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1.
JAMA ; 324(14): 1429-1438, 2020 10 13.
Artigo em Inglês | MEDLINE | ID: mdl-33048153

RESUMO

Importance: The prevalence of leading risk factors for morbidity and mortality in the US significantly varies across regions, states, and neighborhoods, but the extent these differences are associated with a person's place of residence vs the characteristics of the people who live in different places remains unclear. Objective: To estimate the degree to which geographic differences in leading risk factors are associated with a person's place of residence by comparing trends in health outcomes among individuals who moved to different areas or did not move. Design, Setting, and Participants: This retrospective cohort study estimated the association between the differences in the prevalence of uncontrolled chronic conditions across movers' destination and origin zip codes and changes in individuals' likelihood of uncontrolled chronic conditions after moving, adjusting for person-specific fixed effects, the duration of time since the move, and secular trends among movers and those who did not move. Electronic health records from the Veterans Health Administration were analyzed. The primary analysis included 5 342 207 individuals with at least 1 Veterans Health Administration outpatient encounter between 2008 and 2018 who moved zip codes exactly once or never moved. Exposures: The difference in the prevalence of uncontrolled chronic conditions between a person's origin zip code and destination zip code (excluding the individual mover's outcomes). Main Outcomes and Measures: Prevalence of uncontrolled blood pressure (systolic blood pressure level >140 mm Hg or diastolic blood pressure level >90 mm Hg), uncontrolled diabetes (hemoglobin A1c level >8%), obesity (body mass index >30), and depressive symptoms (2-item Patient Health Questionnaire score ≥2) per quarter-year during the 3 years before and the 3 years after individuals moved. Results: The study population included 5 342 207 individuals (mean age, 57.6 [SD, 17.4] years, 93.9% men, 72.5% White individuals, and 12.7% Black individuals), of whom 1 095 608 moved exactly once and 4 246 599 never moved during the study period. Among the movers, the change after moving in the prevalence of uncontrolled blood pressure was 27.5% (95% CI, 23.8%-31.3%) of the between-area difference in the prevalence of uncontrolled blood pressure. Similarly, the change after moving in the prevalence of uncontrolled diabetes was 5.0% (95% CI, 2.7%-7.2%) of the between-area difference in the prevalence of uncontrolled diabetes; the change after moving in the prevalence of obesity was 3.1% (95% CI, 2.0%-4.2%) of the between-area difference in the prevalence of obesity; and the change after moving in the prevalence of depressive symptoms was 15.2% (95% CI, 13.1%-17.2%) of the between-area difference in the prevalence of depressive symptoms. Conclusions and Relevance: In this retrospective cohort study of individuals receiving care at Veterans Health Administration facilities, geographic differences in prevalence were associated with a substantial percentage of the change in individuals' likelihood of poor blood pressure control or depressive symptoms, and a smaller percentage of the change in individuals' likelihood of poor diabetes control and obesity. Further research is needed to understand the source of these associations with a person's place of residence.


Assuntos
Transtorno Depressivo/epidemiologia , Diabetes Mellitus/epidemiologia , Migração Humana/estatística & dados numéricos , Hipertensão/epidemiologia , Obesidade/epidemiologia , Características de Residência/estatística & dados numéricos , Doença Crônica/epidemiologia , Doença Crônica/etnologia , Transtorno Depressivo/etnologia , Diabetes Mellitus/etnologia , Registros Eletrônicos de Saúde/estatística & dados numéricos , Feminino , Geografia Médica , Migração Humana/tendências , Humanos , Hipertensão/etnologia , Masculino , Pessoa de Meia-Idade , Obesidade/etnologia , Prevalência , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Incerteza , Estados Unidos/epidemiologia , Estados Unidos/etnologia , Serviços de Saúde para Veteranos Militares/estatística & dados numéricos
2.
PLoS One ; 15(7): e0235839, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32634156

RESUMO

Given recent slowing of declines in national all-cause, heart disease, and stroke mortality, examining spatiotemporal distributions of coronary heart disease (CHD) death rates and trends can provide data critical to improving the cardiovascular health of populations. This paper documents county-level CHD death rates and trends by age group, race, and gender from 1979 through 2017. Using data from the National Vital Statistics System and a Bayesian multivariate space-time conditional autoregressive model, we estimated county-level age-standardized annual CHD death rates for 1979 through 2017 by age group (35-64 years, 65 years and older), race (white, black, other), and gender (men, women). We then estimated county-level total percent change in CHD death rates during four intervals (1979-1990, 1990-2000, 2000-2010, 2010-2017) using log-linear regression models. For all intervals, national CHD death rates declined for all groups. Prior to 2010, although most counties across age, race, and gender experienced declines, pockets of increasing CHD death rates were observed in the Mississippi Delta, Oklahoma, East Texas, and New Mexico across age groups and gender, and were more prominent among non-white populations than whites. Since 2010, across age, race, and gender, county-level declines in CHD death rates have slowed, with a marked increase in the percent of counties with increasing CHD death rates (e.g. 4.4% and 19.9% for ages 35 and older during 1979-1990 and 2010-2017, respectively). Recent increases were especially prevalent and geographically widespread among ages 35-64 years, with 40.5% of counties (95% CI: 38.4, 43.1) experiencing increases. Spatiotemporal differences in these long term, county-level results can inform responses by the public health community, medical providers, researchers, and communities to address troubling recent trends.


