tbuckley/cabot-search huggingface dataset:
Abstract P307: Differences in Cardiovascular Disease Burden, Screening, Education, and Care by Clinic Type in the 2022 Health Center Patient Survey (HRSA)
Authors: Ben King, Sarina Attri, David Buck
Journal: Circulation (2024)

Background: Persons experiencing homelessness (PEH) have a 2-3-fold risk for cardiovascular disease (CVD) mortality. Evidence has repeatedly shown elevated chronic disease burden, reduced access to care, and lower utilization of medication to control CVD risk factors in this setting. Migrant communities also experience reduced access to care and the impacts from deferring care. There are targeted, federally-funded health clinics in place for both settings. However, these systems are frequently overwhelmed and limited by their scope of care to primary care. There is scarce evidence on differences between access, quality, and experiences of care delivered relative to other safety-net models. Method: The 2022 Health Center Patient Survey (HCPS) was collected on behalf of the Health Resources and Services Administration (HRSA). The HCPS is a nationally-representative, three-staged, sample-based survey collected via 1:1 interviews with clinic patients. The survey assessed sociodemographics, health conditions and behaviors, access to and utilization of care, and patients’ experiences with comprehensive services they received at HRSA-funded health centers, including: community health centers (CHC), healthcare for the homeless (HCH) clinics, migrant health centers (MHC), and public housing primary care (PHPC) clinics. A total of 103 unique awardees and 318 health center sites were recruited, and 4,414 patient interviews were completed. Investigators analyzed patient characteristics and multiple survey items related to AHA’s Essential 8 metrics for differences across clinic type. Results: MHC and HCH clinics had fewer elderly patients (~7%) than CHC and PHPC clinics (~17%). There were differences across sex, race, and ethnicity across all four clinic types. Cardiovascular disease history ranged from 4.9% (MHC) to 14.7% (HCH). Reported 7-day physical activity measures, average sleep below 7 hours per day, and Lifetime smoking (&gt;100 cigarettes; OR=4.2, p&lt;0.001) were all greatest among HCH patients. Fewer HCH and MHC patients reported ever having or recent lipid tests (both p&lt;0.001). HCH patients were more likely to report hypertension (p=0.003), but less likely to report receiving nutrition advice (all p&lt;0.05). MHC patients were less likely to be prescribed hypertension medication (p=0.044) and HCH patients were less likely to be taking medication even if it was prescribed (p&lt;0.001). Adjustment for differences in age or CVD history were able to explain some observed differences, but increased the magnitude of other disparities. Conclusion: CVD burden differs across the various HRSA funding mechanisms for clinics, as do demographics and multiple metrics of health behaviors and biomarkers of cardiovascular health. Greater disease burden in HCH and MHC patients is likely compounded by increased risk factors and under performance in providing health education interventions.
Abstract P140: Using Group Model-Building to Understand and Address Type 2 Diabetes in Native Hawaiian Communities
Authors: Claire T Ing, Ka'apuni Kama, Meghan Kenney, Brooke Dolin, Sarah M Marshall, Gregory Hester, Yi Zhu, B P Kekauoha, Adrienne Y Dillard
Journal: Circulation (2024)

