Socioeconomic status as an independent predictor of physiological biomarkers of cardiovascular disease: Evidence from NHANES

Background C-reactive protein, homocysteine, cholesterol, and fibrinogen are known to vary by socioeconomic status (SES). Using a nationally representative study, we examined whether these factors vary independently of all other known risk factors, such as diet, exercise, and genetic predisposition. Methods We analyzed the 1999–2002 National Health Examination and Nutrition Survey using logistic regression models. Results We found that high-density lipoprotein cholesterol blood levels increase with income and educational attainment after controlling all known risk factors for elevated cholesterol (e.g., diet, exercise, and family history). Blood levels of C-reactive protein are inversely associated with income and education. Homocysteine blood levels are inversely associated with income even after controlling for blood folate level. A non-significant inverse relationship between homocysteine levels and educational attainment was also observed. Blood levels of low-density lipoprotein cholesterol and fibrinogen were not significantly associated with income or education. Conclusions Levels of “good” (high density lipoprotein) cholesterol increase with income and education even after controlling for factors known to place people at risk of high cholesterol. Stress differences by social class may play a role

The State of Evaluation Research on Food Policies to Reduce Obesity and Diabetes Among Adults in the United States, 2000–2011

Introduction Improvements in diet can prevent obesity and type 2 diabetes. Although policy changes provide a foundation for improvement at the population level, evidence for the effectiveness of such changes is slim. This study summarizes the literature on recent efforts in the United States to change food-related policies to prevent obesity and diabetes among adults. Methods We conducted a systematic review of evidence of the impact of food policies. Websites of government, academic, and nonprofit organizations were scanned to generate a typology of food-related policies, which we classified into 18 categories. A key-word search and a search of policy reports identified empirical evaluation studies of these categories. Analyses were limited to strategies with 10 or more reports. Of 422 articles identified, 94 met these criteria. Using publication date, study design, study quality, and dietary outcomes assessed, we evaluated the strength of evidence for each strategy in 3 assessment categories: time period, quality, and study design. Results Five strategies yielded 10 or more reports. Only 2 of the 5 strategies, menu labeling and taxes on unhealthy foods, had 50% or more studies with positive findings in at least 2 of 3 assessment categories. Most studies used methods that were rated medium quality. Although the number of published studies increased over 11 years, study quality did not show any clear trend nor did it vary by strategy. Conclusion Researchers and policy makers can improve the quality and rigor of policy evaluations to synthesize existing evidence and develop better methods for gleaning policy guidance from the ample but imperfect data available

Understanding COVID-19 Among People of Dominican Descent in the U.S.: A Comparison of New York, New Jersey, Florida, Massachusetts, Pennsylvania, Rhode Island and Connecticut

The present study “Understanding COVID-19 Among People of Dominican Descent in the U.S.: A Comparison of New York, New Jersey, Florida, Massachusetts, Pennsylvania, Rhode Island and Connecticut” is the first research study to examine the experience of people of Dominican origins residing in the United States (U.S.) amidst the pandemic caused by the SARS-CoV-2 virus. The current study is based on a probabilistic and representative sample of Dominicans across the seven states in which the majority—85%—of Dominicans living in the U.S. reside. The Dominican Studies Institute (CUNY-DSI) at City College and the School of Medicine, both of the City University of New York, conducted this study. These institutions brought together a team of researchers who worked on the design of the study and the parameters of the data analysis. The purpose of the study was twofold: First, to create knowledge on COVID-19 based on empirical evidence as it relates to the Dominican people and, second, to encourage the scientific community, particularly in the area of health, to study the effects of the pandemic on the different ethnic groups that make up the U.S

The complexities of measuring access to parks and physical activity sites in New York City: a quantitative and qualitative approach

