Intersectional Discrimination and Change in Blood Pressure Control among Older Adults: The Health and Retirement Study

BACKGROUND: Associations between multiple forms of discrimination and blood pressure control in older populations remain unestablished. METHODS: Participants were 14582 non-institutionalized individuals (59% women) in the Health and Retirement Study aged at least 51 years (76% Non-Hispanic White, 15% Non-Hispanic Black, 9% Hispanic/Latino). Primary exposures included the mean frequency of discrimination in everyday life, intersectional discrimination (defined as marginalization ascribed to more than one reason), and the sum of discrimination over the lifespan. We assessed whether discrimination was associated with change in measured hypertension status (N=14582) and concurrent medication use among reported hypertensives (N=9086) over four years (2008-2014). RESULTS: There was no association between the frequency of everyday discrimination and change in measured hypertension. Lifetime discrimination was associated with higher odds of hypertension four years later among men (OR: 1.21, 95% CI: 1.08, 1.36) but not women (OR: 0.98, 95% CI: 0.86, 1.13). Only among men, everyday discrimination due at least two reasons was associated with a 1.44 (95% CI: 1.03, 2.01)-fold odds of hypertension than reporting no everyday discrimination; reporting intersectional discrimination was not associated with developing hypertension among women (OR: 0.91, 95% CI: 0.70, 1.20). All three discriminatory measures were inversely related to time-averaged antihypertensive medication use, without apparent gender differences (e.g., OR for everyday discrimination-antihypertensive use associations: 0.85, 95% CI: 0.77, 0.94)). CONCLUSIONS: Gender differences in marginalization may more acutely elevate hypertensive risk among older men than similarly aged women. Experiences of discrimination appear to decrease the likelihood of antihypertensive medication use among older adults overall

Neighborhood Characteristics and Elevated Blood Pressure in Older Adults

IMPORTANCE: The local environment remains an understudied contributor to elevated blood pressure among older adults. Untargeted approaches can identify neighborhood conditions interrelated with racial segregation that drive hypertension disparities. OBJECTIVE: To evaluate independent associations of sociodemographic, economic, and housing neighborhood factors with elevated blood pressure. DESIGN, SETTING, AND PARTICIPANTS: In this cohort study, the sample included Health and Retirement Study participants who had between 1 and 3 sets of biennial sphygmomanometer readings from 2006 to 2014 or 2008 to 2016. Statistical analyses were conducted from February 5 to November 30, 2021. EXPOSURES: Fifty-one standardized American Community Survey census tract variables (2005-2009). MAIN OUTCOMES AND MEASURES: Elevated sphygmomanometer readings over the study period (6-year period prevalence): a value of at least 140 mm Hg for systolic blood pressure and/or at least 90 mm Hg for diastolic blood pressure. Participants were divided 50:50 into training and test data sets. Generalized estimating equations were used to summarize multivariable associations between each neighborhood variable and the period prevalence of elevated blood pressure, adjusting for individual-level covariates. Any neighborhood factor associated (Simes-adjusted for multiple comparisons P ≤ .05) with elevated blood pressure in the training data set was rerun in the test data set to gauge model performance. Lastly, in the full cohort, race- and ethnicity-stratified associations were evaluated for each identified neighborhood factor on the likelihood of elevated blood pressure. RESULTS: Of 12 946 participants, 4565 (35%) had elevated sphygmomanometer readings (median [IQR] age, 68 [63-73] years; 2283 [50%] male; 228 [5%] Hispanic or Latino, 502 [11%] non-Hispanic Black, and 3761 [82%] non-Hispanic White). Between 2006 and 2016, a lower likelihood of elevated blood pressure was observed (relative risk for highest vs lowest tertile, 0.91; 95% CI, 0.86-0.96) among participants residing in a neighborhood with recent (post-1999) in-migration of homeowners. This association was precise among participants with non-Hispanic White and other race and ethnicity (relative risk, 0.91; 95% CI, 0.85-0.97) but not non-Hispanic Black participants (relative risk, 0.97; 95% CI, 0.85-1.11; P = .48 for interaction) or Hispanic or Latino participants (relative risk, 0.84; 95% CI, 0.65-1.09; P = .78 for interaction). CONCLUSIONS AND RELEVANCE: In this cohort study of older adults, recent relocation of homeowners to a neighborhood was robustly associated with reduced likelihood of elevated blood pressure among White participants but not their racially and ethnically marginalized counterparts. Our findings indicate that gentrification may influence later-life blood pressure control

