{"title":"The beacon of hope program: Co-creating effective, measurable solutions for health equity","authors":"Priscilla Pemu , Celia Maxwell , Rajbir Singh , Jaydutt Vadgama , Shahanaz Arjumand , Linda Armstrong","doi":"10.1016/j.jnma.2024.09.002","DOIUrl":"10.1016/j.jnma.2024.09.002","url":null,"abstract":"","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"116 5","pages":"Pages 566-568"},"PeriodicalIF":2.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142485017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.jnma.2024.09.004
Amie A. Ogunsakin , Tomilola I. Olakunde , Moses D. Fehintola , Ifeoluwa Malmberg , Akinwale Olakunde , Ayotunde O. Dokun
Obesity is now recognized as a chronic, progressive condition requiring early intervention and long-term management to achieve health benefits and improve metabolic risk factors. The main objective of obesity pharmacotherapy is weight loss and weight loss maintenance. There is increasing acceptance of anti-obesity medications as an adjunct to lifestyle modifications and/or surgery. In recent years there has been an evolution in management approach and pharmacologic options for treatment. As a result, there is increased focus on the efficacy and safety of these agents. We provide a historical perspective, review of recent studies on anti-obesity medication outcomes showing efficacy, potential side effects and promising therapies in development.
{"title":"Updates in pharmacotherapy of obesity","authors":"Amie A. Ogunsakin , Tomilola I. Olakunde , Moses D. Fehintola , Ifeoluwa Malmberg , Akinwale Olakunde , Ayotunde O. Dokun","doi":"10.1016/j.jnma.2024.09.004","DOIUrl":"10.1016/j.jnma.2024.09.004","url":null,"abstract":"<div><div>Obesity is now recognized as a chronic, progressive condition requiring early intervention and long-term management to achieve health benefits and improve metabolic risk factors. The main objective of obesity pharmacotherapy is weight loss and weight loss maintenance. There is increasing acceptance of anti-obesity medications as an adjunct to lifestyle modifications and/or surgery. In recent years there has been an evolution in management approach and pharmacologic options for treatment. As a result, there is increased focus on the efficacy and safety of these agents. We provide a historical perspective, review of recent studies on anti-obesity medication outcomes showing efficacy, potential side effects and promising therapies in development.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"116 5","pages":"Pages 576-587"},"PeriodicalIF":2.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142549948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hypertension is the predominant risk factor for cardiovascular disease related morbidity and mortality among Black adults in the United States. It contributes significantly to the development of heart failure and increases the risk of death following heart failure diagnosis. It is also a leading predisposing factor for hypertensive disorders of pregnancy and peripartum cardiomyopathy in Black women. As such, all stakeholders including health care providers, particularly primary care clinicians (including physicians and advanced practice providers), patients, and communities must be aware of the consequences of uncontrolled hypertension among Black adults. Appropriate treatment strategies should be identified and implemented to ensure timely and effective blood pressure management among Black individuals, particularly those with, and at risk for heart failure.
{"title":"Managing hypertension in African Americans with heart failure: A guide for the primary care clinician","authors":"Bria Rice , Lydia Mbatidde , Oludamilola Oluleye , Anekwe Onwuanyi , Demilade Adedinsewo","doi":"10.1016/j.jnma.2023.11.004","DOIUrl":"10.1016/j.jnma.2023.11.004","url":null,"abstract":"<div><div>Hypertension is the predominant risk factor for cardiovascular disease related morbidity and mortality among Black adults in the United States. It contributes significantly to the development of heart failure and increases the risk of death following heart failure diagnosis. It is also a leading predisposing factor for hypertensive disorders of pregnancy and peripartum cardiomyopathy<span> in Black women. As such, all stakeholders including health care providers, particularly primary care clinicians (including physicians and advanced practice providers), patients, and communities must be aware of the consequences of uncontrolled hypertension among Black adults. Appropriate treatment strategies should be identified and implemented to ensure timely and effective blood pressure management among Black individuals, particularly those with, and at risk for heart failure.</span></div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"116 5","pages":"Pages 477-489"},"PeriodicalIF":2.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138505058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.jnma.2024.10.004
Marie L. Borum MD, EdD, MPH, MACP, FACG, AGAF, FRCP (Editor-In-Chief, Journal of the National Medical Association)
{"title":"Special Issue on Cardiovascular Health in African-Americans and More","authors":"Marie L. Borum MD, EdD, MPH, MACP, FACG, AGAF, FRCP (Editor-In-Chief, Journal of the National Medical Association)","doi":"10.1016/j.jnma.2024.10.004","DOIUrl":"10.1016/j.jnma.2024.10.004","url":null,"abstract":"","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"116 5","pages":"Page 465"},"PeriodicalIF":2.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142690269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.jnma.2023.11.008
JaNae’ Richard , Jacob Sama , Anekwe Onwuanyi , Onyedika J. Ilonze
Black patients develop heart failure at younger ages and have worse outcomes such as higher mortality rates compared to other racial and ethnic groups in the United States. Despite significant recent improvements in heart failure medical therapy, these worse outcomes have persisted. Multiple reasons have been provided to explain the situation, including but not limited to higher baseline cluster of cardiovascular risk factors amongst Black patients, inadequate use of heart failure guideline directed medical therapy and delayed referral for advanced heart failure therapies and interventions. Strategic interventions considering social and structural determinants of health, addressing structural inequalities/ bias, implementation of quality improvement programs, early diagnosis and prevention are critically needed to bridge the racial/ ethnic disparities gap and improve longevity of Black patients with heart failure. In this review, we propose evidence-based solutions that provide a framework for the primary care physician addressing these challenges to engender equity in treatment allocation and improve outcomes for all patients with heart failure.
