The contribution of syndemic conditions to cardiovascular disease risk

Rodriguez, Violeta J.; Chahine, Antonio; Parrish, Manasi S.; Alcaide, María L.; Lee, Tae Kyoung; Hurwitz, Barry E.; Sawhney, Manisha; Weiss, Stephen M.; Jones, Deborah L.; Kumar, Mahendra

doi:10.1080/09540121.2020.1761518

Cited by 6 publications

(4 citation statements)

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“…The research clearly shows that obesity is associated with a dearth of illnesses, many of which we looked at in this study [34,35]. In fact, individuals who are obese are more likely to have deleterious effects on pulmonary function, respiratory mechanics, gas exchange, control of breathing, and exercise capacity which result in respiratory conditions [36][37][38] such as obstructive sleep apneas (OSAS), asthma, chronic obstructive pulmonary disease (COPD), emphysema and chronic bronchitis [13,[39][40][41][42].…”

Section: Discussionmentioning

confidence: 71%

“…In this equation, p is the probability of overweight/obese status (weighted), N is the number of weighted observations, k is the (likely non-integer) number of successes, and ϕ is the variance that is not accounted for by the binomial distribution. Analyses were performed using the survey package for complex weighting [ 34 ] in R Statistical Software [ 35 ]:

…”

Section: Methodsmentioning

confidence: 99%

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Obesity and Morbidity Risk in the U.S. Veteran

et al. 2020

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The obesity epidemic in the United States has been well documented and serves as the basis for a number of health interventions across the nation. However, those who have served in the U.S. military (Veteran population) suffer from obesity in higher numbers and have an overall disproportionate poorer health status when compared to the health of the older non-Veteran population in the U.S. which may further compound their overall health risk. This study examined both the commonalities and the differences in obesity rates and the associated co-morbidities among the U.S. Veteran population, utilizing data from the 2018 Behavioral Risk Factor Surveillance System (BRFSS). These data are considered by the Centers for Disease Control and Prevention (CDC) to be the nation’s best source for health-related survey data, and the 2018 version includes 437,467 observations. Study findings show not only a significantly higher risk of obesity in the U.S. Veteran population, but also a significantly higher level (higher odds ratio) of the associated co-morbidities when compared to non-Veterans, including coronary heart disease (CHD) or angina (odds ratio (OR) = 2.63); stroke (OR = 1.86); skin cancer (OR = 2.18); other cancers (OR = 1.73); chronic obstructive pulmonary disease (COPD) (OR = 1.52), emphysema, or chronic bronchitis; arthritis (OR = 1.52), rheumatoid arthritis, gout, lupus, or fibromyalgia; depressive disorders (OR = 0.84), and diabetes (OR = 1.61) at the 0.95 confidence interval level.

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Section: Discussionmentioning

confidence: 71%

…”

Section: Methodsmentioning

confidence: 99%

Obesity and Morbidity Risk in the U.S. Veteran

et al. 2020

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“…Syndemic is an emergent concept that characterizes the mutually aggravating interactions between two or more concurrent or sequential epidemics or disease clusters in populations associated with socioeconomic status and environmental factors [39]. It has been well established that syndemic conditions of low education and poor quality of population nutrition-childhood undernourishment, impaired mental health, viral infection (COVID-19 and HIV), drug abuse, and obesity-are risk factors for the silent development of cardiovascular diseases, such as HTN [40]. HTN affects 1.28 billion people worldwide and is considered a significant risk factor for heart disease, stroke, and kidney failure, resulting in premature death and disability [41,42].…”

Section: Discussionmentioning

confidence: 99%

The Triad Na+ Activated Na+ Channel (Nax)—Salt Inducible KINASE (SIK) and (Na+ + K+)-ATPase: Targeting the Villains to Treat Salt Resistant and Sensitive Hypertension

