Trends in Racial/Ethnic and Nativity Disparities in Cardiovascular Health Among Adults Without Prevalent Cardiovascular Disease in the United States, 1988 to 2014

Introduction: Social determinants of health are multi-dimensional and span various interrelated domains. In order to inform community-engaged clinical and policy efforts, we sought to examine the association between a national social vulnerability index (SVI) and age-adjusted mortality rate (AAMR) of CVD. Hypothesis: Higher county-level SVI or greater vulnerability will be associated with higher AAMR of CVD between 1999-2018 in the United States. Methods: In this serial, cross-sectional analysis, we queried CDC WONDER for age-adjusted mortality rates (AAMRs) per 100,000 population for cardiovascular disease (I00-78) at the county-level between 1999-2018. We quantified the association of county-level SVI and CVD AAMR using Spearman correlation coefficients and examined trends in CVD AAMR stratified by median SVI at the county-level. Finally, we performed geospatial county-level analysis stratified by combined median SVI and CVD AAMR (high/high, high/low, low/high, and low/low). Results: We included data from 2766 counties (representing 95% of counties in the US) with median SVI 0.53 (IQR 0.28, 0.76). Overall SVI and the household and socioeconomic subcomponents were strongly correlated with 2018 CVD AAMR (0.47, 0.50, and 0.56, respectively with p<0.001 for all). CVD mortality declined between 1999-2011 and was stagnant between 2011-2018 with similar patterns in high and low SVI counties (FIGURE). Counties with high SVI and CVD AAMR were clustered in the South and Midwest (n=977, 35%). Conclusion: County-level social vulnerability is associated with higher CVD mortality. High SVI and CVD AAMR coexist in more than 1 in 3 US counties and have persisted over the past 2 decades. Identifying counties that are disproportionately vulnerable may inform targeted and community-based strategies to equitably improve cardiovascular health across the country.

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Greater Acculturation is Associated With Poorer Cardiovascular Health in the Multi‐Ethnic Study of Atherosclerosis

Journal of the American Heart Association ◽

10.1161/jaha.120.019828 ◽

2021 ◽

Author(s):

Olatokunbo Osibogun ◽

Oluseye Ogunmoroti ◽

Lena Mathews ◽

Victor Okunrintemi ◽

Martin Tibuakuu ◽

...

Keyword(s):

United States ◽

Cardiovascular Disease ◽

Cardiovascular Health ◽

Hispanic Americans ◽

The United States ◽

Foreign Born ◽

Cross Sectional ◽

Lower Odds ◽

Increased Risk ◽

At Home

Background Greater acculturation is associated with increased risk of cardiovascular disease. However, little is known about the association between acculturation and ideal cardiovascular health (CVH) as measured by the American Heart Association's 7 CVH metrics. We investigated the association between acculturation and ideal CVH among a multi‐ethnic cohort of US adults free of clinical cardiovascular disease at baseline. Methods and Results This was a cross‐sectional analysis of 6506 men and women aged 45 to 84 years of 4 races/ethnicities. We examined measures of acculturation(birthplace, language spoken at home, and years lived in the United States [foreign‐born participants]) by CVH score. Scores of 0 to 8 indicate inadequate, 9 to 10 average and 11 to 14 optimal CVH. We used multivariable regression to examine associations between acculturation and CVH, adjusting for age, sex, race/ethnicity, education, income and health insurance. The mean (SD) age was 62 (10) years, 53% were women, 39% non‐Hispanic White‐, 26% non‐Hispanic Black‐, 12% Chinese‐ and 22% Hispanic‐Americans. US‐born participants had lower odds of optimal CVH (odds ratio [OR]: 0.63 [0.50–0.79], P <0.001) compared with foreign‐born participants. Participants who spoke Chinese and other foreign languages at home had greater odds of optimal CVH compared with those who spoke English (1.91 [1.08–3.36], P =0.03; and 1.65 [1.04–2.63], P =0.03, respectively). Foreign‐born participants who lived the longest in the United States had lower odds of optimal CVH (0.62 [0.43–0.91], P =0.02). Conclusions Greater US acculturation was associated with poorer CVH. This finding suggests that the promotion of ideal CVH should be encouraged among immigrant populations since more years lived in the United States was associated with poorer CVH.

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Racial/Ethnic Disparities in Atrial Fibrillation Treatment and Outcomes among Dialysis Patients in the United States

Journal of the American Society of Nephrology ◽

10.1681/asn.2019050543 ◽

2020 ◽

Vol 31 (3) ◽

pp. 637-649 ◽

Cited By ~ 3

Author(s):

Salina P. Waddy ◽

Allen J. Solomon ◽

Adan Z. Becerra ◽

Julia B. Ward ◽

Kevin E. Chan ◽

...