Assuntos
Doença das Coronárias/mortalidade , Adulto , Afro-Americanos , Fatores Etários , Idoso , Teorema de Bayes , Doença das Coronárias/epidemiologia , Doença das Coronárias/etnologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade , Análise Multivariada , Fatores Sexuais , Estados Unidos/epidemiologia , Estados Unidos/etnologia
4.
Biochem Biophys Res Commun ; 529(2): 263-269, 2020 08 20.
Artigo em Inglês | MEDLINE | ID: mdl-32703421

RESUMO

The World Health Organization recently announced that pandemic status has been achieved for coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Exponential increases in patient numbers have been reported around the world, along with proportional increases in the number of COVID-19-related deaths. The SARS-CoV-2 infection rate in a population is expected to be influenced by social practices, availability of vaccines or prophylactics, and the prevalence of susceptibility genes in the population. Previous work revealed that cellular uptake of SARS-CoV-2 requires Angiotensin Converting Enzyme 2 (ACE-2) and a cellular protease. The spike (S) protein on SARS-CoV-2 binds ACE-2, which functions as an entry receptor. Following receptor binding, transmembrane protease serine 2 (encoded by TMPRSS2) primes the S protein to allow cellular uptake. Therefore, individual expression of TMPRSS2 may be a crucial determinant of SARS-CoV-2 infection susceptibility. Here, we utilized multiple large genome databases, including the GTEx portal, SNP nexus, and Ensembl genome project, to identify gene expression profiles for TMPRSS2 and its important expression quantitative trait loci. Our results show that four variants (rs464397, rs469390, rs2070788 and rs383510) affect expression of TMPRSS2 in lung tissue. The allele frequency of each variant was then assessed in regional populations, including African, American, European, and three Asian cohorts (China, Japan and Taiwan). Interestingly, our data shows that TMPRSS2-upregulating variants are at higher frequencies in European and American populations than in the Asian populations, which implies that these populations might be relatively susceptible to SARS-CoV-2 infection.


Assuntos
Betacoronavirus/metabolismo , Regulação da Expressão Gênica/genética , Internacionalidade , Pulmão/metabolismo , Receptores Virais/genética , Serina Endopeptidases/genética , Ásia/etnologia , Estudos de Coortes , Europa (Continente)/etnologia , Frequência do Gene , Genética Populacional , Mapeamento Geográfico , Humanos , Especificidade de Órgãos/genética , Polimorfismo de Nucleotídeo Único , Locos de Características Quantitativas/genética , Estados Unidos/etnologia , Regulação para Cima/genética
5.
J Comput Assist Tomogr ; 44(4): 562-568, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32697527

RESUMO

OBJECTIVE: The objective of this article was to study the association of aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) with bone mineral density (BMD). METHODS: Spine BMD was evaluated in a subset of 2028 participants from the Multiethnic Study of Atherosclerosis cohort who were NSAID users (including aspirin) and underwent both lumbar and thoracic imaging. Multiethnic Study of Atherosclerosis is a prospective cohort study that includes 4 ethnic groups (white, Asian, African American, and Hispanic). Trabecular BMD was evaluated by quantitative computed tomography based on cardiac computed tomography images, which were obtained during coronary calcium scans. The analyses were cross sectional using baseline examination data for exposure and outcomes. RESULTS: After adjustment for potential confounders including age, sex, race, and traditional cardiovascular risk factors, a small association between trabecular BMD and baseline use of COX-2-selective NSAID was observed. COX-2-selective NSAID use was associated with 7.4 mg/cm (95% confidence interval [CI], 1.6-13.3; P = 0. 013) higher trabecular BMD in thoracic spine and 10.6 mg/cm higher at lumbar spine (95% CI, 5.1-16.1; P < 0.001). Among regular aspirin users, there was no association between drug use and trabecular BMD. Considering all spine fractures together, the prevalence ratio of fractures among aspirin users was 1.0 (95% CI, 0.6-1.6) and 1.1 (95% CI, 0.5-2.3) among COX-2-selective NSAID users. CONCLUSIONS: Regular use of aspirin has no significant association with trabecular BMD in either the thoracic or lumbar spine and no association with fracture prevalence. COX-2-selective NSAIDs may have modest positive association with BMD, but the mechanisms were not assessed and the observational study design makes residual confounding a possible alternate explanation. Potential pathological mechanisms warrant further longitudinal exploration.


Assuntos
Anti-Inflamatórios não Esteroides/administração & dosagem , Aspirina/administração & dosagem , Osso Esponjoso/diagnóstico por imagem , Fraturas Ósseas/epidemiologia , Vértebras Lombares/diagnóstico por imagem , Vértebras Torácicas/diagnóstico por imagem , Idoso , Anti-Inflamatórios não Esteroides/efeitos adversos , Aspirina/efeitos adversos , Densidade Óssea/efeitos dos fármacos , Osso Esponjoso/efeitos dos fármacos , Estudos Transversais , Feminino , Fraturas Ósseas/diagnóstico por imagem , Humanos , Vértebras Lombares/efeitos dos fármacos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Vértebras Torácicas/efeitos dos fármacos , Tomografia Computadorizada por Raios X , Estados Unidos/etnologia
6.
JAMA Netw Open ; 3(6): e2012403, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: covidwho-607323

