The Risk of Cardiovascular Disease Risk Among Adults with Vision Impairment from Low-, Middle- and High-Income Countries.

PURPOSE: The limited evidence for cardiovascular disease (CVD) among adults with vision impairment (VI) has often been from developed countries using self-reported VI. This study evaluated the association of objectively-determined VI with the risk of CVD among adults from low-, middle-, and high-income countries. METHODS: Data were from 32,268 adults aged 30-74 years without CVD or blindness from China, Ghana, India, Mexico, Russian Federation, South Africa, and the United States during 2007-2010. VI and severe VI was defined as presenting visual acuity worse than 6/18, and 6/60, respectively. The Framingham risk algorithm was used to estimate the risk for incident CVD. Logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals. RESULTS: The mean age of participants was 46.4 years, with half of them being women (49.3%). The age-adjusted prevalence of VI ranged from 1.1% (United States) to 14.2% (South Africa) while severe VI ranged from 0.4% (United States) to 4.5% (Ghana). In models adjusting for country, sociodemographic factors, waist girth, healthcare use, activities of daily living and other health-related factors, VI was associated with CVD risk ≥ 10% (OR = 1.69, 95% CI: 1.22-2.36). This observed association was largely consistent across countries (p = 0.119). The observed CVD risk was similar among adults with moderate or severe VI (OR = 0.95, 95% CI: 0.50-1.83). CVD risk was higher among adults with VI who were <65 years old (OR = 1.89, 95% CI: 1.36-2.63) or were employed (OR = 2.24, 95% CI: 1.58-3.16). CONLUSIONS: This cross-national study shows that individuals with VI are at high risk for future CVD.

The role of mental health and substance use disorders on the relation of migraine with self-directed violence among women in the United States.

OBJECTIVES: Migraine disproportionately affects women of reproductive age, and is associated with self-directed violence (SDV) which confers substantial risk for suicides. Mental health disorders (MHD) and substance use disorders (SUD) are higher among persons with migraines. However, there's limited information on the influence of these conditions on SDV among women. We evaluated the interplay of MHD and SUD on the relation of migraine with SDV among US women. METHODS: We analyzed data from 96 million hospitalizations among women aged 15-49 years from the National Inpatient Sample (2004-2015). International Classification of Disease codes were used to identify hospitalizations for migraine and other health conditions. Logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI). RESULTS: From 2004 to 2015 the prevalence (per 1000 hospitalizations) of migraine increased from 17.5 to 33.5, while SDV prevalence also increased from 10.5 to 38.9. A greater proportion of women hospitalized with migraine had epilepsy, suicidal ideations, SUD and MHD than women without migraine. In models adjusted for demographic and behavioral/lifestyle factors, menstrual disorders, pregnancy, health conditions and violent assault, hospitalization with migraine was positively associated with SDV (OR = 1.15, CI: 1.12-1.18). Women with migraine and either SUD (OR = 5.17, CI: 4.46-5.97) or MHD (OR = 14.13; CI: 12.1-16.47) had elevated odds of SDV, with the odds varying by type of MHD and SUD. CONCLUSIONS: A significant relation between hospitalization with migraine and SDV was observed especially among reproductive-age women with SUD and MHD. Clinicians should consider monitoring women with these characteristics for suicide risk.

Geographic Disparity in Asthma Hospitalizations: The Role of Race/Ethnicity, Socioeconomic Status, and Other Factors.

Background In the United States, asthma is the most common chronic disease in children, and is associated with low sociodemographic, economic, and environmental factors.  Objective To investigate geographic disparities in asthma hospitalizations and the roles that race/ethnicity, health insurance, and other environmental factors played on these disparities in Lubbock County, Texas.  Methods Data were obtained from the Texas Inpatient Public Use Data File for the years 1999-2018. International classification of disease codes were used to identify primary diagnoses of asthma among all severe inpatient admissions. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs).  Results Of the 248,768 patients admitted for severe conditions, 4,224 had a primary diagnosis of asthma. In multivariable-adjusted models, the odds of asthma hospitalizations varied across geographic regions of Lubbock with the Northeast having the highest age-adjusted prevalence (7.17 per 1,000) and ORs for asthma hospitalizations (OR: 1.25, CI: 1.12-1.40). Data suggested that non-Hispanic Blacks using federal insurance in the Northeast region had the highest odds for asthma hospitalizations (OR: 4.88, CI: 3.06-7.79; p-interaction = 0.001). Across all regions, a 1 µg/m3 increase in particulate matter 2.5 was associated with a 27% higher likelihood of asthma hospitalization (OR: 1.27, 95% CI: 1.23-1.31).  Conclusion In this study, geographic disparities in asthma hospitalizations were observed within Lubbock County and were significantly influenced by a disparate distribution of socioeconomic factors related to health insurance and race/ethnicity. The potential contributory role of particulate matter needs further investigation.