{"title":"Top five considerations for improving outcomes in black patients with heart failure: A guide for primary care clinicians","authors":"JaNae’ Richard , Jacob Sama , Anekwe Onwuanyi , Onyedika J. Ilonze","doi":"10.1016/j.jnma.2023.11.008","DOIUrl":"10.1016/j.jnma.2023.11.008","url":null,"abstract":"<div><div>Black patients develop heart failure at younger ages and have worse outcomes such as higher mortality rates compared to other racial and ethnic groups in the United States. Despite significant recent improvements in heart failure medical therapy, these worse outcomes have persisted. Multiple reasons have been provided to explain the situation, including but not limited to higher baseline cluster of cardiovascular risk factors amongst Black patients, inadequate use of heart failure guideline directed medical therapy and delayed referral for advanced heart failure therapies and interventions. Strategic interventions considering social and structural determinants of health, addressing structural inequalities/ bias, implementation of quality improvement programs, early diagnosis and prevention are critically needed to bridge the racial/ ethnic disparities gap and improve longevity of Black patients with heart failure. In this review, we propose evidence-based solutions that provide a framework for the primary care physician addressing these challenges to engender equity in treatment allocation and improve outcomes for all patients with heart failure.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"116 5","pages":"Pages 499-507"},"PeriodicalIF":2.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138541409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.jnma.2023.11.007
Hakeem Ayinde , Favour Markson , Ugonna Kevin Ogbenna , Larry Jackson II
Atrial fibrillation (AF) is the most common sustained arrhythmia, affecting between 3 and 6 million people in the United States. It is associated with a reduced quality of life and increased risk of stroke, cognitive decline, heart failure and death. Black patients have a lower prevalence of AF than White patients but are more likely to suffer worse outcomes with the disease. It is important that stakeholders understand the disproportionate burden of disease and management gaps that exists among Black patients living with AF. Appropriate treatments, including aggressive risk factor control, early referral to cardiovascular specialists and improving healthcare access may bridge some of the gaps in management and improve outcomes.
{"title":"Addressing racial differences in the management of atrial fibrillation: Focus on black patients","authors":"Hakeem Ayinde , Favour Markson , Ugonna Kevin Ogbenna , Larry Jackson II","doi":"10.1016/j.jnma.2023.11.007","DOIUrl":"10.1016/j.jnma.2023.11.007","url":null,"abstract":"<div><div>Atrial fibrillation<span> (AF) is the most common sustained arrhythmia<span>, affecting between 3 and 6 million people in the United States. It is associated with a reduced quality of life and increased risk of stroke, cognitive decline, heart failure and death. Black patients have a lower prevalence of AF than White patients but are more likely to suffer worse outcomes with the disease. It is important that stakeholders understand the disproportionate burden of disease and management gaps that exists among Black patients living with AF. Appropriate treatments, including aggressive risk factor control, early referral to cardiovascular specialists and improving healthcare access may bridge some of the gaps in management and improve outcomes.</span></span></div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"116 5","pages":"Pages 490-498"},"PeriodicalIF":2.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138541445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.jnma.2024.10.011
{"title":"Leonidas H. Berry Health Equity Research Award - ACG Announcement","authors":"","doi":"10.1016/j.jnma.2024.10.011","DOIUrl":"10.1016/j.jnma.2024.10.011","url":null,"abstract":"","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"116 5","pages":"Pages 626-631"},"PeriodicalIF":2.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142697808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.jnma.2024.09.003
Milena Bastos Brito , Andrea Queiroz Vilas Boas , Anelise Maria Nicolau Silva , Flávia Pimentel Miranda , Carolina Brabec Barreto Matos , Oziemile Silva Santos , Tais Paiva da Costa
Background
Sickle cell disease is a hereditary hemolytic anemia that exposes women to increased health risks especially in pregnancy, with serious implications for the woman and fetus. Acute pain episodes can occur multiple times per month and result in reduction of quality of life and disruption of her life.