RESUMO

Importance: Data from the coronavirus disease 2019 (COVID-19) pandemic in the US show large differences in hospitalizations and mortality across race and geography. However, there are limited data on health information, beliefs, and behaviors that might indicate different exposure to risk. Objective: To determine the association of sociodemographic characteristics with reported incidence, knowledge, and behavior regarding COVID-19 among US adults. Design, Setting, and Participants: A US national survey study was conducted from March 29 to April 13, 2020, to measure differences in knowledge, beliefs, and behavior about COVID-19. The survey oversampled COVID-19 hotspot areas. The survey was conducted electronically. The criteria for inclusion were age 18 years or older and residence in the US. Data analysis was performed in April 2020. Main Outcomes and Measures: The main outcomes were incidence, knowledge, and behaviors related to COVID-19 as measured by survey response. Results: The survey included 5198 individuals (mean [SD] age, 48 [18] years; 2336 men [45%]; 3759 white [72%], 830 [16%] African American, and 609 [12%] Hispanic). The largest differences in COVID-19-related knowledge and behaviors were associated with race/ethnicity, sex, and age, with African American participants, men, and people younger than 55 years showing less knowledge than other groups. African American respondents were 3.5 percentage points (95% CI, 1.5 to 5.5 percentage points; P = .001) more likely than white respondents to report being infected with COVID-19, as were men compared with women (3.2 percentage points; 95% CI, 2.0 to 4.4 percentage points; P < .001). Knowing someone who tested positive for COVID-19 was more common among African American respondents (7.2 percentage points; 95% CI, 3.4 to 10.9 percentage points; P < .001), people younger than 30 years (11.6 percentage points; 95% CI, 7.5 to 15.7 percentage points; P < .001), and people with higher incomes (coefficient on earning ≥$100 000, 12.3 percentage points; 95% CI, 8.7 to 15.8 percentage points; P < .001). Knowledge of potential fomite spread was lower among African American respondents (-9.4 percentage points; 95% CI, -13.1 to -5.7 percentage points; P < .001), Hispanic respondents (-4.8 percentage points; 95% CI, -8.9 to -0.77 percentage points; P = .02), and people younger than 30 years (-10.3 percentage points; 95% CI, -14.1 to -6.5 percentage points; P < .001). Similar gaps were found with respect to knowledge of COVID-19 symptoms and preventive behaviors. Conclusions and Relevance: In this survey study of US adults, there were gaps in reported incidence of COVID-19 and knowledge regarding its spread and symptoms and social distancing behavior. More effort is needed to increase accurate information and encourage appropriate behaviors among minority communities, men, and younger people.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/psicologia , Comportamentos de Risco à Saúde/fisiologia , Pneumonia Viral/epidemiologia , Pneumonia Viral/psicologia , Adulto , Afro-Americanos/psicologia , Afro-Americanos/estatística & dados numéricos , Idoso , Estudos de Casos e Controles , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/prevenção & controle , Cultura , Grupo com Ancestrais do Continente Europeu/psicologia , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Hispano-Americanos/psicologia , Hispano-Americanos/estatística & dados numéricos , Hospitalização/tendências , Humanos , Incidência , Renda/tendências , Conhecimento , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Pandemias/prevenção & controle , Pneumonia Viral/mortalidade , Pneumonia Viral/prevenção & controle , Prevalência , Inquéritos e Questionários , Estados Unidos/epidemiologia , Estados Unidos/etnologia
7.
Psychol Trauma ; 12(5): 443-445, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32478545

RESUMO

COVID-19 has had disproportionate contagion and fatality in Black, Latino, and Native American communities and among the poor in the United States. Toxic stress resulting from racial and social inequities have been magnified during the pandemic, with implications for poor physical and mental health and socioeconomic outcomes. It is imperative that our country focus and invest in addressing health inequities and work across sectors to build self-efficacy and long-term capacity within communities and systems of care serving the most disenfranchised, now and in the aftermath of the COVID-19 epidemic. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


Assuntos
Infecções por Coronavirus/etnologia , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde/etnologia , Serviços de Saúde Mental , Pneumonia Viral/etnologia , Trauma Psicológico/etnologia , Autoeficácia , Justiça Social , Fatores Socioeconômicos , Adulto , Criança , Humanos , Pandemias , Trauma Psicológico/terapia , Estados Unidos/etnologia , Populações Vulneráveis
8.
Psychol Trauma ; 12(5): 439-442, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32551756

RESUMO

The present commentary offers a timely exploration of the racial trauma experienced by Asian, Black, and Latinx communities as it relates to COVID-19. Instances of individual, cultural, and structural racism and implications for mental health are discussed. Evidence-based strategies are identified for mental health professionals in order to support healing and mitigate the risk of further racial traumas. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


Assuntos
Assistência à Saúde Culturalmente Competente , Disparidades em Assistência à Saúde , Serviços de Saúde Mental , Trauma Psicológico/etnologia , Trauma Psicológico/terapia , Racismo/etnologia , Adulto , Criança , Infecções por Coronavirus , Humanos , Pandemias , Pneumonia Viral , Socialização , Estados Unidos/etnologia
9.
JAMA Netw Open ; 3(6): e2012403, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-32556260

