Bassent Abdelbary

Application of a novel method for assessing cumulative risk burden by county.

The purpose of this study is to apply the Human Security Index (HSI) as a tool to detect social and economic cumulative risk burden at a county-level in the state of Texas. The HSI is an index comprising a network of three sub-components or “fabrics”; the Economic, Environmental, and Social Fabrics. We hypothesized that the HSI will be a useful instrument for identifying and analyzing socioeconomic conditions that contribute to cumulative risk burden in vulnerable counties. We expected to identify statistical associations between cumulative risk burden and (a) ethnic concentration and (b) geographic proximity to the Texas-Mexico border. Findings from this study indicate that the Texas-Mexico border region did not have consistently higher total or individual fabric scores as would be suggested by the high disease burden and low income in this region. While the Economic, Environmental, Social Fabrics (including the Health subfabric) were highly associated with Hispanic ethnic concentration, the overall HSI and the Crime subfabric were not. In addition, the Education, Health and Crime subfabrics were associated with African American racial composition, while Environment, Economic and Social Fabrics were not. Application of the HSI to Texas counties provides a fuller and more nuanced understanding of socioeconomic and environmental conditions, and increases awareness of the role played by environmental, economic, and social factors in observed health disparities by race/ethnicity and geographic region.

Impact of Hispanic Ethnic Concentration and Socioeconomic Status on Obesity Prevalence in Texas Counties

The purpose of this study is to determine whether Hispanic ethnic concentration is associated with a higher prevalence of obesity and, if this relationship exists, whether it is affected by the socioeconomic environment. The study uses the Texas Behavioral Risk Factor Surveillance System (BRFSS) linked to 2000 census data to access the relationship between prevalence of obesity, Hispanic ethnic concentration, poverty and level of education at a county-level. The findings suggest that the association of Hispanic ethnic concentration and obesity varies by socioeconomic environment. Although little influence was observed for % poverty, the relationship between Hispanic ethnic concentration and obesity differed by county-level educational attainment. High proportion of residents with a bachelor’s degree is associated with a low prevalence of obesity; counties with both high % Hispanic and high % with Bachelor’s degrees had the lowest prevalence of obesity. Our results suggest that promoting and improving education, perhaps including training on healthful living, may serve as an effective means of curbing current obesity trends and associated health problems in Hispanic and possibly other ethnic communities.

Using the Framingham Risk Score to Evaluate Immigrant Effect on Cardiovascular Disease Risk in Mexican Americans

Background. This study uses the Framingham Risk Score (FRS) for 10-year cardiovascular disease (CVD) to evaluate differences between Mexican American immigrants and the U.S.-born population. Methods and Results. Data from the Cameron County Hispanic Cohort (N=1,559). Average total risk scores were generated by age group for each gender. Regression analysis was conducted adjusting for covariates and interaction effects. Both women and men in the CCHC sample who were long-term immigrant residents (mean FRS scores women 4.2 with p<.001 vs. men 4.0 with p<.001) or born in the U.S. (mean FRS scores women 4.6 with p<.001 vs. men 3.3 with p<.001) had significantly higher risk scores than immigrants who had only been in this country for less than 10 years. The interaction model indicates that differences between immigrant and native-born Mexican Americans are most greatly felt at lowest levels of socioeconomic status for men in the CCHC. Conclusions. This study suggests that in terms of immigrant advantage in CVD risk, on whom, where, and how the comparisons are being made have important implications for the degree of difference observed.

Cardiovascular Disease Risk Among the Mexican American Population in the Texas-Mexico Border Region, by Age and Length of Residence in United States

Introduction Although the relationship between health behaviors and outcomes such as smoking and obesity with longer residence in the United States among Mexican American immigrants is established, the relationship between length of residency in the United States and risk for cardiovascular disease (CVD) is not fully understood. The objective of this study was to determine the relationship between immigrant status, length of residence in the United States, age, and CVD markers in a sample of Mexican American adults living in Brownsville, Texas. Methods We categorized participants in the Cameron County Hispanic Cohort study as immigrants in the United States for 10 years or less, immigrants in the United States for more than 10 years, or born in the United States. We conducted logistic and ordinary least squares regression for self-reported chronic conditions and CVD biomarkers. Results We found bivariate differences in the prevalence of self-reported conditions and 1 CVD biomarker (low-density lipoprotein cholesterol) by length of residence in the middle (41–64 y) and younger (18–40 y) age groups. After adjusting for covariates, the following varied significantly by immigrant status: stroke and high cholesterol (self-reported conditions) and diastolic blood pressure, systolic blood pressure, total cholesterol, and low-density lipoprotein cholesterol (CVD biomarkers). Conclusion The association between immigrant status, length of residence in the United States, and CVD markers varied. The effect of length of residence in the United States or immigrant status may depend on age and may be most influential in middle or older age.

