Suchergebnisse

OBJECTIVE: To assess recent trends in age adjusted mortality rates (AAMRs) in the United States based on county level presidential voting patterns. DESIGN: Cross sectional study. SETTING: USA, 2001-19. PARTICIPANTS: 99.8% of the US population. MAIN OUTCOME MEASURES: AAMR per 100 000 population and average annual percentage change (APC). METHODS: The Centers for Disease Control and Prevention WONDER database was linked to county level data on US presidential elections. County political environment was classified as either Democratic or Republican for the four years that followed a November presidential election. Additional sensitivity analyses analyzed AAMR trends for counties that voted only for one party throughout the study, and county level gubernatorial election results and state level AAMR trends. Joinpoint analysis was used to assess for an inflection point in APC trends. RESULTS: The study period covered five presidential elections from 2000 to 2019. From 2001 to 2019, the AAMR per 100 000 population decreased by 22% in Democratic counties, from 850.3 to 664.0 (average APC −1.4%, 95% confidence interval −1.5% to −1.2%), but by only 11% in Republican counties, from 867.0 to 771.1 (average APC −0.7%, −0.9% to −0.5%). The gap in AAMR between Democratic and Republican counties therefore widened from 16.7 (95% confidence interval 16.6 to 16.8) to 107.1 (106.5 to 107.7). Statistically significant inflection points in APC occurred for Democratic counties between periods 2001-09 (APC −2.1%, −2.3% to −1.9%) and 2009-19 (APC −0.8%, −1.0% to −0.6%). For Republican counties between 2001 and 2008 the APC was −1.4% (−1.8% to −1.0%), slowing to near zero between 2008 and 2019 (APC −0.2%, −0.4% to 0.0%). Male and female residents of Democratic counties experienced both lower AAMR and twice the relative decrease in AAMR than did those in Republican counties. Black Americans experienced largely similar improvement in AAMR in both Democratic and Republican counties. However, the AAMR gap between white residents in ...

Objective: To evaluate interest in coronary artery calcium (CAC) among the general public during the past 17 years and to compare trends with real-world data on number of CAC procedures performed. Methods: We used Google Trends, a publicly available database, to access search query data in a systematic and quantitative fashion to search for CAC-related key terms. Search terms included calcium test, heart score, calcium score, coronary calcium, and calcium test score. We accessed Google Trends in January 2021 and analyzed data from 2004 to 2020. Results: From 2004 to December 31, 2020, CAC-related search interest (in relative search volume) increased continually worldwide (+201.9%) and in the United States (+354.8%). Three main events strongly influenced search interest in CAC: reports of a CAC scan of the president of the United States led to a transient 10-fold increase in early January 2018. American College of Cardiology/American Heart Association guideline release led to a sustained increase, and lockdown after the global pandemic due to COVID-19 led to a transient decrease. Real-world data on performed CAC scans showed an increase between 2006 and 2017 (+200.0%); during the same time period, relative search volume for CAC-related search terms increased in a similar pattern (+70.6%-1511.1%). For the search term coronary calcium scan near me, a potential representative of active online search for CAC scanning, we found a +28.8% increase in 2020 compared with 2017. Conclusion: Google Trends, a valuable tool for assessing public interest in health-related topics, suggests increased overall interest in CAC during the last 17 years that mirrors real-world usage data. Increased interest is seemingly linked to reports of CAC testing in world leaders and endorsement in major guidelines.

National estimates describing the overall prevalence of and disparities in influenza vaccination among patients with diabetes mellitus (DM) in United States are not well described. Therefore, we analyzed the prevalence of influenza vaccination among adults with DM, overall and by sociodemographic characteristics, using the Medical Expenditure Panel Survey database from 2008 to 2016. Associations between sociodemographic factors and lack of vaccination were examined using adjusted logistic regression. Among adults with DM, 36% lacked influenza vaccination. Independent predictors of lacking influenza vaccination included age 18 to 39 years (odds ratio [OR] 2.54; 95% confidence interval [CI], 2.14-3.00), Black race/ethnicity (OR 1.29; 95% CI, 1.14-1.46), uninsured status (OR 1.88; 95% CI, 1.59-2.21), and no usual source of care (OR 1.61; 95% CI, 1.39-1.85). Nearly 64% individuals with ≥ 4 higher-risk sociodemographic characteristics lacked influenza vaccination (OR 3.50; 95% CI 2.79-4.39). One-third of adults with DM in the United States lack influenza vaccination, with younger age, Black race, and lower socioeconomic status serving as strong predictors. These findings highlight the continued need for focused public health interventions to increase vaccine coverage and utilization among disadvantaged communities.

Thoracic aortic calcium (TAC) has been associated with a higher prevalence of coronary arterial calcium (CAC). The purpose of this study was to assess the relationship between TAC with both incident CAC and CAC progression in a cohort from the Multi-Ethnic Study of Atherosclerosis (MESA). MESA is a prospective cohort study of 6,814 participants free of clinical cardiovascular disease at entry who underwent non-contrast cardiac computed tomography scanning at baseline examination and at a 2 year follow up. We investigated the independent association between TAC and incident CAC among those without CAC at baseline and between TAC and CAC progression among those with CAC at baseline. The final study population consisted of 5,755 (84%) individuals (62±10 years, 48% males) who had a follow up CAC score an average of 2.4 years later. Incident CAC was significantly higher among those with TAC versus without TAC at baseline (11 per 100 person years versus 6 per 100 person years). Similarly, TAC was associated with a higher CAC change (p<0.0001) in those with some CAC at baseline. In demographic & follow-up duration adjusted analysis, TAC was associated with both incident CAC (RR 1.72; P < 0.0001) as well as with a greater CAC change (RR for 1(st) and 4(th) quartiles and 95% CI: RR 2.89; −3.16, 8.95; RR 24.21; 18.25, 30.18. In conclusion, TAC is associated with incidence and progression of CAC. Detection of TAC may improve risk stratification efforts. Future clinical outcomes studies are needed to support such approach.