RESUMO

Importance: Data from the coronavirus disease 2019 (COVID-19) pandemic in the US show large differences in hospitalizations and mortality across race and geography. However, there are limited data on health information, beliefs, and behaviors that might indicate different exposure to risk. Objective: To determine the association of sociodemographic characteristics with reported incidence, knowledge, and behavior regarding COVID-19 among US adults. Design, Setting, and Participants: A US national survey study was conducted from March 29 to April 13, 2020, to measure differences in knowledge, beliefs, and behavior about COVID-19. The survey oversampled COVID-19 hotspot areas. The survey was conducted electronically. The criteria for inclusion were age 18 years or older and residence in the US. Data analysis was performed in April 2020. Main Outcomes and Measures: The main outcomes were incidence, knowledge, and behaviors related to COVID-19 as measured by survey response. Results: The survey included 5198 individuals (mean [SD] age, 48 [18] years; 2336 men [45%]; 3759 white [72%], 830 [16%] African American, and 609 [12%] Hispanic). The largest differences in COVID-19-related knowledge and behaviors were associated with race/ethnicity, sex, and age, with African American participants, men, and people younger than 55 years showing less knowledge than other groups. African American respondents were 3.5 percentage points (95% CI, 1.5 to 5.5 percentage points; P = .001) more likely than white respondents to report being infected with COVID-19, as were men compared with women (3.2 percentage points; 95% CI, 2.0 to 4.4 percentage points; P < .001). Knowing someone who tested positive for COVID-19 was more common among African American respondents (7.2 percentage points; 95% CI, 3.4 to 10.9 percentage points; P < .001), people younger than 30 years (11.6 percentage points; 95% CI, 7.5 to 15.7 percentage points; P < .001), and people with higher incomes (coefficient on earning ≥$100 000, 12.3 percentage points; 95% CI, 8.7 to 15.8 percentage points; P < .001). Knowledge of potential fomite spread was lower among African American respondents (-9.4 percentage points; 95% CI, -13.1 to -5.7 percentage points; P < .001), Hispanic respondents (-4.8 percentage points; 95% CI, -8.9 to -0.77 percentage points; P = .02), and people younger than 30 years (-10.3 percentage points; 95% CI, -14.1 to -6.5 percentage points; P < .001). Similar gaps were found with respect to knowledge of COVID-19 symptoms and preventive behaviors. Conclusions and Relevance: In this survey study of US adults, there were gaps in reported incidence of COVID-19 and knowledge regarding its spread and symptoms and social distancing behavior. More effort is needed to increase accurate information and encourage appropriate behaviors among minority communities, men, and younger people.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/psicologia , Comportamentos de Risco à Saúde/fisiologia , Pneumonia Viral/epidemiologia , Pneumonia Viral/psicologia , Adulto , Afro-Americanos/psicologia , Afro-Americanos/estatística & dados numéricos , Idoso , Estudos de Casos e Controles , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/prevenção & controle , Cultura , Grupo com Ancestrais do Continente Europeu/psicologia , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Hispano-Americanos/psicologia , Hispano-Americanos/estatística & dados numéricos , Hospitalização/tendências , Humanos , Incidência , Renda/tendências , Conhecimento , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Pandemias/prevenção & controle , Pneumonia Viral/mortalidade , Pneumonia Viral/prevenção & controle , Prevalência , Inquéritos e Questionários , Estados Unidos/epidemiologia , Estados Unidos/etnologia
10.
Am J Clin Nutr ; 112(2): 257-267, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32469401

RESUMO

BACKGROUND: Concentrations of 25-hydroxyvitamin D [25(OH)D] tend to be lower in African Americans than in non-Hispanic whites, but whether adding information on parathyroid hormone (PTH) can help explain the higher cardiometabolic risk among African Americans is unknown. OBJECTIVES: This study examined race (black/white)-specific independent and joint associations of 25(OH)D and PTH with cardiometabolic biomarkers including high-sensitivity C-reactive protein (hs-CRP), estimated glomerular filtration rate (eGFR), and homeostasis model assessment of insulin resistance (HOMA-IR) and ß-cell function (HOMA-B). METHODS: Among 1500 white and 1300 black postmenopausal women without cardiovascular disease from the Women's Health Initiative Observational Study, a weighted linear regression analysis and a novel penalized spline-based semiparametric model with contour plots, accounting for possible nonlinear relations and interactions simultaneously, were used to investigate the race-specific independent and joint associations of 25(OH)D and PTH with each biomarker. RESULTS: Black women had lower concentrations of 25(OH)D and higher PTH, HOMA-IR, HOMA-B, hs-CRP, and eGFR than white women (all P values < 0.0001). Lower 25(OH)D and higher PTH were each independently and jointly associated with higher HOMA-IR in both white and black women, whereas a similar joint relation with HOMA-B was observed in white women only. In contrast, PTH was nonlinearly associated with HOMA-B in black women and positively associated with hs-CRP in white women, independently of 25(OH)D. Whereas there was an inverse linear relation between PTH and eGFR in white women after accounting for 25(OH)D, PTH and 25(OH)D were jointly and nonlinearly associated with eGFR in black women. CONCLUSIONS: We found that the joint association of 25(OH)D and PTH with ß-cell function, systemic inflammation, and kidney function apparently differed between white and black women. Further studies are needed to determine whether differences in the vitamin D-PTH endocrine system contribute to racial disparities in cardiovascular health.


Assuntos
Doenças Cardiovasculares/sangue , Hormônio Paratireóideo/sangue , Pós-Menopausa/sangue , Vitamina D/análogos & derivados , Afro-Americanos , Idoso , Biomarcadores/sangue , Proteína C-Reativa/metabolismo , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etnologia , Grupo com Ancestrais do Continente Europeu , Feminino , Humanos , Pessoa de Meia-Idade , Especificidade da Espécie , Estados Unidos/epidemiologia , Estados Unidos/etnologia , Vitamina D/sangue
11.
PLoS One ; 15(5): e0231782, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32369487

RESUMO

RATIONALE: Severe early-life respiratory illnesses, particularly those caused by respiratory syncytial virus (RSV) and human rhinovirus (HRV), are strongly associated with the development of asthma in children. Puerto Rican children in particular have a strikingly high asthma burden. However, prior studies of the potential associations between early-life respiratory illnesses and asthma in Puerto Rican and other minority populations have been limited. OBJECTIVES: We sought to determine whether early-life respiratory illness was associated with asthma in Puerto Rican, Mexican American, and African American children. METHODS: Using a logistic regression analysis, we examined the association between early-life respiratory illnesses (report of upper respiratory infection (URI), pneumonia, bronchitis, and bronchiolitis/RSV) within the first two years of life and physician-diagnosed asthma after the age of two in a large cohort of Puerto Rican, Mexican American, and African American children. MEASUREMENTS AND MAIN RESULTS: While early-life respiratory illnesses were associated with greater asthma odds in Puerto Ricans, Mexican Americans, and African Americans, these associations were stronger among Puerto Rican children. Specifically, in Puerto Ricans, the odds was 6.15 (95% CI: 4.21-9.05) if the child reported at least one of the following respiratory illness: URI, pneumonia, bronchitis or bronchiolitis. The odds were also higher in Puerto Ricans when considering these conditions separately. CONCLUSIONS: We observed population-specific associations between early-life respiratory illnesses and asthma, which were especially significant and stronger in Puerto Ricans. Taken together with the known high burden of RSV in Puerto Rico, our results may help explain the high burden of asthma in Puerto Ricans.