Predicting treatment failure, death and drug resistance using a computed risk score among newly diagnosed TB patients in Tamaulipas, Mexico

The purpose of this study was to develop a method for identifying newly diagnosed tuberculosis (TB) patients at risk for TB adverse events in Tamaulipas, Mexico. Surveillance data between 2006 and 2013 (8431 subjects) was used to develop risk scores based on predictive modelling. The final models revealed that TB patients failing their treatment regimen were more likely to have at most a primary school education, multi-drug resistance (MDR)-TB, and few to moderate bacilli on acid-fast bacilli smear. TB patients who died were more likely to be older males with MDR-TB, HIV, malnutrition, and reporting excessive alcohol use. Modified risk scores were developed with strong predictability for treatment failure and death (c-statistic 0·65 and 0·70, respectively), and moderate predictability for drug resistance (c-statistic 0·57). Among TB patients with diabetes, risk scores showed moderate predictability for death (c-statistic 0·68). Our findings suggest that in the clinical setting, the use of our risk scores for TB treatment failure or death will help identify these individuals for tailored management to prevent these adverse events. In contrast, the available variables in the TB surveillance dataset are not robust predictors of drug resistance, indicating the need for prompt testing at time of diagnosis.

Socioeconomic Context and the Food Landscape in Texas: Results from Hotspot Analysis and Border/Non-Border Comparison of Unhealthy Food Environments

Purpose: The purpose of this paper is to describe the food landscape of Texas using the CDC’s Modified Retail Food Environment (mRFEI) and to make comparisons by border/non-border. Methods: The Modified Retail Food Environment index (mRFEI (2008)) is an index developed by the CDC that measures what percent of the total food vendors in a census track sell healthy food. The range of values is 0 (unhealthy areas with limited access to fruits and vegetables) to (100—Healthy). These data were linked to 2010 US Census socioeconomic and ethnic concentration data. Spatial analysis and GIS techniques were applied to assess the differences between border and non-border regions. Variables of interest were mRFEI score, median income, total population, percent total population less than five years, median age, % receiving food stamps, % Hispanic, and % with a bachelor degree. Results: Findings from this study reveal that food environment in Texas tends to be characteristic of a “food desert”. Analysis also demonstrates differences by border/non-border location and percent of the population that is foreign born and by percent of families who receive food stamps. Conclusions: Identifying the relationship between socioeconomic disparity, ethnic concentration and mRFEI score could be a fundamental step in improving health in disadvantage communities, particularly those on the Texas-Mexico border.

Region of birth and cardiovascular disease in mexican americans living in the texas-Mexico border

The study aims to determine whether place of origin has an effect on Mexican American cardiovascular disease (CVD) risk on the South Texas Border. Although many studies have investigated the effect of immigration on Mexican American health, few have considered how region of origin may impact CVD risk. Subjects in the Cameron County Cohort Study were divided into 3 groups according to place of origin: Southern Mexico, Northern Mexico, and U.S. Border States. Descriptive statistics and regression analyses were conducted using CVD biomarkers and self-reported angina, stroke, and elevated blood pressure. Logistic regression revealed that subjects born in U.S. Border States and Northern Mexico states were significantly less likely to have high glucose levels (p < .05) than those born in Southern Mexico. Subjects born in Northern Mexico were less likely to have high triglycerides (p = .05). This study illustrates the importance of considering region of origin in studying the effect of immigration on Mexican American health beyond the standard: number of years in the United States.

Diabetes screen during tuberculosis contact investigations highlights opportunity for new diabetes diagnosis and reveals metabolic differences between ethnic groups

Type 2 diabetes (T2D) is a prevalent risk factor for tuberculosis (TB), but most studies on TB-T2D have focused on TB patients, been limited to one community, and shown a variable impact of T2D on TB risk or treatment outcomes. We conducted a cross-sectional assessment of sociodemographic and metabolic factors in adult TB contacts with T2D (versus no T2D), from the Texas-Mexico border to study Hispanics, and in Cape Town to study South African Coloured ethnicities. The prevalence of T2D was 30.2% in Texas-Mexico and 17.4% in South Africa, with new diagnosis in 34.4% and 43.9%, respectively. Contacts with T2D differed between ethnicities, with higher smoking, hormonal contraceptive use and cholesterol levels in South Africa, and higher obesity in Texas-Mexico (p < 0.05). PCA analysis revealed striking differences between ethnicities in the relationships between factors defining T2D and dyslipidemias. Our findings suggest that screening for new T2D in adult TB contacts is effective to identify new T2D patients at risk for TB. Furthermore, studies aimed at predicting individual TB risk in T2D patients, should take into account the heterogeneity in dyslipidemias that are likely to modify the estimates of TB risk or adverse treatment outcomes that are generally attributed to T2D alone.

Contextualizing the Burden of Chronic Disease: Diabetes, Mortality and Disability in Older Mexicans

Objectives: This study’s purpose is to examine the prevalence of chronic conditions among older Mexicans with diabetes and to determine the incidence of newly diagnosed medical conditions at follow-up by diabetes status.