Swine acute diarrhea syndrome coronavirus replication in primary human cells reveals potential susceptibility to infection

Zoonotic coronaviruses represent an ongoing threat, yet the myriads of circulating animal viruses complicate the identification of higher-risk isolates that threaten human health. Swine acute diarrhea syndrome coronavirus (SADS-CoV) is a newly discovered, highly pathogenic virus that likely evolved from closely related HKU2 bat coronaviruses, circulating in Rhinolophus spp. bats in China and elsewhere. As coronaviruses cause severe economic losses in the pork industry and swine are key intermediate hosts of human disease outbreaks, we synthetically resurrected a recombinant virus (rSADS-CoV) as well as a derivative encoding tomato red fluorescent protein (tRFP) in place of ORF3. rSADS-CoV replicated efficiently in a variety of continuous animal and primate cell lines, including human liver and rectal carcinoma cell lines. Of concern, rSADS-CoV also replicated efficiently in several different primary human lung cell types, as well as primary human intestinal cells. rSADS-CoV did not use human coronavirus ACE-2, DPP4, or CD13 receptors for docking and entry. Contemporary human donor sera neutralized the group I human coronavirus NL63, but not rSADS-CoV, suggesting limited human group I coronavirus cross protective herd immunity. Importantly, remdesivir, a broad-spectrum nucleoside analog that is effective against other group 1 and 2 coronaviruses, efficiently blocked rSADS-CoV replication in vitro. rSADS-CoV demonstrated little, if any, replicative capacity in either immune-competent or immunodeficient mice, indicating a critical need for improved animal models. Efficient growth in primary human lung and intestinal cells implicate SADS-CoV as a potential higher-risk emerging coronavirus pathogen that could negatively impact the global economy and human health

Risk and Cooperation: Managing Hazardous Fuel in Mixed Ownership Landscapes

Managing natural processes at the landscape scale to promote forest health is important, especially in the case of wildfire, where the ability of a landowner to protect his or her individual parcel is constrained by conditions on neighboring ownerships. However, management at a landscape scale is also challenging because it requires cooperation on plans and actions that cross ownership boundaries. Cooperation depends on people’s beliefs and norms about reciprocity and perceptions of the risks and benefits of interacting with others. Using logistic regression tests on mail survey data and qualitative analysis of interviews with landowners, we examined the relationship between perceived wildfire risk and cooperation in the management of hazardous fuel by nonindustrial private forest (NIPF) owners in fire-prone landscapes of eastern Oregon. We found that NIPF owners who perceived a risk of wildfire to their properties, and perceived that conditions on nearby public forestlands contributed to this risk, were more likely to have cooperated with public agencies in the past to reduce fire risk than owners who did not perceive a risk of wildfire to their properties. Wildfire risk perception was not associated with past cooperation among NIPF owners. The greater social barriers to private–private cooperation than to private–public cooperation, and perceptions of more hazardous conditions on public compared with private forestlands may explain this difference. Owners expressed a strong willingness to cooperate with others in future cross-boundary efforts to reduce fire risk, however. We explore barriers to cooperative forest management across ownerships, and identify models of cooperation that hold potential for future collective action to reduce wildfire risk

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Intersectional Discrimination and Change in Blood Pressure Control among Older Adults: The Health and Retirement Study

Background: The association of intersectional discrimination (e.g., ageism in conjunction with classism) and blood pressure control in diverse older populations remains unestablished. Methods: Participants were 14582 non-institutionalized individuals (59% women) in the Health and Retirement Study aged at least 51 years at baseline (76% Non-Hispanic White, 15% Non-Hispanic Black, 9% Hispanic/Latinx). Discrimination measures included the mean frequency of discrimination in everyday life, intersectional discrimination (defined as ascribing everyday discrimination to more than one reason), and the sum of discrimination over the lifespan. We assessed whether discrimination was independently associated with change in measured hypertension status (N=14582) and concurrent medication use among reported hypertensives (N=9086) over a four-year period (2008-2014). Results: There was no association between the frequency of everyday discrimination and change in measured hypertension in men or women. Lifetime discrimination was associated with a higher odds of hypertension four years later among men (OR: 1.21, 95% CI: 1.08, 1.36) but not women (OR: 1.00, 95% CI: 0.87, 1.15). Also among men, ascribing everyday discrimination to at least two reasons was associated with a 1.50 (95% CI: 1.07, 2.19)-fold odds of hypertension than reporting no everyday discrimination; intersectional discrimination was not associated with developing hypertension among women (OR: 0.96, 95% CI: 0.73, 1.26). All three discriminatory measures were associated with lower likelihood of reported antihypertensive medication use, without apparent gender differences. Conclusions: Experiences of lifetime as well as intersectional everyday discrimination may elevate hypertensive risk among older men, and decrease the likelihood of antihypertensive medication use among older adults overall