Introduction: Native Hawaiians, the indigenous people of Hawai‘i, have a prevalence of type 2 diabetes more than twice that of non-Hispanic Whites. Risk factors and social determinants of health for type 2 diabetes are multilevel and interrelated including individual-level factors, household-level, community-level, and societal-level. To address this complex issue effectively, it is crucial to understand the structure of how these factors interrelate and result in prevalence of type 2 diabetes in Native Hawaiian communities. Group Model-Building (GMB) is a participatory method rooted in systems theory, which provides a conceptual framework to understand such complex systems. It engages stakeholders in a structured process that leverages local knowledge to create contextually relevant causal loop diagrams (CLDs).Purpose: To demonstrate the value of GMB in constructing a CLD that captures the relationships and feedback mechanisms underlying type 2 diabetes in a Hawaiian homestead region and identify potential targeted interventions and policies to address type 2 diabetes prevalence, morbidity and mortality. Methods: Prior to the GMB workshops, we identified and engaged key homestead stakeholders, aquired necessary materials, selected a meeting location, create and train a facilitation team, and create the GMB agenda. The workshops were held over two evenings and included structured activities: Hopes and Fears, Graphs over Time, Causal Loop Diagrams, and Action Ideas. Results: Hopes and fears themes included: decreasing prevalence, healing, health education, community programs, decreasing quality of life, death, and the impact on the family spectrum. Graphs over time depicted increases in behavioral risk factors for type 2 diabetes, increases in type 2 diabetes-related morbidity, changing access to care, and changing quality of life. Participants developed and revised a CLD illustrating balancing and reinforcing feedback structures. Finally, participants developed 13 intervention/program ideas to address type 2 diabetes including health-related policies, community programs, and addressing social determinants of health (eg., access to care and healthy food, employment services). Conclusion: GMB was seen as a valuable tool for visualizing the connections and interdependencies between factors which community understands intuitively but hasn’t seen represented on paper. The process revealed the extent to which community programs impact community members, and highlighted collaborations to foster to sustain these effects. The constraints of physical space limiting the programs they can offer were identified. GMB is a promising method for collaboration, knowledge sharing, and co-creating a comprehensive understanding of diabetes-related factors in Native Hawaiian communities.
Abstract P408: Plasma Metabolomic Profile of Dyslipidemia in Childhood: Genetics of Glucose Regulation in Gestation and Growth (Gen3G) Study
Authors: Zhila Semnani-Azad, Patrice Perron, Luigi Bouchard, Marie-France Hivert
Journal: Circulation (2024)

Objective: Dyslipidemia is a major risk factor for atherosclerosis development. Evidence suggests atherosclerotic plaque accumulation can begin in childhood and lead to adverse cardiovascular events into adulthood. The use of metabolomics to identify metabolites specific to dyslipidemia may provide insights into the pathogenesis of cardiovascular-related outcomes. Thus, our aim was to identify metabolite networks associated with dyslipidemia in childhood. Methods: We used cross-sectional data from 326 children (median age of 5.2 years) from Gen3G, a prospective pre-birth cohort. We evaluated 1,038 plasma metabolites (798 annotated and 240 unannotated). Lipid measures included total cholesterol, non-HDL, LDL, triglyceride, and HDL. Using the AHA and the American Academy of Pediatrics guidelines, we identified normal and borderline/high classifications for each lipid. We applied weighted-correlation network analysis to find highly correlated metabolite networks. Spearman’s partial correlations were applied to assess the associations of lipids with metabolite networks, adjusting for age and sex, with false discovery rate correction. Results: We identified a green module of 120 metabolites, mainly comprised of lipids, that showed positive correlations with total cholesterol, non-HDL, and LDL classified as borderline/high vs normal (ρ adjusted = 0.28 to 0.40) and as continuous measures (ρ adjusted = 0.32 to 0.63), while HDL (borderline/high vs normal) was inversely associated ( Figure ). In this module, sphingomyelin (d18:2/16:0, d18:1/16:1)* and sphingomyelin (d18:2/23:0, d18:1/23:1, d17:1/24:1)* appeared to be driving the associations. Also, the blue and yellow modules showed inverse correlations (mainly driven by 10-nonadecenoate (19:1n9) and 3-hydroxyhexanoate, respectively), while the brown module showed positive correlations with triglyceride (driven by 1-palmitoyl-GPC (16:0)). Conclusions: A unique network of metabolites was associated with dyslipidemia in childhood.
Abstract P326: Patient Predictors of Antihypertensive Medications Prescription Classes Revealed by the All of Us Research Project (AOURP) Registry
Authors: Jingzhi Yu, Abigail Gauen, Rachel Zmora, Lucia Petito, Abel Kho, Norrina B Allen
Journal: Circulation (2024)