Keyword(s):

United States ◽

Atrial Fibrillation ◽

Cardiovascular Disease ◽

Stroke Prevention ◽

Ethnic Disparities ◽

The United States ◽

Hemodialysis Patients ◽

Prescription Medications ◽

Asian Patients ◽

Racial Ethnic

BackgroundBecause stroke prevention is a major goal in the management of ESKD hemodialysis patients with atrial fibrillation, investigating racial/ethnic disparities in stroke among such patients is important to those who could benefit from strategies to maximize preventive measures.MethodsWe used the United States Renal Data System to identify ESKD patients who initiated hemodialysis from 2006 to 2013 and then identified those with a subsequent atrial fibrillation diagnosis and Medicare Part A/B/D. Patients were followed for 1 year for all-cause stroke, mortality, prescription medications, and cardiovascular disease procedures. The survival mediational g-formula quantified the percentage of excess strokes attributable to lower use of atrial fibrillation treatments by race/ethnicity.ResultsThe study included 56,587 ESKD hemodialysis patients with atrial fibrillation. Black, white, Hispanic, and Asian patients accounted for 19%, 69%, 8%, and 3% of the population, respectively. Compared with white patients, black, Hispanic, or Asian patients were more likely to experience stroke (13%, 15%, and 16%, respectively) but less likely to fill a warfarin prescription (10%, 17%, and 28%, respectively). Warfarin prescription was associated with decreased stroke rates. Analyses suggested that equalizing the warfarin distribution to that in the white population would prevent 7%, 10%, and 12% of excess strokes among black, Hispanic, and Asian patients, respectively. We found no racial/ethnic disparities in all-cause mortality or use of cardiovascular disease procedures.ConclusionsRacial/ethnic disparities in all-cause stroke among hemodialysis patients with atrial fibrillation are partially mediated by lower use of anticoagulants among black, Hispanic, and Asian patients. The reasons for these disparities are unknown, but strategies to maximize stroke prevention in minority hemodialysis populations should be further investigated.

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Cardiovascular health and cognitive functioning among centenarians: a comparison between the Tokyo and Georgia centenarian studies

International Psychogeriatrics ◽

10.1017/s1041610218001813 ◽

2019 ◽

Vol 31 (04) ◽

pp. 455-465 ◽

Cited By ~ 4

Author(s):

Peter Martin ◽

Yasuyuki Gondo ◽

Yasumichi Arai ◽

Yoshiko Ishioka ◽

Mary Ann Johnson ◽

...

Keyword(s):

United States ◽

Blood Pressure ◽

Cardiovascular Disease ◽

Cognitive Functioning ◽

Cardiovascular Health ◽

The United States ◽

C Reactive Protein ◽

Differential Effects ◽

Reactive Protein ◽

Positive Effects

ABSTRACTObjectives:Centenarians have survived into very late life, but whether they reach very old age in good health remains unclear. The purpose of this study was to compare the cardiovascular health status and cognitive functioning of centenarians in the United States with centenarians in Japan.Design, Setting, and Participants:This cross-national design compared centenarians from the United States and Japan. The sample of U.S. centenarians was recruited from the Georgia Centenarian Study and included 287 centenarians. The sample of Japanese centenarians was recruited from the Tokyo Centenarian Study and included 304 centenarians.Measurements:Cognitive functioning was assessed with a mental status questionnaire, and cardiovascular disease by a health history assessment, blood pressure, and selected blood parameters.Results:The results suggest that Tokyo centenarians had lower disease experiences and BMI values, when compared to Georgia centenarians, but blood pressure was higher among Japanese centenarians. Lower levels of hemoglobin in Japanese centenarians and higher levels of C-reactive protein in Georgia were also found. The positive association of hypertension and albumin levels with cognitive functioning and the negative association of stroke occurrence with cognitive functioning were replicated in both countries. Differential effects were obtained for heart problems, BMI, and C-reactive protein (with positive effects for Tokyo centenarians, except for C-reactive protein).Conclusion:For extremely old individuals, some markers of cardiovascular disease are replicable across countries, whereas differential effects for cardiovascular health also need to be considered in cardiovascular health.

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Racial, Ethnic, and Geographic Disparities in Cardiovascular Health Among Women of Childbearing Age in the United States

Journal of the American Heart Association ◽

10.1161/jaha.120.020138 ◽

2021 ◽

Author(s):

Yi Zheng ◽

Xiaoxiao Wen ◽

Jiang Bian ◽

Jinying Zhao ◽

Heather S. Lipkind ◽

...