<p>Abstract</p> <p>Background</p> <p>Proximity to parks and physical activity sites has been linked to an increase in active behaviors, and positive impacts on health outcomes such as lower rates of cardiovascular disease, diabetes, and obesity. Since populations with a low socio-economic status as well as racial and ethnic minorities tend to experience worse health outcomes in the USA, access to parks and physical activity sites may be an environmental justice issue. Geographic Information systems were used to conduct quantitative and qualitative analyses of park accessibility in New York City, which included kernel density estimation, ordinary least squares (global) regression, geographically weighted (local) regression, and longitudinal case studies, consisting of field work and archival research. Accessibility was measured by both density of park acreage and density of physical activity sites. Independent variables included percent non-Hispanic black, percent Hispanic, percent below poverty, percent of adults without high school diploma, percent with limited English-speaking ability, and population density.</p> <p>Results</p> <p>The ordinary least squares linear regression found weak relationships in both the park acreage density and the physical activity site density models (R_a²= .11 and .23, respectively; AIC = 7162 and 3529, respectively). Geographically weighted regression, however, suggested spatial non-stationarity in both models, indicating disparities in accessibility that vary over space with respect to magnitude and directionality of the relationships (AIC = 2014 and -1241, respectively). The qualitative analysis supported the findings of the local regression, confirming that although there is a geographically inequitable distribution of park space and physical activity sites, it is not globally predicted by race, ethnicity, or socio-economic status.</p> <p>Conclusion</p> <p>The combination of quantitative and qualitative analyses demonstrated the complexity of the issues around racial and ethnic disparities in park access. They revealed trends that may not have been otherwise detectable, such as the spatially inconsistent relationship between physical activity site density and socio-demographics. In order to establish a more stable global model, a number of additional factors, variables, and methods might be used to quantify park accessibility, such as network analysis of proximity, perception of accessibility and usability, and additional park quality characteristics. Accurate measurement of park accessibility can therefore be important in showing the links between opportunities for active behavior and beneficial health outcomes.</p

Expansion of Electronic Health Record-Based Screening, Prevention, and Management of Diabetes in New York City

To address the increasing burden of diabetes in New York City, we designed 2 electronic health records (EHRs)-facilitated diabetes management systems to be implemented in 6 primary care practices on the West Side of Manhattan, a standard system and an enhanced system. The standard system includes screening for diabetes. The enhanced system includes screening and ensures close patient follow-up; it applies principles of the chronic care model, including community–clinic linkages, to the management of patients newly diagnosed with diabetes and prediabetes through screening. We will stagger implementation of the enhanced system across the 6 clinics allowing comparison, through a quasi-experimental design (pre–post difference with a control group), of patients treated in the enhanced system with similar patients treated in the standard system. The findings could inform health system practices at multiple levels and influence the integration of community resources into routine diabetes care

Outcomes along the HIV continuum of care for Men who have Sex with Men in Haiti edit

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Loss to follow up among men who have sex with men and heterosexual men living with HIV in Haiti

Abstract Background Despite the benefits of adherence in HIV medication, health systems are struggling to keep all categories of patients in care due to loss to follow up (LTFU). Men who have sex with men (MSM) are at higher risk of HIV infection and also face several barriers to reach treatment, it is hypothesized that they may also have higher incidence of dropping-off. This study aims to determine whether MSM living with HIV have a greater risk of LTFU compared with heterosexual men and to identify the risk factors for the two groups. Methods A retrospective matched cohort study of electronic medical record data from 554 patients living with HIV and enrolled in care between 2015 and 2018 at a Port-au-Prince-based HIV clinic was performed. The 125 MSM and 429 heterosexual patients were matched on gender age and enrolment date. The primary outcome was LTFU defined as not refilling an ART prescription for a period of 90 days. MSM and heterosexual men was compared using t-tests and chi-square tests. The Kaplan-Meier technique was used to estimate time to LTFU after initiation of ART and the Cox Proportional Hazards regression model was used to determine predictors of LTFU. Results The sample had a mean age of 31.1 years (SD 8.0) for MSM and 32.4 years (SD 7.7) for heterosexual men. LTFU was significantly more common among the MSM group than the heterosexual group (MSM 48.8%, heterosexual men 34.7%; p = 0.012). Factors associated with LTFU were greater amongst younger patients, with lower educational and economic level. The median time to LTFU for MSM was 679 days and 1110 days for heterosexual men. The log rank test showed that this is statistically significant at p = 0.001. Conclusions This study showed that the risk of LTFU is significantly higher and the time to LTFU is significantly shorter for MSM relative to heterosexual men. Identifying predictors to LTFU in HIV clinical settings and providing appropriate services and supports are important steps in addressing this issue. Key messages Men who have sex with men continue to face barriers to effective HIV treatment in Haiti. Adapted interventions are needed to improve HIV care for Men who have sex with Men in Haiti.info:eu-repo/semantics/publishe

Income Inequality and Infant Mortality in New York City

A series of studies have demonstrated that people who live in regions where there are disparities in income have poorer average health status than people who live in more economically homogeneous regions. To test whether such disparities might explain health variations within urban areas, we examined the possible association between income inequality and infant mortality for zip code regions within New York City using data from the 1990 census and the New York City Department of Health. Both infant mortality and income inequality (percentage of income received by the poorest 50% of households) varied widely across these regions (range in infant mortality: 0.6-29.611,000 live births; range in income inequality: 12.7-27.3). An increase of one standard deviation in income inequality was associated with an increase of 0.80 deaths/1,000 live births (P < .001), controlling for other socioeconomic factors. This finding has important implications for public health practice and social epidemiological research in large urban areas, which face significant disparities both in health and in social and economic conditions