tobaccocontrol-2019-055478 ◽

Cited By ~ 1

Author(s):

Nancy L Fleischer ◽

J Travis Donahoe ◽

M Chandler McLeod ◽

James F Thrasher ◽

David T Levy ◽

...

Keyword(s):

Smoking Initiation ◽

Smoking Behaviour ◽

Lower Probability ◽

Linear Regression Models ◽

Cross Sectional ◽

Smoking Intensity ◽

Cigarette Taxes ◽

Race Ethnicity ◽

And Gender ◽

Average Marginal Effects

ObjectiveThis study examines the extent to which cigarette taxes affect smoking behaviour and disparities in smoking among adolescents by gender, socioeconomic status (SES) and race/ethnicity.MethodsWe used US nationally representative, repeated cross-sectional data from the 2005 to 2016 Monitoring the Future study to evaluate the relationship between state cigarette taxes and past 30-day current smoking, smoking intensity, and first cigarette and daily smoking initiation using modified Poisson and linear regression models, stratified by grade. We tested for interactions between tax and gender, SES and race/ethnicity on the additive scale using average marginal effects.ResultsWe found that higher taxes were associated with lower smoking outcomes, with variation by grade. Across nearly all of our specifications, there were no statistically significant interactions between tax and gender, SES or race/ethnicity for any grades/outcomes. One exception is that among 12th graders, there was a statistically significant interaction between tax and college plans, with taxes being associated with a lower probability of 30-day smoking among students who definitely planned to attend college compared with those who did not.ConclusionWe conclude that higher taxes were associated with reduced smoking among adolescents, with little difference by gender, SES and racial/ethnicity groups. While effective at reducing adolescent smoking, taxes appear unlikely to reduce smoking disparities among youth.

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Abstract P033: Identifying Racial/Ethnic Differences In Patterns Of Early Childhood Cardiovascular Health Using Electronic Health Record Data

Circulation ◽

10.1161/circ.143.suppl_1.p033 ◽

2021 ◽

Vol 143 (Suppl_1) ◽

Author(s):

Lindsay Pool ◽

Xiaoyun Yang ◽

Amy Krefman ◽

Amanda M Perak ◽

Matthew Davis ◽

...

Keyword(s):

Blood Pressure ◽

Early Childhood ◽

Racial Differences ◽

Ethnic Differences ◽

Cardiovascular Health ◽

Hispanic Children ◽

Electronic Health Record Data ◽

Glucose Levels ◽

Race Ethnicity ◽

Racial Ethnic

Introduction: Racial/ethnic differences in CVH beginning at age 8 have been identified and linked with the development of cardiometabolic disease in adulthood; however, there is scarce research on CVH in very childhood. Our objective was to use a large, diverse pediatric EHR consortium to identify racial/ethnic patterns of clinical CVH from ages 2-12 years. Methods: We used ambulatory visit data spanning 2010-2018 from children aged 2-12 years within CAPriCORN - an EHR repository that combines medical records throughout the city of Chicago. The 4 clinical CVH metrics - BMI, blood pressure, cholesterol, and glucose - were categorized as ideal or non-ideal using available values of weight, height, blood pressure, laboratory readings, and ICD diagnosis codes. Multiple measurements within a given integer age were averaged by individual. Frequency of ideal and non-ideal status for each CVH metric was plotted by age in years and stratified by race/ethnicity (Figure). Results: There were 162,621 children included (47% female) with a median of 2 visits during follow-up. The race/ethnicity distribution was 4% Asian/Pacific Islander (API), 26% non-Hispanic Black (NHB), 44% non-Hispanic white (NHW), 18% Hispanic, and 8% other/unknown. Sustained decrease in ideal BMI occurred across race/ethnicity groups; however, proportion in ideal was consistently lower for NHB and Hispanic children. Ideal BP appeared to increase across childhood with few racial differences. Ideal cholesterol levels were constant across childhood, but the proportion of NHW children in ideal was lower than NHB and Hispanic children. Almost all individuals had ideal glucose levels throughout early childhood. Conclusions: Early childhood declines in CVH appeared to be driven by changes in ideal BMI. Racial/ethnic differences in ideal BMI and cholesterol were present by age 2 and were mostly sustained through age 12. Selection bias may account for some of these findings; consistent monitoring in early childhood is needed to better understand observed differences.