Perceived Discrimination and Hypertension: Contextual and Mediating Factors

Marginalized groups in the United States are often diagnosed with hypertension at younger ages, contributing to their excess burden of cardiovascular disease. These disparities in blood pressure control do not appear to be fully accounted for by individual risk factors, such as health behaviors or genetic differences. Experiences of discrimination are theorized to act as stressors, inducing a physiological response that over time dysregulates the cardiovascular system. Unequal access to institutions and services may also decrease the likelihood of adherence to antihypertensive medication regimens. Discrimination may adversely impact mental health outcomes, limit opportunities to engage in health-promoting behaviors, and prevent residence in health-promoting environments: established hypertension risk factors. Furthermore, simultaneous evaluation of structural inequity at local and regional levels can complement the study of personally mediated discrimination and hypertension among racial and ethnic minorities or people of lower socioeconomic status. The Health and Retirement Study (HRS) includes non institutionalized adults at least 51 years residing in the contiguous United States. Our sample (N=14582) contributed validated psychosocial questionnaires, clinical blood pressure measurements, sociodemographic covariates, and linkage to American Community Survey data; participants provided four years of follow-up data at two time points between 2008 and 2014. Our main exposures included 1) the frequency of microaggressions that comprise discrimination in daily life, 2) the number of reasons to which this everyday discrimination was ascribed, and 3) the sum of discrimination over the life course in key domains such as healthcare and housing. Our blood pressure control outcomes were 1) the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure criteria for high blood pressure and 2) reported antihypertensive use among those diagnosed by a doctor with hypertension (N=9098). In the first manuscript, we evaluated with logistic mixed modeling whether perceived discrimination was associated with impaired blood pressure control over four years. When we tested for gender differences, men ascribing discrimination to at least two reasons (OR: 1.44 (95% CI: 1.03, 2.01) or more experiences of discrimination over the life course (OR: 1.21, 95% CI: 1.08, 1.36) had higher odds of either developing hypertension or failing to return to a normotensive state. We also observed, via generalized estimating equations, that the time-averaged likelihood of antihypertensive use among participants reporting hypertension, was reduced for people reporting discrimination in either daily life or over the life course (e.g., OR for everyday discrimination-antihypertensive use associations: 0.85, 95% CI: 0.77, 0.94)). We refined the antihypertensive use finding in our second manuscript, implementing causal mediation analyses to explore the interactive and mediating roles of depressive symptoms, subjective social standing, or household wealth among hypertensive participants. Depressive symptoms appeared to mediate associations of lifetime discrimination and subsequent reduced likelihood of antihypertensive use (mediating OR: 95% CI: 0.98; 0.96, 1.00). In the final chapter, we used a machine learning approach known as elastic net regularization to comprehensively assess how area-level inequity informs associations between personally mediated discrimination and baseline hypertensive status. Out of the nearly 200 variables at the level of census tract, county, and state, state-level indicators of economic deprivation and isolation among older men were among the factors related to higher odds of hypertension after adjustment for individual variables including perceived discrimination. Meanwhile, this hypothesis-generating analysis indicates that factors related to the increased availability of vacant recent properties and the availability of public transit for the labor force were inversely associated with hypertension. Using the rich HRS data, I filled an evidence gap by assessing the heterogeneity of the role of discrimination in the population-level burden of hypertension amongst a racially and culturally diverse US study sample. My most striking findings included the gender differences in how intersectional discrimination and cumulative unequal treatment impair blood pressure control among aging men. Furthermore, the intermediate effect of depressive symptoms endorses the need for medication adherence interventions that cultivate mental health hygiene with among underserved populations. My simultaneous assessment of spatial inequity at multiple levels identified residence in resource-deprived states as a potential target for public policy. Innovating by pairing a social determinant of health framework with methodological rigor, I have contributed meaningfully to the evidence regarding inequity as a stressor deleterious to health

Perceived Discrimination and Trajectories of C-Reactive Protein: The Jackson Heart Study.