Assuntos
Afro-Americanos/estatística & dados numéricos , Asma/epidemiologia , Hispano-Americanos/estatística & dados numéricos , Americanos Mexicanos/estatística & dados numéricos , Infecções Respiratórias/epidemiologia , Adolescente , Asma/etiologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Modelos Logísticos , Masculino , Infecções Respiratórias/complicações , Infecções Respiratórias/virologia , Estados Unidos/etnologia , Adulto Jovem
12.
Am J Clin Nutr ; 112(1): 57-65, 2020 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-32469399

RESUMO

BACKGROUND: Genetic or pharmacological inhibition of de novo sphingolipid synthases prevented diabetes in animal studies. OBJECTIVES: We sought to evaluate prospective associations of serum sphingolipids with incident diabetes in a population-based cohort. METHODS: We included 2010 participants of the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) aged 18-74 y who were free of diabetes and other major chronic diseases at baseline (2008-2011). Metabolomic profiling of fasting serum was performed using a global, untargeted approach. A total of 43 sphingolipids were quantified and, considering subclasses and chemical structures of individual species, 6 sphingolipid scores were constructed. Diabetes status was assessed using standard procedures including blood tests. Multivariable survey Poisson regressions were applied to estimate RR and 95% CI of incident diabetes associated with individual sphingolipids or sphingolipid scores. RESULTS: There were 224 incident cases of diabetes identified during, on average, 6 y of follow-up. After adjustment for socioeconomic and lifestyle factors, a ceramide score (RR Q4 versus Q1 = 2.40; 95% CI: 1.24, 4.65; P-trend = 0.003) and a score of sphingomyelins with fully saturated sphingoid-fatty acid pairs (RR Q4 versus Q1 = 3.15; 95% CI: 1.75, 5.67; P-trend <0.001) both were positively associated with risk of diabetes, whereas scores of glycosylceramides, lactosylceramides, or other unsaturated sphingomyelins (even if having an SFA base) were not associated with risk of diabetes. After additional adjustment for numerous traditional risk factors (especially triglycerides), both associations were attenuated and only the saturated-sphingomyelin score remained associated with risk of diabetes (RR Q4 versus Q1 = 1.98; 95% CI: 1.09, 3.59; P-trend = 0.031). CONCLUSIONS: Our findings suggest that a cluster of saturated sphingomyelins may be associated with elevated risk of diabetes beyond traditional risk factors, which needs to be verified in other population studies. This study was registered at clinicaltrials.gov as NCT02060344.


Assuntos
Diabetes Mellitus/sangue , Diabetes Mellitus/etnologia , Esfingolipídeos/sangue , Adolescente , Adulto , Idoso , Diabetes Mellitus/epidemiologia , Feminino , Hispano-Americanos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Estados Unidos/epidemiologia , Estados Unidos/etnologia , Adulto Jovem
13.
Aggress Behav ; 46(4): 327-340, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32249458

RESUMO

We investigated whether bidirectional associations between parental warmth and behavioral control and child aggression and rule-breaking behavior emerged in 12 cultural groups. Study participants included 1,298 children (M = 8.29 years, standard deviation [SD] = 0.66, 51% girls) from Shanghai, China (n = 121); Medellín, Colombia (n = 108); Naples (n = 100) and Rome (n = 103), Italy; Zarqa, Jordan (n = 114); Kisumu, Kenya (n = 100); Manila, Philippines (n = 120); Trollhättan/Vänersborg, Sweden (n = 101); Chiang Mai, Thailand (n = 120); and Durham, NC, United States (n = 111 White, n = 103 Black, n = 97 Latino) followed over 5 years (i.e., ages 8-13). Warmth and control were measured using the Parental Acceptance-Rejection/Control Questionnaire, child aggression and rule-breaking were measured using the Achenbach System of Empirically-Based Assessment. Multiple-group structural equation modeling was conducted. Associations between parent warmth and subsequent rule-breaking behavior were found to be more common across ontogeny and demonstrate greater variability across different cultures than associations between warmth and subsequent aggressive behavior. In contrast, the evocative effects of child aggressive behavior on subsequent parent warmth and behavioral control were more common, especially before age 10, than those of rule-breaking behavior. Considering the type of externalizing behavior, developmental time point, and cultural context is essential to understanding how parenting and child behavior reciprocally affect one another.