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Abstract P315: Is Self-rated Health Associated With Ideal Cardiovascular Health? The Multi-Ethnic Study of Atherosclerosis

Circulation ◽

10.1161/circ.137.suppl_1.p315 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Olatokunbo I Osibogun ◽

Oluseye Ogunmoroti ◽

Erica S Spatz ◽

Gregory L Burke ◽

Erin D Michos

Keyword(s):

Cardiovascular Health ◽

Reference Group ◽

Multinomial Logistic Regression ◽

Heart Association ◽

Cross Sectional ◽

Ethnic Study ◽

Ideal Cardiovascular Health ◽

Health Insurance Status ◽

Self Rated Health ◽

Race Ethnicity

Introduction: Self-rated health (SRH) is a commonly used indicator of health status. It has been identified as a determinant of health-promoting behaviors and a predictor of morbidity and mortality. However, little is known about the association between SRH and ideal cardiovascular health (CVH) as measured by the American Heart Association Life’s Simple 7 (LS7) criteria. We examined whether SRH was associated with ideal CVH, for the overall cohort and by sex and race/ethnicity. Methods: We conducted a cross-sectional analysis of 6457 men and women of 4 race/ethnicities, aged 45 to 84 years, who participated in the Multi-Ethnic Study of Atherosclerosis. SRH was measured on a 5-point Likert scale (excellent, very good, good, fair and poor). CVH was determined using the LS7 score with each of the 7 metrics scored from 0-2, and a total score ranging from 0-14. Scores of 0-8 indicate an inadequate score, 9-10, average and 11-14, optimal. Odds ratios (OR) and 95% confidence intervals were calculated for the associations between SRH and LS7 score categories using multinomial logistic regression, adjusted for age, sex, race/ethnicity, education, income, marital status, health insurance status and chronic diseases Results: The mean age (SD) of participants was 62 (10) years; 53% were women. Approximately, 16% of participants rated their health as excellent, 33% very good, 41% good and 9% poor-fair. In this population, 47% had inadequate LS7 scores, 33%, average and 20% optimal. The odds of having a higher LS7 score increased as SRH improved. Using participants who rated their health as poor-fair as the reference group, the adjusted OR for having an optimal LS7 score in the overall cohort was: excellent 3.0 (2.1-4.3); very good 1.6 (1.1-2.1); good 1.2 (0.9-1.7). A similar trend was observed in the stratified analyses by sex and race/ethnicity ( Table ) Conclusion: A more favorable SRH was associated with better CVH irrespective of sex or race/ethnicity. Further research could explore whether optimization of SRH predicts cardiovascular outcomes.

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Abstract P236: Association Between Alcohol and Ideal Cardiovascular Health: The Multi-Ethnic Study of Atherosclerosis

Circulation ◽

10.1161/circ.137.suppl_1.p236 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Oluseye Ogunmoroti ◽

Olatokunbo Osibogun ◽

Robyn L McClelland ◽

Erin D Michos ◽

Gregory L Burke ◽

...

Keyword(s):