Gonsalez

Gomes

Souza

et al. 2023

IJMS

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The Na+-activated Na+ channel (Nax) and salt-inducible kinase (SIK) are stimulated by increases in local Na+ concentration, affecting (Na+ + K+)-ATPase activity. To test the hypothesis that the triad Nax/SIK/(Na+ + K+)-ATPase contributes to kidney injury and salt-sensitive hypertension (HTN), uninephrectomized male Wistar rats (200 g; n = 20) were randomly divided into 4 groups based on a salt diet (normal salt diet; NSD—0.5% NaCl—or high-salt diet; HSD—4% NaCl) and subcutaneous administration of saline (0.9% NaCl) or deoxycorticosterone acetate (DOCA, 8 mg/kg), as follows: Control (CTRL), CTRL-Salt, DOCA, and DOCA-Salt, respectively. After 28 days, the following were measured: kidney function, blood pressure, (Na+ + K+)-ATPase and SIK1 kidney activities, and Nax and SIK1 renal expression levels. SIK isoforms in kidneys of CTRL rats were present in the glomerulus and tubular epithelia; they were not altered by HSD and/or HTN. CTRL-Salt rats remained normotensive but presented slight kidney function decay. HSD rats displayed augmentation of the Nax/SIK/(Na+ + K+)-ATPase pathway. HTN, kidney injury, and kidney function decay were present in all DOCA rats; these were aggravated by HSD. DOCA rats presented unaltered (Na+ + K+)-ATPase activity, diminished total SIK activity, and augmented SIK1 and Nax content in the kidney cortex. DOCA-Salt rats expressed SIK1 activity and downregulation in (Na+ + K+)-ATPase activity in the kidney cortex despite augmented Nax content. The data of this study indicate that the (Na+ + K+)-ATPase activity response to SIK is attenuated in rats under HSD, independent of HTN, as a mechanism contributing to kidney injury and salt-sensitive HTN.

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“…The existing literature has focused primarily on discrimination at the individual or institutional level. Studies of structural discrimination—the ways societies foster discrimination through mutually reinforcing inequitable systems that may not be intentionally designed but still produce inequity—in stroke care are scant . There is some evidence that stroke centers are preferentially located in higher-income areas; that hospitals in lower-income areas with lower profit margins are less likely to be certified; and that nonurban areas with a higher proportion of American Indian, uninsured, or low-income residents tend to be located farther away from a CSC .…”

Section: Introductionmentioning

confidence: 99%

Structural Inequities for Historically Underserved Communities in the Adoption of Stroke Certification in the United States

2022

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IMPORTANCE Stroke centers are associated with better outcomes. There is substantial literature surrounding disparities in stroke outcomes for underserved populations. However, the existing literature has focused primarily on discrimination at the individual or institutional level, and studies of structural discrimination in stroke care are scant.OBJECTIVE To examine differences in hospitals' likelihood of adopting stroke care certification between historically underserved and general communities. DESIGN, SETTING, AND PARTICIPANTSThis study combined a data set of hospital stroke certification from all general acute nonfederal hospitals in the continental US from January 1, 2009, to December 31, 2019, with national, hospital, and census data to define historically underserved communities by racial and ethnic composition, income distribution, and rurality. For all categories except rurality, communities were categorized by the composition and degree of segregation of each characteristic. Cox proportional hazard models were then estimated to compare the hazard of adopting stroke care certification between historically underserved and general communities, adjusting for population size and hospital bed capacity. Data were analyzed from June 2021 to April 2022. MAIN OUTCOMES AND MEASURES Hospitals' likelihood of adopting stroke care certification.RESULTS A total of 4984 hospitals were included. From 2009 to 2019, the total number of hospitals with stroke certification grew from 961 to 1763. Hospitals serving Black, racially segregated communities had the highest hazard of adopting stroke care certification (hazard ratio [HR], 1.67; 95% CI, 1.41-1.97) in models not accounting for population size, but their hazard was 26% lower than among those serving non-Black, racially segregated communities (HR, 0.74; 95% CI, 0.62-0.89) in models controlling for population and hospital size. Adoption hazard was lower in low-income communities compared with high-income communities, regardless of their level of economic segregation, and rural hospitals were much less likely to adopt any level of stroke care certification relative to urban hospitals (HR, 0.43; 95% CI, 0.35-0.51). CONCLUSIONS AND RELEVANCEIn this analysis of stroke certification adoption across acute care hospitals in the US from 2009 to 2019, hospitals in low-income and rural communities had a lower likelihood of receiving stroke certification than hospitals in general communities. Hospitals operating in Black, racially segregated communities had the highest likelihood of adopting stroke care, but because these communities had the largest population, patients in these communities had the lowest likelihood of access to stroke-certified hospitals when the model controlled for population size. These findings provide empirical evidence that the provision of acute neurological services is structurally inequitable across historically underserved communities.

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The contribution of syndemic conditions to cardiovascular disease risk

Cited by 6 publications

References 62 publications

Obesity and Morbidity Risk in the U.S. Veteran

Obesity and Morbidity Risk in the U.S. Veteran

The Triad Na+ Activated Na+ Channel (Nax)—Salt Inducible KINASE (SIK) and (Na+ + K+)-ATPase: Targeting the Villains to Treat Salt Resistant and Sensitive Hypertension

Structural Inequities for Historically Underserved Communities in the Adoption of Stroke Certification in the United States

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