BACKGROUND AND AIMS: Inflammatory biomarkers and adipocytokines (IBA) may contribute to atherosclerosis by promoting vascular inflammation. The association between IBA and coronary artery calcium (CAC), a marker of subclinical atherosclerosis, is not well defined in South Asians (SA). We hypothesized that IBA (high sensitivity C-reactive protein [hsCRP], tumor necrosis factor alpha [TNF-α], adiponectin, and leptin) were independently associated with and improved discrimination of CAC among SA. METHODS: We analyzed IBA and CAC among participants in the prospective Mediators of Atherosclerosis in South Asians Living in America (MASALA) study. We used logistic regression models to examine cross-sectional associations of IBA with CAC presence (CAC >0) and severity (CAC >100), and C-statistics to assess the incremental contribution of each IBA to traditional risk factors (TRF) from the AHA/ACC Pooled Cohort Equations (PCE) for discrimination of CAC. RESULTS: Among 906 participants of the MASALA study, women (n=420) had significantly higher levels of hsCRP, adiponectin, and leptin but lower levels of TNF-α than men (p<0.01 for all). There was no significant association between any of the four IBA and either CAC category in multivariable-adjusted models, respectively. Lastly, none of the four IBA improved discrimination of CAC presence or severity when added to elements of the PCE. CONCLUSIONS: IBA were not associated with CAC presence or severity in the MASALA population. IBA did not help identify SA at risk of subclinical atherosclerosis, although associations with ASCVD events remain unclear. In SA, CAC may have a distinct pathophysiology independent of inflammation as measured by IBA.

Purpose: Diabetes imposes a significant economic burden on employers, particularly when including productivity costs. Given the great interest on multicomponent lifestyle interventions in these individuals, we assessed the short-term and long-term efficacy of a structured lifestyle modification program, My Unlimited Potential, among employees with diabetes of Baptist Health South Florida (BHSF), a large non-for profit health-care system. Design: This is a pre- and post-effectiveness of a workplace health promotion program. Setting: Worksite intervention at BHSF. Participants: The study analyzed the data of 93 employees with diabetes involved in a worksite wellness program after completion of a year long program. Intervention: The intervention was an intense lifestyle modification program that was targeted to the individual needs of the participants. Measures: Cardimetabolic risk factors such as body mass index (BMI), weight, systolic blood pressure, diastolic blood pressure, glycated hemoglobin, total cholesterol, triglycerides, high-sensitivity C-reactive protein, low-density lipoprotein, high-density lipoprotein, and maximal oxygen consumption. Analysis: Paired 2-sample t tests for means and descriptive statistics were used. Results: A mean decrease of 0.6 percentage points was observed in HbA1c values from baseline to 12 months. Weight, BMI, blood pressure, and lipid profile improved significantly after 12 months. Conclusion: This study suggests worksites with existing health promotion programs, and health-care staff can effectively deliver a diabetes prevention program that appears to have a long-term impact on employee health.

OBJECTIVES. To quantify and model conversion of a normal to an abnormal coronary artery calcium (CAC) scan. BACKGROUND. While absence of CAC is associated with excellent prognosis, progression to CAC>0 confers increased risk. The time interval for repeat scanning remains poorly defined. METHODS. Our study included 3,116 participants from the Multi-Ethnic Study of Atherosclerosis (MESA) with baseline CAC=0 and follow-up scans over 10 years after baseline. Prevalence of incident CAC, defined by thresholds of either CAC>0, CAC>10, or CAC>100, was calculated and time-to-progression was derived from a Weibull parametric survival model. Warranty periods were modeled as a function of sex, race/ethnicity, cardiovascular risk, and desired yield of repeat CAC testing. We further analyzed the proportion of coronary events occurring in participants with baseline CAC=0 that precede and follow repeat CAC testing at different time intervals. RESULTS. Mean age was 58 ± 9 years, with 63% women, and mean 10-year cardiovascular risk of 14%. Prevalence of CAC>0, CAC>10, and CAC>100 was 53%, 36%, and 8% respectively at 10 years. Using a 25% testing yield (Number Needed to Scan=4) the estimated warranty period of CAC>0 varied between 3 to 7 years depending on sex and race/ethnicity. Approximately 15% progressed to CAC>10 in 5 to 8 years, while 10-year progression to CAC>100 was rare. Presence of diabetes was associated with significantly shorter warranty period, while family history and smoking had small effects. 19% of all 10-year coronary events occurred in CAC=0 prior to performance of a subsequent scan at 3–5 years, while new detection of CAC>0 preceded 55% of future events and identified individuals at 3-fold higher risk of coronary events. CONCLUSION. In a large population of individuals with baseline CAC=0, we provide a robust estimation of the CAC=0 warranty period, considering progression to CAC>0, CAC>10, and CAC>100, and impact on missed vs. detectable 10-year year CHD events. ...