Hypertension (HTN) treatment guidelines recommend five general classes (ACEi, ARB, CCB, diuretics, beta-blockers) of medications with minimal guidance regarding specific classes for different types of patients. Understanding heterogeneity in HTN treatment and demographic and clinical traits of individuals receiving different medication classes may provide insights into outcome disparities and enable the development of more tailored treatment recommendations. Using EHR data from the national All of Us Research Project (AOURP) registry, we examined patient predictors of first-line HTN medication class usage. From the AOURP we selected: 1) patients aged 18+ and diagnosed with new-onset HTN between 2010 and 2021 which is determined by having no HTN medication prescription prior to diagnosis date; 2) patients not pregnant within a year before and after the HTN diagnosis. We restricted our analyses to individuals receiving routine care within the EHR database as defined by having at least one in-person visit in the year prior to the first HTN diagnosis and prescribed with a single class of HTN medications within a year of their HTN diagnosis. We performed multivariate regression analysis on the outcome of whether a certain class of first-line medication was prescribed another class. Our covariates include age, sex, race/ethnicity, comorbidities (diabetes, CVD, CKD), and household income. All reported odds ratios below have a p-value of less than 0.05. Among 5,521 AOURP participants, ACEi was the most prescribed class (29%), followed by CCB (23%), Diuretic (22%), Beta-blocker (17%), and ARB (9%). We found ACEi were more likely to prescribed for females (OR: 0.74) while diuretics were less likely to be prescribed for males (OR: 1.45). We found CCB (OR: 2.73) and diuretics (OR: 1.54) were more likely to be prescribed for Blacks than their White counterparts. We also found that ACEi (OR: 2.75) were more likely prescribed for diabetics. In terms of household income, we found that ARB (OR: 1.67) were prescribed more frequently for those in higher income brackets (&lt;$25,000 vs $100,000+) compared to other classes of medication. This corresponds to the fact that ARB are relatively newer and more expensive class of HTN medications. Our findings show that although there are levels of clinical equipoise in terms of prescribed medication classes among the general population, evidence-based guidance on personalized antihypertension treatments may be needed.
Abstract P482: Associations Between Determinates of Food Choice and Healthy Eating Index-2015 in Adults: An NHANES 2017 - 2018 Analysis
Authors: Kayla E Tate, Kristina Petersen
Journal: Circulation (2024)

Introduction: Previous work in nationally representative US samples has focused on associations between single determinants of food choice and diet quality assessed by the Health Eating Index-2015 (HEI-2015). Limited research has examined the relationship between multiple domains of food choice and diet quality. A greater understanding of the association between individual-level determinants of food choice and diet quality may inform the development of interventions to improve diet quality. Aim: The aim was to examine the association between potentially modifiable factors known to affect individual-level food choice and HEI-2015. Methods: This cross-sectional analysis included adult participants in NHANES 2017 - 2018. Determinates of individual-level food choice were based on a previously proposed framework. Variables assessed in NHANES were mapped to the following four domains: 1) food-external factors (use of nutrition labels, hours worked weekly, typical work schedule); 2) personal-state factors (health status, consumption of food away from home); 3) cognitive factors (perceived diet quality, knowledge of MyPlate); 4) society-related features (monthly grocery expenditures, food security status, income to poverty ratio). Univariate regression assessed the relationship between food choice determinates and HEI-2015 score. Statistically significant variables were entered into multivariate regression models predicting HEI-2015 score. Significant variables from the final model were used in multivariate regression models predicting adequacy and moderation component sub scores of HEI-2015. All models were adjusted for non-modifiable determinates of food choice, including age, sex, race, BMI, education, and relationship status. All analyses were survey weighted. Results: The weighted mean HEI-2015 score for the sample (N=1467) was 51.69 points (95% CI 49.55, 53.84; weighted n=95.6 million). In the final model, perceived diet quality, food away from home, and use of nutrition labels were significant predictors of HEI-2015 (R 2 adj =0.25, p&lt;0.001). Those with excellent/very good perceived diet quality had a 4.88-pt higher HEI-2015 score than those with fair/poor perceived diet quality (p&lt;0.001). Consuming food away from home ≥5 times per week resulted in a 5.92-pt lower HEI-2015 score than 0 times per week (p=0.02). Always/most of the time using nutrition labels was associated with a 7.85-pt higher HEI-2015 score compared to rarely/never using labels (p&lt;0.001). Variables accounted for a higher proportion of variance in adequacy score (R 2 adj =0.10, p&lt;.001) than moderation score (R 2 adj =0.24, p&lt;.001). Conclusion: Food-external, personal-state, cognitive, and socio-cultural factors are associated with diet quality. Future research should consider multiple individual-level food-choice determinates when developing interventions to improve diet quality.
Abstract P438: Combined Association of Body Mass Index and Central Obesity on Mortality Risk in Diabetes Population: The China Health And Retirement Longitudinal Study (CHARLS)
Authors: Ruolin Zhang, Xiong Ding, Huiyuan Zhou, Xian Zhang, Zhengting He, Lijing L Yan
Journal: Circulation (2024)