INTRODUCTION: Perceiving discriminatory treatment may contribute to systemic inflammation, a risk factor of cardiovascular pathophysiology. This study evaluated the association of self-reported discrimination with changes in high-sensitivity C-reactive protein and the mediating role of adiposity. METHODS: The sample included 5,145 African-Americans, aged 21-92 years, in the Jackson Heart Study. Everyday, lifetime, and burden from perceived discrimination comprised primary predictors in 3 sets of multivariable linear regression models of baseline (2000-2004) discrimination and natural logarithm of high-sensitivity C-reactive protein. Multivariable linear mixed models assessed mean changes in natural logarithm of high-sensitivity C-reactive protein over the study period (2000-2013). Mediation was quantified by percentage changes in estimates adjusted for BMI, waist circumference, and waist-to-height ratio. Multiple imputation addressed missingness in baseline covariates and in high-sensitivity C-reactive protein taken at all 3 study examinations. Analyses were conducted in 2018. RESULTS: In cross-sectional analyses, male participants in the middle and highest tertiles of lifetime discrimination had natural logarithm of high-sensitivity C-reactive protein levels that were 0.13 (95% CI= -0.24, -0.01) and 0.15 (95% CI= -0.27, -0.02) natural logarithm(mg/dL) lower than those in the lowest tertile. In longitudinal analyses, all participants reporting more frequent everyday discrimination had a 0.07 natural logarithm(mg/dL) greater increase in natural logarithm of high-sensitivity C-reactive protein per examination than those reporting none (95% CI=0.01, 0.12). A similar trend emerged for lifetime discrimination and changes in natural logarithm of high-sensitivity C-reactive protein (adjusted mean increase per visit: 0.04 natural logarithm[mg/dL], 95% CI=0.01, 0.08). Adiposity did not mediate the longitudinal associations. CONCLUSIONS: Everyday and lifetime discrimination were associated with significant high-sensitivity C-reactive protein increases over 13 years. The physiologic response to discrimination may lead to systemic inflammation

Recovery From Mobility Limitation in Middle-Aged African Americans: The Jackson Heart Study.

BACKGROUND: Despite evidence that African Americans shoulder a high burden of mobility limitation, little is known about factors associated with recovery. METHOD: Participants from the Jackson Heart Study underwent 3 in-person exams from 2000 to 2013. Mobility limitations were assessed over this period by self-reported limitations in walking half a mile or climbing stairs during annual phone calls. The outcome of interest, recovery from mobility limitation, was defined as no mobility limitation the year following an incident event. Candidate predictor variables were assessed in logistic regression models, including sociodemographic, psychosocial, and health measures. Inverse probability weights were used to address missing data in the outcome. RESULTS: Among 4526 participants (mean [SD] age = 54.5 (12.8) years) without a mobility limitation at baseline, 1445 (32%) had an incident mobility limitation over 12 years of follow-up, and 709 (49%) reported recovery from mobility limitation by 1 year later. Low income and daily discrimination were associated with a lower likelihood of recovery even after adjustment for covariates. In adjusted models, greater comorbidity was associated with a lower likelihood of recovering (p-value for trend = .05). History of heart failure and cancer were associated with a lower likelihood of recovering from mobility limitation (OR: 0.52, 95% CI: 0.29, 0.94 and OR: 0.74, 95% CI: 0.55, 1.00). Adiposity, smoking status, and physical activity were not associated with recovery from mobility limitation. CONCLUSION: Half of incident mobility limitations in this population of middle-aged African Americans were transient. Adverse sociodemographic factors and comorbidities were associated with lower likelihood of recovery

Neighborhood factors and survival to old age: The Jackson Heart Study.

Few studies have evaluated environmental factors that predict survival to old age. Our study included 913 African American participants in the Jackson Heart Study (JHS) who resided in the tri-county area of the Jackson, MS metropolitan area and were 65-80 years at baseline. Participants were followed from 2000 through 2019 for the outcome of survival to 85 years old. We evaluated each of the following census tract-level measures of the social/physical environment as exposures: socioeconomic status, cohesion, violence, disorder, healthy food stores, residential land use, and walkability. We assessed mediation by physical activity and chronic conditions. As a complementary ecologic analysis, we used census-tract data to examine factors associated with a greater life expectancy. A total of 501 (55%) JHS participants survived to age 85 years or older. Higher social cohesion and greater residential land use were modestly associated with survival to old age (risk difference = 25%, 95% CI: 0-49%; and 4%, 95% CI: 1-7%, respectively). These neighborhood effects were modestly mediated through leisure time physical activity; additionally, social cohesion was mediated through home and yard activity. In our ecologic analysis, a greater percentage of homeowners and a greater proportion of people living in partnered families were associated with higher census-tract level life expectancy. African American older adults living in residential neighborhoods or neighborhoods with high social cohesion were more likely to survive to old age