Alcohol Intake ◽

Cardiovascular Health ◽

Multinomial Logistic Regression ◽

Cvd Risk ◽

Cross Sectional ◽

Ideal Cardiovascular Health ◽

Logistic Regression Models ◽

Race Ethnicity ◽

Moderate Alcohol Intake ◽

Heavy Alcohol Intake

Introduction: Alcohol intake is associated with cardiovascular disease (CVD), with moderate drinkers having a decreased CVD risk compared to non- and heavy drinkers. However, this association is yet to be examined using the AHA Life’s Simple 7 (LS7) metrics as a proxy for cardiovascular health (CVH). We explored associations between alcohol intake and CVH in a multi-ethnic population. Methods: Our cross-sectional analyses included 6,506 MESA participants, free of CVD, aged 45 to 84 years. The LS7 metrics (smoking, physical activity, body mass index, diet, blood pressure, total cholesterol and blood glucose) were each scored 0-2, with 2 indicating “ideal”, 1 “intermediate” and 0 “poor”. Total LS7 score ranged from 0-14. Alcohol data was obtained from personal history and food frequency questionnaires. Participants were classified as never, former or current drinkers. Current drinkers were categorized as <1 (light), 1-2 (moderate) and >2 (heavy) drinks/day. Multinomial logistic regression models assessed associations between alcohol intake and CVH, adjusted for age, sex, race/ethnicity, education, income and health insurance. Results: Mean (SD) age was 62 (10) years, 53% were women; 20% were never, 24% former and 56% current drinkers. Among current drinkers, 44% had <1, 9% 1-2 and 3% >2 drinks/day. Additionally, 47% had inadequate LS7 scores, 33% average and 20% optimal. Compared to never drinkers, those who drank <1 drink/day were more likely to have average and optimal scores, although most of the associations were not significant. Women with 1-2 drinks/day were more likely than men to have optimal scores. Overall and in men, those who drank >2 drinks/day were less likely to have average or optimal scores. Whites and Hispanics with >2 drinks/day were less likely to have optimal and average scores, respectively (Table). Conclusion: Light alcohol intake tended to show favorable CVH, whereas heavy alcohol intake was unfavorable. For moderate alcohol intake, the associations with CVH varied by sex and race/ethnicity.

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Abstract P349: Accelerometer-measured Sleep Duration and Markers of Cardiometabolic Health: Findings From a Large Racially Ethnic Diverse Cohort of Older Adult Women

Circulation ◽

10.1161/circ.137.suppl_1.p349 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Kelsie M Full ◽

Jacqueline Kerr ◽

Dana Song ◽

Atul Malhotra ◽

Linda Gallo ◽

...

Keyword(s):

Sleep Duration ◽

Older Adult ◽

Cardiovascular Health ◽

Cardiometabolic Risk ◽

Hdl Cholesterol ◽

Cardiometabolic Health ◽

Adult Women ◽

Cross Sectional ◽

Race Ethnicity ◽

The Relationship

Background: Cross-sectional and prospective studies have demonstrated that self-reported short sleep is a predictor of cardiometabolic conditions including obesity, Type 2 Diabetes, and cardiovascular events. The relationship may be non-linear, with short and long sleep related to markers of cardiometabolic risk. Research on sleep duration and cardiometabolic health is limited by use of single item self-report sleep measures and homogeneous populations. The current study tested the hypothesis that accelerometer-measured sleep duration would be significantly associated with objective markers of cardiometabolic risk in older adult women. Methods: Cross-sectional data were analyzed in 2662 women (mean age: 79.05, 52.8% white, 29.8% black, 17.4% Hispanic), from the Objective Physical Activity and Cardiovascular Health Study, ancillary study to the Women’s Health Initiative. Women wore accelerometers on the hip for 24 hours over 7 days and completed a daily sleep log. To be included in the present analysis women must have validated night wear for at least 3 nights. Sleep data were scored according to a standard protocol using sleep logs and visual inspection of the accelerometer data. Body mass index (BMI) and fasting blood samples were obtained at home visits prior to accelerometer monitoring. Adjusting for age and race/ethnicity, linear regression models estimated the relationship between sleep duration and BMI (kg/m 2 ), HDL cholesterol, triglycerides, and glucose (mg/dL each), and C-reactive protein (CRP; mg/L). A quadratic term for sleep was included in the models to evaluate nonlinearity. Results: The mean nightly sleep duration in the sample was 489.6 mins per night (8.16 hours) with 14.8% of the sample sleeping less than 7 hours per night and 21% sleeping more than 9 hours per night. After adjusting for age and race/ethnicity, sleep duration was significantly related to BMI (regression coefficient [ B ] :- 0.034, p<.01), and the relationship appeared to be non-linear (quadratic, p=.02). The estimated quadratic function indicated a decreasing BMI as sleep duration increased up to 500 minutes/night, and then an increasing BMI as sleep duration continued to increase beyond 500 minutes/night. Additionally, sleep duration was significantly related to CRP ( B: - 0.005, p=.03), triglycerides ( B: 0.002, p=.03) and glucose ( B: - 0.125, p=.05), with both the CRP (quadratic, p =.02) and glucose (quadratic, p =.03) relationships appearing to be u-shaped and the triglyceride relationship linear. Sleep duration was not significantly related to HDL cholesterol. Conclusions: In older women, there is a significant relationship between sleep duration and cardiometabolic risk factors, independent of age and race/ethnicity. These cross-sectional relationships should be further explored in prospective studies to inform sleep guidelines for better cardiovascular health in older adult women.

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