Introduction: Abdominal fat is associated with an elevated mortality risk and higher healthcare costs. Body mass index (BMI), commonly used to measure body fatness, underestimates excess abdominal fat due to its limited accuracy in reflecting fat and muscle distribution. Waist circumference (WC) is a more precise indicator of central obesity, which is defined as excess abdominal fat accumulation. The joint associations of combined BMI and WC with mortality risk in the diabetes population are not fully understood. Methods: We included individuals with diabetes and at least one measure of BMI and WC, from 2011, 2013, and 2015 waves with follow-up to 2018 in CHARLS. All individuals were classified into four groups: normal weight without central obesity, normal weight with central obesity (WC, male ≥ 90 cm, female ≥ 85 cm), overweight (BMI ≥ 24 kg/m 2 ) without central obesity, and overweight with central obesity. Multivariable logistic regression was used to model the associations between four groups and the mortality risk among people with diabetes adjusted for demographic characteristics, smoking, drinking, multimorbidities, and diabetes treatment. Results: Among 940 participants (mean age 60.4 years, 58.3% women), there were 124 incident cases of death recorded. Compared to normal weight without central obesity group, the mortality risk was increased among normal weight with central obesity group (Adjusted odds ratio = 2.11, 95% CI: [1.07, 4.18]). Other groups exhibited no statistically significant association with mortality risk (Figure 1). In sensitivity analysis excluding individuals with BMI ≤ 18.5 kg/m 2 , results were largely consistent with the previous findings. Conclusions: A significant association between central obesity and increased mortality risk in diabetes population was revealed. While, overweight with central obesity showed no significant association to mortality risk. Our findings stress the importance of customized strategies for central obesity in the diabetes population to reduce medical expenses.
Abstract P507: Adherence to Pediatric Screening Guidelines for Cardiovascular Risk Factors in a Diverse Cohort of Children in Chicago
Authors: Abigail Gauen, Yaojie Wang, Amanda M Perak, Matthew Davis, Marc Rosenman, Donald M Lloyd-Jones, Rachel Zmora, Norrina B Allen, Lucia Petito
Journal: Circulation (2024)

Background: Preventive screenings in children and adolescents encourage maintenance of optimal cardiovascular health (CVH) early in life, but there may be a gap between recommendations and clinical practice. We evaluated adherence to pediatric guidelines for universal age-based and risk-based screening for body mass index (BMI), blood pressure (BP), lipids, and blood glucose. Methods: We used 2010-2018 ambulatory visit data from children aged 2-12y within CAPriCORN, an electronic health record network from major healthcare systems in Chicago. For each child who attended a well-child visit and met age and/or risk-based criteria, receipt of BMI, BP, lipids, and/or HbA1c or fasting blood glucose measurements were assessed. For each metric, proportion adherence was calculated via generalized estimating equations with an exchangeable correlation structure and was stratified by age, sex, race/ethnicity, and insurance status. Results: This study included 87,549 children who attended 197,559 well-child encounters. Across all encounters, children were 51.5% male and mean (SD) age 6.4 (3.3) years. Universal age-based screening prevalence (95% CI) per 100 eligible children was 77.1 (76.8, 77.3) for BMI, 33.4 (33.1, 33.7) for BP, and 9.6 (9.3, 9.9) for lipids. Risk-based screening prevalence (95% CI) per 100 eligible children was 13.9 (12.2, 15.9) for BP, 6.9 (6.4, 7.5) for lipids, and 13.3 (12.6, 14.1) for blood glucose. Conclusions: Early screening of CVH risk factors could lead to earlier interventions, which could alter CVH trajectories across the lifetime. Low levels of adherence to universal age-based and risk-based CVH screening highlight the gap between recommendations and clinical practice, emphasizing the need to understand and address barriers to screening in pediatric populations.
Abstract P201: Adherence to Time-Restricted Eating is Related to Long-Term Weight Changes Among Women
Authors: Yoriko Heianza, Leah E Cahill, Oona J DiMatteo, Emily M Drotz, Qi Sun, JoAnn E Manson, Lu Qi
Journal: Circulation (2024)