Keyword(s):

Physical Activity ◽

United States ◽

Blood Pressure ◽

Cardiovascular Health ◽

The United States ◽

Women Of Childbearing Age ◽

Childbearing Age ◽

Geographic Disparities ◽

Racial Ethnic ◽

Hispanic White

Background In the United States, large disparities in cardiovascular health (CVH) exist in the general population, but little is known about the CVH status and its disparities among women of childbearing age (ie, 18–49 years). Methods and Results In this cross‐sectional study, we examined racial, ethnic, and geographic disparities in CVH among all women of childbearing age in the United States, using the 2011 to 2019 Behavioral Risk Factor Surveillance System. Life's Simple 7 (ie, blood pressure, glucose, total cholesterol, smoking, body mass index, physical activity, and diet) was used to examine CVH. Women with 7 ideal CVH metrics were determined to have ideal CVH. Among the 269 564 women of childbearing age, 13 800 (4.84%) had ideal CVH. After adjusting for potential confounders, non‐Hispanic Black women were less likely to have ideal CVH (odds ratio, 0.54; 95% CI, 0.46–0.63) compared with non‐Hispanic White women, and with significantly lower odds of having ideal metrics of blood pressure, blood glucose, body mass index, and physical activity. No significant difference in CVH was found between non‐Hispanic White and Hispanic women. Large geographic disparities with temporal variations were observed, with the age‐ and race‐adjusted ideal CVH prevalence ranging from 4.05% in the District of Columbia (2011) to 5.55% in Maine and Montana (2019). States with low ideal CVH prevalence and average CVH score were mostly clustered in the southern United States. Conclusions Large racial, ethnic, and geographic disparities in CVH exist among women of childbearing age. More efforts are warranted to understand and address these disparities.

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Abstract # P-18: Economic Burden of Type 2 Diabetes Mellitus in Patients with Cardiovascular Disease in Commercially-Insured Patients in the United States

Endocrine Practice ◽

10.1016/s1530-891x(20)43831-5 ◽

2016 ◽

Vol 22 ◽

pp. 21-22

Author(s):

Weijia Wang ◽

Eileen M. Farrelly ◽

Sharash Shetty ◽

Dana Stafkey-Mailey ◽

Stephen D. Sander ◽

...

Keyword(s):

Diabetes Mellitus ◽

United States ◽

Type 2 Diabetes ◽

Cardiovascular Disease ◽

Type 2 Diabetes Mellitus ◽

Economic Burden ◽

The United States ◽

Insured Patients

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1488-P: Closing the Racial/Ethnic Disparity Gap in Kidney Failure from Diabetes in the United States, 2000-2016

Diabetes ◽

10.2337/db20-1488-p ◽

2020 ◽

Vol 69 (Supplement 1) ◽

pp. 1488-P

Author(s):

NILKA RIOS BURROWS ◽

YAN ZHANG ◽

ISRAEL A. HORA ◽

MEDA E. PAVKOV ◽

GIUSEPPINA IMPERATORE

Keyword(s):

United States ◽

Kidney Failure ◽

The United States ◽

Ethnic Disparity ◽

Racial Ethnic

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The Politics of US Latino Literature and American Realism

The Oxford Handbook of American Literary Realism ◽

10.1093/oxfordhb/9780190642891.013.14 ◽

2019 ◽

pp. 231-248

Author(s):

Ramón J. Guerra

Keyword(s):

United States ◽

Social Justice ◽

Mexican Revolution ◽

The United States ◽

Spanish American ◽

Spanish American War ◽

Men And Women ◽

Latino Literature ◽

The Common ◽

Racial Ethnic

This chapter examines the development of Latino literature in the United States during the time when realism emerged as a dominant aesthetic representation. Beginning with the Treaty of Guadalupe Hidalgo (1848) and including the migrations resulting from the Spanish-American War (1898) and the Mexican Revolution (1910), Latinos in the United States began to realistically craft an identity served by a sense of displacement. Latinos living in the United States as a result of migration or exile were concerned with similar issues, including but not limited to their predominant status as working-class, loss of homeland and culture, social justice, and racial/ethnic profiling or discrimination. The literature produced during the latter part of the nineteenth century by some Latinos began to merge the influence of romantic style with a more socially conscious manner to reproduce the lives of ordinary men and women, draw out the specifics of their existence, characterize their dialects, and connect larger issues to the concerns of the common man, among other realist techniques.

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