Objective
To assess the clinical, including pain and metabolic parameters of women with sickle cell disease using etonogestrel-releasing contraceptive implants.
Methods
Women with sickle cell disease, aged 18–40 years, with reports of pain crises in the preceding 3 months were included and followed up for 12 months. Blood samples were collected to evaluate the blood count, reticulocytes, liver profile (alkaline phosphatase, gamma-glutamyl transferase, alanine aminotransferase, aspartate aminotransferase, and total bilirubin and its fractions), lipid profile, and lactate dehydrogenase levels before and 6 and 12 months after implant insertion. The following clinical variables were analyzed every 3 months: bleeding pattern, blood pressure, weight, body mass index, pain intensity (assessed using a visual analogic scale (VAS) from 0 to 10), and frequency of pain crises.
Results
Twenty-three women completed the study. There were no differences in laboratory variables between baseline and 6 and 12 months after implant insertion. Similarly, clinical variables did not differ, except for pain intensity (VAS pre-insertion = 8 vs. VAS 12 months post insertion = 4; p = 0.005) and frequency of pain crises (pre-insertion = 6 vs. 12 days/month post insertion = 0; p = 0.000).
Conclusions
Etonogestrel-releasing contraceptive implants were associated with a reduction in the intensity and frequency of pain crises in women with sickle cell disease. Moreover, it was safety among these population due to no changes in laboratory parameters during the first 12 months of use.
{"title":"Impact of Etonogestrel-releasing contraceptive implant use in cisgender women with Sickle cell disease","authors":"Milena Bastos Brito , Andrea Queiroz Vilas Boas , Anelise Maria Nicolau Silva , Flávia Pimentel Miranda , Carolina Brabec Barreto Matos , Oziemile Silva Santos , Tais Paiva da Costa","doi":"10.1016/j.jnma.2024.09.003","DOIUrl":"10.1016/j.jnma.2024.09.003","url":null,"abstract":"<div><h3>Background</h3><div>Sickle cell disease is a hereditary hemolytic anemia that exposes women to increased health risks especially in pregnancy, with serious implications for the woman and fetus. Acute pain episodes can occur multiple times per month and result in reduction of quality of life and disruption of her life.</div></div><div><h3>Objective</h3><div>To assess the clinical, including pain and metabolic parameters of women with sickle cell disease using etonogestrel-releasing contraceptive implants.</div></div><div><h3>Methods</h3><div>Women with sickle cell disease, aged 18–40 years, with reports of pain crises in the preceding 3 months were included and followed up for 12 months. Blood samples were collected to evaluate the blood count, reticulocytes, liver profile (alkaline phosphatase, gamma-glutamyl transferase, alanine aminotransferase, aspartate aminotransferase, and total bilirubin and its fractions), lipid profile, and lactate dehydrogenase levels before and 6 and 12 months after implant insertion. The following clinical variables were analyzed every 3 months: bleeding pattern, blood pressure, weight, body mass index, pain intensity (assessed using a visual analogic scale (VAS) from 0 to 10), and frequency of pain crises.</div></div><div><h3>Results</h3><div>Twenty-three women completed the study. There were no differences in laboratory variables between baseline and 6 and 12 months after implant insertion. Similarly, clinical variables did not differ, except for pain intensity (VAS pre-insertion = 8 vs. VAS 12 months post insertion = 4; p = 0.005) and frequency of pain crises (pre-insertion = 6 vs. 12 days/month post insertion = 0; p = 0.000).</div></div><div><h3>Conclusions</h3><div>Etonogestrel-releasing contraceptive implants were associated with a reduction in the intensity and frequency of pain crises in women with sickle cell disease. Moreover, it was safety among these population due to no changes in laboratory parameters during the first 12 months of use.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"116 5","pages":"Pages 569-575"},"PeriodicalIF":2.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142485016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.jnma.2023.11.003
Ebubechukwu Ezeh , Onyedika Ilonze , Maddie Perdoncin , Archana Ramalingam , Gurleen Kaur , Bisher Mustafa , Samson Teka , Keith C. Ferdinand
Cardiovascular diseases remain the leading cause of death in the United States. Several studies have shown racial disparities in the cardiovascular outcomes. When compared to their Non-Hispanic White (NHW) counterparts, non-Hispanic Black (NHB) individuals have higher prevalence of cardiovascular risk factors and thus, increased mortality from atherosclerotic cardiovascular diseases. This is evidenced by lower scoring in the indices of the American Heart Association's Life Essential 8 among NHB individuals. NHB individuals score lower in blood pressure, blood lipids, nicotine exposure, sleep, physical activity level, glycemic control, weight, and diet when compared to NHW individuals. Measures to improve these indices at the primary care level may potentially hold the key in mitigating the health care disparities in cardiovascular health experienced by NHB individuals.