Assuntos
Agressão , Comparação Transcultural , Relações Pais-Filho/etnologia , Poder Familiar/etnologia , Pais/psicologia , Adolescente , Adulto , Criança , China/etnologia , Colômbia/etnologia , Feminino , Humanos , Itália/etnologia , Jordânia/etnologia , Quênia/etnologia , Masculino , Poder Familiar/psicologia , Filipinas/etnologia , Inquéritos e Questionários , Suécia/etnologia , Tailândia/etnologia , Estados Unidos/etnologia
14.
JAMA Netw Open ; 3(4): e202950, 2020 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-32267515

RESUMO

Importance: Information about stage of cancer at diagnosis, use of therapy, and survival among patients from different racial/ethnic groups with 1 of the most common cancers is lacking. Objective: To assess stage of cancer at diagnosis, use of therapy, overall survival (OS), and cancer-specific survival (CSS) in patients with cancer from different racial/ethnic groups. Design, Setting, and Participants: This cohort study included 950 377 Asian, black, white, and Hispanic patients who were diagnosed with prostate, ovarian, breast, stomach, pancreatic, lung, liver, esophageal, or colorectal cancers from January 2004 to December 2010. Data were collected using the Surveillance, Epidemiology, and End Results (SEER) database, and patients were observed for more than 5 years. Data analysis was conducted in July 2018. Main Outcomes and Measures: Multivariable logistic and Cox regression were used to evaluate the differences in stage of cancer at diagnosis, treatment, and survival among patients from different racial/ethnic groups. Results: A total of 950 377 patients (499 070 [52.5%] men) were included in the study, with 681 251 white patients (71.7%; mean [SD] age, 65 [12] years), 116 015 black patients (12.2%; mean [SD] age, 62 [12] years), 65 718 Asian patients (6.9%; mean [SD] age, 63 [13] years), and 87 393 Hispanic patients (9.2%; mean [SD] age, 61 [13] years). Compared with Asian patients, black patients were more likely to have metastatic disease at diagnosis (odds ratio [OR], 1.144; 95% CI, 1.109-1.180; P < .001). Black and Hispanic patients were less likely to receive definitive treatment than Asian patients (black: adjusted OR, 0.630; 95% CI, 0.609-0.653; P < .001; Hispanic: adjusted OR, 0.751; 95% CI, 0.724-0.780; P < .001). White, black, and Hispanic patients were more likely to have poorer CSS and OS than Asian patients (CSS, white: adjusted HR, 1.310; 95% CI, 1.283-1.338; P < .001; black: adjusted HR, 1.645; 95% CI, 1.605-1.685; P < .001; Hispanic: adjusted HR, 1.300; 95% CI, 1.266-1.334; P < .001; OS, white: adjusted HR, 1.333; 95% CI, 1.310-1.357; P < .001; black: adjusted HR, 1.754; 95% CI, 1.719-1.789; P < .001; Hispanic: adjusted HR, 1.279; 95% CI, 1.269-1.326; P < .001). Conclusions and Relevance: In this study of patients with 1 of 9 leading cancers, stage at diagnosis, treatment, and survival were different by race and ethnicity. These findings may help to optimize treatment and improve outcomes.


Assuntos
Afro-Americanos/estatística & dados numéricos , Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , Grupos Étnicos/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Hispano-Americanos/estatística & dados numéricos , Neoplasias/etnologia , Neoplasias/mortalidade , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Diagnóstico Precoce , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias/estatística & dados numéricos , Razão de Chances , Fatores Raciais , Estados Unidos/etnologia
15.
Am J Clin Nutr ; 112(1): 180-186, 2020 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-32297956

RESUMO

BACKGROUND: The optimal macronutrient composition of the diet is controversial and many adults attempt to regulate the intake of specific macronutrients for various health-related reasons. OBJECTIVE: The objective was to compare stability and ranges of intakes of different macronutrients across diverse adult populations in the USA and globally. METHODS: US dietary intake data from NHANES 2009-2014 were used to determine macronutrient intake as a percentage of total energy intake. Variability in macronutrient intake was estimated by calculating the difference between 75th and 25th percentile (Q3-Q1) IQRs of macronutrient intake distributions. In addition, intake data from 13 other countries with per capita gross domestic product (GDP) over $10,000 US dollars (USD) were used to assess variability of intake internationally since there are large differences in types of foods consumed in different countries. RESULTS: Protein, carbohydrate, and fat intake (NHANES 2009-2014) was 15.7 ± 0.1, 48.1 ± 0.1, and 32.9 ± 0.1% kcal, respectively, in US adults. The IQR of protein intake distribution (3.73 ± 0.11% kcal) was 41% of carbohydrate intake distribution (9.18 ± 0.20% kcal) and 58% of fat intake distribution (6.40 ± 0.14% kcal). The IQRs of carbohydrate and fat intake distributions were significantly (P <0.01) influenced by age and race; however, the IQR of protein intake was not associated with demographic and lifestyle factors including sex, race, income, physical activity, and body weight. International mean protein intake was 16.3 ± 0.2% kcal, similar to US intake, and there was less variation in protein than carbohydrate or fat intake. CONCLUSION: Protein intake of the US population and multiple international populations, regardless of demographic and lifestyle factors, was consistently ∼16% of total energy, suggesting biological control mechanism(s) tightly regulate protein intake and, consequently, influence intake of other macronutrients and food constituents. Substantial differences in intake of the other macronutrients observed in US and international populations had little influence on protein intake. This trial was registered at the ISRCTN registry as ISRCTN46157745 (https://www.isrctn.com/ISRCTN4615774).