Introduction: Chronic disruption of circadian rhythms is linked to weight gain and metabolic dysregulation. Time-restricted eating (TRE), a form of intermittent fasting, has shown effectiveness in improving short-term weight loss and energy homeostasis. However, associations between habitual adherence to TRE and long-term weight change remain understudied. Hypothesis: We tested whether adherence to TRE assessed by the gold-standard seven-day dietary records (7DDRs) was related to 5-year change in body weight among women. Methods: The present analysis included 650 women (mean [SD]: age 63 [9] y; BMI 26.4 [5.3] kg/m 2 ) without cardiovascular disease at baseline who completed 7DDRs in a sub-study of the Nurses’ Health Studies (NHS/NHSII), the Women’s Lifestyle Validation Study (WLVS) (2010-12). TRE was indicated by 4-12 hours of daily eating window (EW). The adherence to TRE was assessed by summing up the TRE days in a week. We also calculated 7-day averaged values of EW hours, last/first time of eating occasion (EO), and within-person variability of these variables. Weight change from baseline to a follow-up survey (NHS: 2016-18; NHSII: 2015-17) were analyzed. Total energy expenditure (TEE) and physical activity expenditure (PAEE) were measured at baseline using the doubly labeled water dilution method. Results: Longer averaged hours of EW were related to greater weight gain (β 0.7 [0.3] kg per 2 hours) after adjusting for covariates of demographic factors, total energy intake, physical activity, alcohol, within-person variation of EW, the averaged time of last EO, and the initial body weight ( p =0.02). Consistently, adherence to TRE was associated with less weight gain (β -0.25 [SE 0.1] kg per day increment; p =0.03) in a model adjusting for these covariates. We found that lower adherence to TRE and longer hours of EW were associated with weight gain ( p &lt;0.05 for both) when the last eating time occurred at a later time in the day than at an earlier time. The baseline energy metabolism (TEE and PAEE) modified the associations between the hours of EW and weight changes ( P interaction-EW-TEE = 0.006; P interaction-EW-PAEE =0.01), showing significant relationships particularly among women with higher levels of adiposity and greater energy expenditure at baseline. Conclusions: Adherence to TRE and fewer habitual hours of eating were related to long-term weight changes among middle-aged and elderly women. The last eating time and energy homeostasis may partly modify the associations.
Abstract P317: Patient Perceptions and Satisfactions of a Remote Blood Pressure Monitoring Program in an Integrated Healthcare System
Authors: Teresa N Harrison, Janet Mora Marquez, Rachelle A Juan, Angeline L Ong-Su, Jeffrey W Brettler, Matthew T Mefford, Jaejin An, Kristi Reynolds
Journal: Circulation (2024)

Background: Uncontrolled high blood pressure (BP) is a leading contributor to cardiovascular disease. Remote BP monitoring (RBPM) can empower patients to participate in their healthcare which may be important for improving BP control. The aim of this study was to understand patients’ attitudes toward and satisfaction with a RBPM program. Methods: We identified Kaiser Permanente (KP) Southern California members aged 18 years and older enrolled in a RBPM program. Eligibility criteria include having uncontrolled BP (≥140/90 mmHg), a smartphone, and an email address. Between July 27 and August 17, 2023, we emailed a letter of invitation and link to an online survey to 716 eligible members followed by 2 reminder emails. The survey consisted of 5 domains to assess patients’ experiences with a BP monitor and the KP Health Ally app: ease of use, trust, perceived benefits, privacy and overall satisfaction. Responses to each question were rated on a scale from 1 (disagree) to 7 (agree). The average score for each domain was calculated as the weighted sum of the questions. Antihypertensive medication adherence was reported on a scale ranging from “all of the time” to “less than half the time”. Results: A total of 71 patients (9.9%) responded to the survey with 60 (8.4%) completing all questions. Respondents had a mean age of 60.4 (SD 13.1) years, with 70.4% being female and 50.5% African American. Overall satisfaction and perceived benefits were the highest scoring domains followed by ease of use and trust in the monitor and app (Figure). Privacy concerns were minimal. The overwhelming majority of respondents (89.7%) reported taking their BP medications all or nearly all of the time. Conclusion: Most respondents rated the RBPM program with a high level of satisfaction, perceived benefits and had limited concern about privacy with the potential opportunity to improve patients’ trust in the BP monitor and app functionality. This high level of patient satisfaction and acceptability should lead to increased implementation and scaling of the RBPM program.