{"title":"Life's essential eight as targets for cardiometabolic risk reduction among non-Hispanic black adults: A primary care approach","authors":"Ebubechukwu Ezeh , Onyedika Ilonze , Maddie Perdoncin , Archana Ramalingam , Gurleen Kaur , Bisher Mustafa , Samson Teka , Keith C. Ferdinand","doi":"10.1016/j.jnma.2023.11.003","DOIUrl":"10.1016/j.jnma.2023.11.003","url":null,"abstract":"<div><div>Cardiovascular diseases remain the leading cause of death in the United States. Several studies have shown racial disparities in the cardiovascular outcomes. When compared to their Non-Hispanic White (NHW) counterparts, non-Hispanic Black (NHB) individuals have higher prevalence of cardiovascular risk factors and thus, increased mortality from atherosclerotic cardiovascular diseases. This is evidenced by lower scoring in the indices of the American Heart Association's Life Essential 8 among NHB individuals. NHB individuals score lower in blood pressure, blood lipids, nicotine exposure, sleep, physical activity level, glycemic control, weight, and diet when compared to NHW individuals. Measures to improve these indices at the primary care level may potentially hold the key in mitigating the health care disparities in cardiovascular health experienced by NHB individuals.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"116 5","pages":"Pages 468-476"},"PeriodicalIF":2.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138541418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.jnma.2024.07.115
Khawaja M. Talha , Eisha Waqar , Heather M. Johnson , Michael D. Shapiro , Vijay Nambi , Salim S. Virani , Anurag Mehta , Khurram Nasir , Michael E. Hall , Dmitry Abramov , Abdul Mannan Khan Minhas
Aim
To study the prevalence of cardiovascular disease (CVD) and associated risk factors among different races/ethnicities across different income groups.
Methods
This retrospective analysis included data from the National Health and Nutrition Examination Survey from 2005-2018. Adults >20 years who identified as non-Hispanic (NH) White, NH Black, or Hispanic were included. Family income-to-poverty ratio (PIR) was calculated by dividing family income by poverty guidelines specific to the survey year and divided into four quartiles. Weighted logistic regression was performed to estimate adjusted odds ratios to determine association of race/ethnicity and CVD in each PIR quartile. Models were adjusted for age, sex, race, health insurance, marital status, citizenship status, education level, and PIR.
Results
We included 31,884 adults that corresponded to ∼191.3 million weighted, nationally representative participants. Of these, 8,009, 7,967, 7,944, and 7,964 participants belonged to 1st, 2nd, 3rd, and 4th quartiles, respectively. The prevalence of diabetes mellitus (DM), hypertension, coronary artery disease (CAD), congestive heart failure (CHF), and stroke decreased with each successive PIR quartile. NH Black participants had higher prevalence odds of DM, hypertension, obesity, CHF, and stroke compared to NH White participants. The difference in prevalence odds between NH White adults and NH Black adults was greater for obesity (p-interaction=0.002), DM (p-interaction=0.027), and stroke (p-interaction=0.053) in the 4th PIR quartile (highest income) compared to the 1st PIR quartile (lowest income).
Conclusion
Racial and ethnic disparities in the risk of CVD persists across income levels, with a greater difference in prevalence of select CVD and risk factors between NH Black and NH White participants in the highest income quartile compared to the lowest income quartile.