Assuntos
Carboidratos da Dieta/metabolismo , Proteínas na Dieta/metabolismo , Adulto , Idoso , Peso Corporal , Demografia , Dieta/etnologia , Dieta/estatística & dados numéricos , Ingestão de Energia/etnologia , Exercício Físico , Feminino , Humanos , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Nutrientes/metabolismo , Inquéritos Nutricionais , Estados Unidos/etnologia , Adulto Jovem
16.
JAMA Netw Open ; 3(4): e201997, 2020 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-32239220

RESUMO

Importance: One factor associated with the rapidly increasing clinical and economic burden of chronic liver disease (CLD) is inpatient health care utilization. Objective: To understand trends in the hospitalization burden of CLD in the US. Design, Setting, and Participants: This cross-sectional study of hospitalized adults in the US used data from the National Inpatient Sample from 2012 to 2016 on adult CLD-related hospitalizations. Data were analyzed from June to October 2019. Main Outcomes and Measures: Hospitalizations identified using a comprehensive review of CLD-specific International Classification of Diseases, Ninth Revision, Clinical Modification and International Statistical Classification of Diseases, Tenth Revision, Clinical Modification codes. Survey-weighted annual trends in national estimates of CLD-related hospitalizations, in-hospital mortality, and hospitalization costs, stratified by demographic and clinical characteristics. Results: This study included 1 016 743 CLD-related hospitalizations (mean [SD] patient age, 57.4 [14.4] years; 582 197 [57.3%] male; 633 082 [62.3%] white). From 2012 to 2016, the rate of CLD-related hospitalizations per 100 000 hospitalizations increased from 3056 (95% CI, 3042-3069) to 3757 (95% CI, 3742-3772), and total inpatient hospitalization costs increased from $14.9 billion (95% CI, $13.9 billion to $15.9 billion) to $18.8 billion (95% CI, $17.6 billion to $20.0 billion). Mean (SD) patient age increased (56.8 [14.2] years in 2012 to 57.8 [14.6] years in 2016) and, subsequently, the proportion with Medicare also increased (41.7% [95% CI, 41.1%-42.2%] to 43.6% [95% CI, 43.1%-44.1%]) (P for trend < .001 for both). The proportion of hospitalizations of patients with hepatitis C virus was similar throughout the period of study (31.6% [95% CI, 31.3%-31.9%]), and the proportion with alcoholic cirrhosis and nonalcoholic fatty liver disease showed increases. The mortality rate was higher among hospitalizations with alcoholic cirrhosis (11.9% [95% CI, 11.7%-12.0%]) compared with other etiologies. Presence of hepatocellular carcinoma was also associated with a high mortality rate (9.8% [95% CI, 9.5%-10.1%]). Cost burden increased across all etiologies, with a higher total cost burden among hospitalizations with alcoholic cirrhosis ($22.7 billion [95% CI, $22.1 billion to $23.2 billion]) or hepatitis C virus ($22.6 billion [95% CI, $22.1 billion to $23.2 billion]). Presence of cirrhosis, complications of cirrhosis, and comorbidities added to the CLD burden. Conclusions and Relevance: Over the study period, the total estimated national hospitalization costs in patients with CLD reached $81.1 billion. The inpatient CLD burden in the US is likely increasing because of an aging CLD population with increases in concomitant comorbid conditions.


Assuntos
Carga Global da Doença/economia , Hospitalização/economia , Hepatopatias/economia , Hepatopatias/epidemiologia , Adulto , Idoso , Carcinoma Hepatocelular/economia , Carcinoma Hepatocelular/epidemiologia , Carcinoma Hepatocelular/mortalidade , Doença Crônica , Comorbidade , Estudos Transversais , Feminino , Carga Global da Doença/tendências , Hepatite C/economia , Hepatite C/epidemiologia , Custos Hospitalares/tendências , Mortalidade Hospitalar/tendências , Hospitalização/tendências , Humanos , Cirrose Hepática Alcoólica/economia , Cirrose Hepática Alcoólica/epidemiologia , Cirrose Hepática Alcoólica/mortalidade , Hepatopatias/mortalidade , Neoplasias Hepáticas/patologia , Masculino , Medicare/economia , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/economia , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Avaliação de Resultados em Cuidados de Saúde , Estados Unidos/epidemiologia , Estados Unidos/etnologia
17.
Ann Emerg Med ; 75(6): 691-703, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32200999

RESUMO

STUDY OBJECTIVE: Brief, easily administered, and valid health literacy assessment tools are needed to optimize health care delivery in the emergency medicine setting. Three health literacy screening items have been proposed to assess health literacy in outpatient settings. We investigated their ability to identify English- and Spanish-speaking adult emergency department (ED) patients with lower health literacy. METHODS: Participants were Spanish- or English-speaking adult patients randomly selected from 4 geographically spread, US, urban, safety-net EDs. Participants completed the 3 health literacy screening items, as well as the Short Assessment of Health Literacy-Spanish and English (SAHL-S&E). Test performance characteristics, including receiver operating characteristics area under the curve, of the 3 health literacy screening items were estimated, as compared with the SAHL-S&E. RESULTS: According to the SAHL-S&E, 36% of the 1,165 English speakers and 35% of the 1,605 Spanish speakers had lower health literacy. Areas under the curve for each health literacy screening item individually were: needing others to help read materials (English 0.59, 95% confidence interval [CI] 0.56 to 0.62; Spanish 0.58, 95% CI 0.56 to 0.61), problems learning because of difficulty reading (English 0.63, 95% CI 0.60 to 0.66; Spanish 0.59, 95% CI 0.56 to 0.62), and confidence with completing forms (English 0.62, 95% CI 0.59 to 0.65; Spanish 0.60, 95% CI 0.57 to 0.63). Areas under the curve for the 3 screening items combined were: English 0.66 (95% CI 0.63 to 0.70) and Spanish 0.62 (95% CI 0.59 to 0.64). CONCLUSION: The 3 health literacy screening items performed poorly in identifying adult ED patients with lower health literacy. Higher-validity screening measures are needed to better serve the health care needs of this vulnerable population in the ED setting.