Sex Differences in Stroke Hospitalization Incidence, 30-Day Mortality, and Readmission in a Regional Medical Center in the Southwestern United States.

OBJECTIVES: This study explores sex differences in ischemic stroke hospitalization incidence, 30-day mortality, and 30-day readmission in a southwestern US medical center. METHODS: Ischemic stroke admissions in a regional medical center in the southwestern United States were obtained for a 6.5-year time frame (N = 1968). Logistic regression models examine the adjusted effects of sex on 30-day mortality and 30-day readmission outcomes among individuals hospitalized for ischemic stroke. RESULTS: Findings confirm that although women experience higher mortality than men (9.1% vs 6.7%), the sex disparity in mortality is explained by the age distribution of strokes. Women experience far more strokes and deaths because of stroke at older ages. No differences in principal procedure or 30-day readmission emerged. CONCLUSIONS: Men experienced higher stroke hospitalization incidence, although women exhibited higher 30-day mortality. Age composition explained sex differences in mortality, but higher male stroke hospitalization incidence represents a larger public health issue that suggests the need for behavioral change at the population level. No meaningful sex differences emerged in treatment, mortality, or readmission.

The Joint Association of Septicemia and Cerebrovascular Diseases with In-Hospital MortalityAmong Patients with Left Ventricular Assist Device in the United States.

OBJECTIVES: Left ventricular assist device (LVAD) is associated with complications such as cerebrovascular diseases (CEVD) as well as septicemia which is often preventable. With their use increasing in the U.S., identifying patients with LVAD who are at high risk for short-term mortality is essential for targeted effective patient management strategies to prevent adverse outcomes. We investigated the individual and joint association of CEVD and septicemia with the risk of in-hospital mortality in patients with LVAD in the U.S. MATERIALS AND METHODS: We used data from the National Inpatient Sample from 2004 to 2015 to identify patients ≥18 years of age who underwent LVAD implantation by means of International Classification of Disease, 9th Revision, codes. Multivariable hierarchical negative binomial regression models were used to estimate risk ratios (RR) and 95% confidence intervals (CI) for in-hospital mortality by CEVD-septicemia status. RESULTS: The mean age of the 4638 patients was 56 years, and 23% of them were women. Approximately 13% of patients had septicemia; 7% had CEVD and 2% had both conditions. In models adjusted for demographic, lifestyle/behavior factors and comorbid conditions, the risk of in-hospital mortality was almost threefold higher among patients with septicemia alone (RR=2.84, CI:2.24-3.60); two-and-half fold higher among patients with CEVD alone (RR=2.53, CI:1.85-3.48); and almost fourfold among patients with both septicemia and CEVD (RR=3.76, CI: 2.38-5.94, Pinteraction = <0.001) CONCLUSION: The presence of both septicemia and CEVD was associated with a substantially higher risk of in-hospital mortality among LVAD patients when compared to septicemia or CEVD alone.

The Association of Ideal Cardiovascular Health and Ocular Diseases Among US Adults.

BACKGROUND: Globally, about 2.2 billion people have a vision impairment or blindness and approximately half of the cases could have been prevented. Several ocular diseases share common characteristics that overlap with risk factors for cardiovascular diseases. The aim of this study was to evaluate the relation between the American Heart Association's prescription for health called the Life's Simple 7 (LS7) metrics and the occurrence of ocular diseases. METHODS: Data were from 6118 adults ages ≥40 years who participated in the 2005-2008 National Health and Nutrition Examination Survey (NHANES). LS7 metrics consisted of information on smoking, physical activity, body mass index, diet, blood pressure, total cholesterol, and blood glucose. Scores were summed for a maximum of 14 (most ideal cardiovascular health). Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: The average age of participants was 57 years with 53% of them being women. A 1-unit increase in LS7 scores was associated with reduced odds for age-related macular degeneration (OR: 0.95, 95% CI: 0.90-0.99), diabetic retinopathy (OR: 0.68, 95% CI: 0.64-0.73), cataract (OR: 0.94, 95% CI: 0.90-0.98), and glaucoma (OR: 0.94, 95% CI: 0.88-0.99). After multivariable adjustment, the association was limited to only diabetic retinopathy (OR: 0.69, 95% CI: 0.64-0.74). This association persisted when diabetic retinopathy was limited to only diagnosis by retinal imaging. CONCLUSIONS: In this study, ideal cardiovascular health, which is indicative of a healthy lifestyle, was associated with lower odds for ocular diseases, especially diabetic retinopathy. These findings suggest that interventions to prevent cardiovascular diseases may also hold promise in preventing ocular diseases.