研究不同收入群体中不同种族/族裔的心血管疾病（CVD）患病率及相关风险因素。这项回顾性分析包括 2005-2018 年国家健康与营养调查的数据。研究对象包括年龄大于 20 岁的非西班牙裔（NH）白人、NH 黑人或西班牙裔成年人。家庭收入与贫困比率（PIR）的计算方法是将家庭收入除以调查年份的贫困准则，并分为四个四分位数。采用加权逻辑回归法估算调整后的几率比，以确定每个 PIR 四分位数中种族/人种与心血管疾病的关系。模型根据年龄、性别、种族、医疗保险、婚姻状况、公民身份、教育水平和 PIR 进行了调整。我们纳入了 31,884 名成年人，相当于 1.913 亿名具有全国代表性的加权参与者。其中，8009 人、7967 人、7944 人和 7964 人分别属于 1、2、3 和 4 四分位数。糖尿病 (DM)、高血压、冠状动脉疾病 (CAD)、充血性心力衰竭 (CHF) 和中风的患病率随着 PIR 四分位数的增加而降低。与新罕布什尔州的白人参与者相比，新罕布什尔州的黑人参与者患糖尿病、高血压、肥胖症、冠心病和中风的几率更高。在肥胖症（p-交互作用=0.002）、糖尿病（p-交互作用=0.027）和中风（p-交互作用=0.053）方面，与 PIR 四分位数 1（收入最低）相比，PIR 四分位数 4（收入最高）的新罕布什尔州白人成人和新罕布什尔州黑人成人之间的患病几率差异更大。在不同收入水平的人群中，心血管疾病风险的种族和民族差异依然存在，与最低收入四分位数相比，最高收入四分位数的北卡罗来纳州黑人和北卡罗来纳州白人参与者在某些心血管疾病和风险因素的患病率上差异更大。
{"title":"Relationship between race, income-level, and Cardiovascular Disease","authors":"Khawaja M. Talha , Eisha Waqar , Heather M. Johnson , Michael D. Shapiro , Vijay Nambi , Salim S. Virani , Anurag Mehta , Khurram Nasir , Michael E. Hall , Dmitry Abramov , Abdul Mannan Khan Minhas","doi":"10.1016/j.jnma.2024.07.115","DOIUrl":"10.1016/j.jnma.2024.07.115","url":null,"abstract":"<div><h3>Aim</h3><div>To study the prevalence of cardiovascular disease (CVD) and associated risk factors among different races/ethnicities across different income groups.</div></div><div><h3>Methods</h3><div>This retrospective analysis included data from the National Health and Nutrition Examination Survey from 2005-2018. Adults >20 years who identified as non-Hispanic (NH) White, NH Black, or Hispanic were included. Family income-to-poverty ratio (PIR) was calculated by dividing family income by poverty guidelines specific to the survey year and divided into four quartiles. Weighted logistic regression was performed to estimate adjusted odds ratios to determine association of race/ethnicity and CVD in each PIR quartile. Models were adjusted for age, sex, race, health insurance, marital status, citizenship status, education level, and PIR.</div></div><div><h3>Results</h3><div>We included 31,884 adults that corresponded to ∼191.3 million weighted, nationally representative participants. Of these, 8,009, 7,967, 7,944, and 7,964 participants belonged to 1<sup>st</sup>, 2<sup>nd</sup>, 3<sup>rd</sup>, and 4<sup>th</sup> quartiles, respectively. The prevalence of diabetes mellitus (DM), hypertension, coronary artery disease (CAD), congestive heart failure (CHF), and stroke decreased with each successive PIR quartile. NH Black participants had higher prevalence odds of DM, hypertension, obesity, CHF, and stroke compared to NH White participants. The difference in prevalence odds between NH White adults and NH Black adults was greater for obesity (p-interaction=0.002), DM (p-interaction=0.027), and stroke (p-interaction=0.053) in the 4<sup>th</sup> PIR quartile (highest income) compared to the 1<sup>st</sup> PIR quartile (lowest income).</div></div><div><h3>Conclusion</h3><div>Racial and ethnic disparities in the risk of CVD persists across income levels, with a greater difference in prevalence of select CVD and risk factors between NH Black and NH White participants in the highest income quartile compared to the lowest income quartile.</div></div>","PeriodicalId":17369,"journal":{"name":"Journal of the National Medical Association","volume":"116 5","pages":"Pages 539-552"},"PeriodicalIF":2.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141940104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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