Assuntos
Serviço Hospitalar de Emergência/organização & administração , Letramento em Saúde/estatística & dados numéricos , Hispano-Americanos/estatística & dados numéricos , Programas de Rastreamento/normas , Desempenho Acadêmico , Adulto , Assistência à Saúde/organização & administração , Serviço Hospitalar de Emergência/tendências , Feminino , Letramento em Saúde/tendências , Necessidades e Demandas de Serviços de Saúde/normas , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Hispano-Americanos/educação , Humanos , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Inquéritos e Questionários , Estados Unidos/epidemiologia , Estados Unidos/etnologia
18.
J Cross Cult Gerontol ; 35(2): 217-234, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32112183

RESUMO

Family members provide the majority of caregiving to individuals living with Alzheimer's disease (AD) and related dementias. Asian American families are disproportionately impacted by the burden of caregiving due to limited knowledge about the disease in this community. This study explored how Vietnamese American caregivers understand AD and provide care to family members with AD. Twenty caregivers who have provided care to a family member with AD participated in a semi-structured qualitative interview. Data were analyzed using thematic analysis. Several themes were identified in the caregivers' understanding of AD: (a) "Now I know:" the disruptions, shocks and surprises leading up to the initial diagnosis; (b) The frustrations of managing family members' cognitive impairments; (c)"Going with the flow:" challenges in managing personality and behavioral changes; (d) The exhaustion of around-the-clock caregiving; (e)"Taking it day by day" in the face of progressively worsening symptoms. Underlining the participants' descriptions of AD was a shared understanding of the progressively worsening, complex and unpredictable nature of the disease that makes it challenging for family caregivers on a daily basis. Findings provide important implications for healthcare workers' outreach to Vietnamese American families to ease the caregiving experience through culturally-responsive education, thereby enhancing the families' ability to recognize the early symptoms and seek appropriate help.


Assuntos
Doença de Alzheimer/enfermagem , Americanos Asiáticos/psicologia , Cuidadores/psicologia , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Adaptação Psicológica , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Estresse Psicológico/etnologia , Estados Unidos/etnologia , Vietnã
19.
PLoS One ; 15(2): e0228336, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32053626

RESUMO

Non-Hispanic blacks have higher mortality rates than non-Hispanic whites whereas Hispanics have similar or lower mortality rates than non-Hispanic blacks and whites despite Hispanics' lower education and access to health insurance coverage. This study examines whether allostatic load, a proxy for cumulative biological risk, is associated with all-cause and cardiovascular (CVD)-specific mortality risks in US adults; and whether these associations vary with race/ethnicity and further with age, sex and education across racial/ethnic groups. Data from the third National Health and Nutritional Examination Survey (NHANES III, 1988-1994) and the 2015 Linked Mortality File were used for adults 25 years or older (n = 13,673 with 6,026 deaths). Cox proportional hazards regression was used to estimate the associations of allostatic load scores (2 and ≥3 relative to ≤1) with a) all-cause and b) CVD-specific mortality risk among NHANES III participants before and after controlling for selected characteristics. Allostatic load scores are associated with higher all-cause and CVD-specific mortality rates among U.S. adults aged 25 years or older, with stronger rates observed for CVD-specific mortality. All-cause mortality rates for each racial/ethnic group differed with age and education whereas for CVD-specific mortality rates, this difference was observed for sex. Our findings of high allostatic load scores associated with all-cause and CVD-specific mortality among US adults call attention to monitor conditions associated with the allostatic load's biomarkers to identify high-risk groups to help monitor social inequities in mortality risk, especially premature mortality.


Assuntos
Alostase , Doenças Cardiovasculares/etnologia , Doenças Cardiovasculares/mortalidade , Grupos de Populações Continentais/estatística & dados numéricos , Grupos Étnicos/estatística & dados numéricos , Disparidades em Assistência à Saúde/estatística & dados numéricos , Adulto , Idoso , Doenças Cardiovasculares/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Risco , Estados Unidos/epidemiologia , Estados Unidos/etnologia
20.
Environ Pollut ; 260: 114004, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32004963

RESUMO

The metabolic syndrome (MetS) is a group of diseases that tend to occur together, including diabetes, hypertension, central obesity, cardiovascular disease and hyperlipidemia. Exposure to persistent organic pollutants (POPs) such as polychlorinated biphenyls (PCBs) and organochlorine pesticides (OCPs) has been associated with increased risk of development of several of the components of the MetS. The goal of this study is to determine whether the associations with POPs are identical for each of the components and for the MetS. The subject population was 601 Native Americans (Akwesasne Mohawks) ages 18 to 84 who answered a questionnaire, were measured for height and weight and provided blood samples for clinical chemistries (serum lipids and fasting glucose) and analysis of 101 PCB congeners and three OCPs [dichlorodiphenyldichloroethylene (DDE), hexachlorobenzene (HCB) and mirex]. Associations between concentrations of total PCBs and pesticides, as well as various PCB congener groups with each of the different components of the MetS were determine so as to ask whether there were similar risk factors for all components of the MetS. After adjustment for other contaminants, diabetes and hypertension were strongly associated with lower chlorinated and mono-ortho PCBs, but not other PCB groups or pesticides. Obesity was most closely associated with highly chlorinated PCBs and was negatively associated with mirex. High serum lipids were most strongly associated with higher chlorinated PCBs and PCBs with multiple ortho-substituted chlorines, as well as total pesticides, DDE and HCB. Cardiovascular disease was not closely associated with levels of any of the measured POPs. While exposure to POPs is associated with increased risk of most of the various diseases comprising the MetS, the specific contaminants associated with risk of the component diseases are not the same.


Assuntos
Exposição Ambiental/estatística & dados numéricos , Poluentes Ambientais/sangue , Síndrome Metabólica/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Humanos , Hidrocarbonetos Clorados , Índios Norte-Americanos/estatística & dados numéricos , Pessoa de Meia-Idade , Praguicidas , Bifenilos Policlorados , Estados Unidos/etnologia , Adulto Jovem
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