Camila X. Romero

Changing Trends in the Prevalence and Disparities of Obesity and Other Cardiovascular Disease Risk Factors in Three Racial/Ethnic Groups of USA Adults

Objectives. To examine trends in the prevalence and disparities of traditional cardiovascular disease (CVD) risk factors among the major race/ethnic groups in the USA: non-Hispanic Whites (NHWs), non-Hispanic Blacks (NHBs), and Mexican Americans (MAs). Methods. We used cross-sectional trend analysis in women and men aged 25–84 years participating in the NHANES surveys, years 1988–1994 (n = 14,341) and 1999–2004 (n = 12,360). Results. The prevalence of obesity and hypertension increased significantly in NHW and NHB, both in men and women; NHB had the highest prevalence of obesity and hypertension in each time period. Diabetes prevalence showed a nonsignificant increasing trend in all groups and was higher in MA in both periods. Smoking significantly decreased in NHW men and NHB, the latter with the largest decline although the highest prevalence in each period; no changes were noted in MA, who had the lowest prevalence in both periods. Race/ethnic CVD risk factors disparities widened for obesity and hypercholesterolemia, remained unchanged for diabetes and hypertension, and narrowed for smoking. Conclusions. The increasing prevalence of obesity and hypertension underscores the need for better preventive measures, particularly in the NHB group that exhibits the worst trends. The decline in smoking rates may offset some of these unfavorable trends.

Prevención cardiovascular estancada: tendencias alarmantes y barreras socioeconómicas persistentes

La prevalencia, creciente en la ultima decada, de los factores de riesgo cardiovascular en todo el mundo y el estancamiento de la reduccion de la mortalidad cardiovascular (dependiente de la enfermedad coronaria sobre todo) en adultos jovenes de baja posicion socioeconomica son tendencias alarmantes que indican que la disminucion de la mortalidad cardiovascular observada en los ultimos 50 anos podria estar llegando a su termino. La obesidad, que ha alcanzado proporciones epidemicas en el mundo, ocupa un lugar central en esta tendencia. La enfermedad coronaria se desarrolla a traves de un proceso que involucra multiples vias causales. La expresion de los factores de riesgo cardiovascular parece estar determinada por caracteristicas que incluyen desde el codigo genetico hasta factores socioeconomicos desfavorables. El control del riesgo cardiovascular hasta ahora se ha centrado predominantemente en el manejo farmacologico de factores de riesgo aislados, en detrimento de otros factores participantes, en especial los socioeconomicos. Estrategias mas efectivas en el control del riesgo cardiovascular tanto en individuos como en las poblaciones deberian considerar este complejo escenario, que incluye caracteristicas socioeconomicas como la educacion, los ingresos y el medio ambiente construido. Las tendencias desfavorables senaladas mas arriba enfatizan la necesidad de redirigir las actuales estrategias preventivas del riesgo cardiovascular.

Does the epidemiologic paradox hold in the presence of risk factors for low birth weight infants among Mexican-born women in Colorado?

Objectives. To test whether foreign-born status confers a protective effect against low birth weight (LBW) outcomes among Mexican-origin women in Colorado. Methods. Retrospective cohort study utilizing Colorado birth records from 1989-2004 for multivariate logistic regression analysis. The study population was 66,422 U.S.-born women of Mexican origin (USB) and 85,000 Mexican-born (MB) women with singleton births. Results. Mexican-born women had 24.9% lower odds of LBW (OR 0.751 95% CI 0.782) than USB women. Mexican-born women had a higher prevalence of risk factors for LBW than their USB counterparts (anemia, cardiac disease, hypertension, inadequate prenatal care, less than high school education). After adjusting for these risk factors, MB women had 22.5% lower odds of having LBW infants than USB women (OR 0.775, 95% CI 0.73-0.81). Conclusions. This study supports the epidemiologic paradox of LBW; despite higher prevalence of risk factors, foreign-born status confers an overall protective effect against low birth weight outcomes.

Stagnant Cardiovascular Prevention: Alarming Trends and Persistent Socioeconomic Hurdles

Recently it has been suggested that the decline in cardiovascular mortality observed over the last 50 years may be coming to an end. This alarming trend, which has been noted mainly in younger adults from lower socioeconomic strata, may be linked to other changes, namely the increasing prevalence of modifiable risk factors, the most important of which is obesity. In contrast, our ability to predict cardiovascular risk continues to improve steadily, although it is unclear which will be its ability in designing more effective global preventive measures. Coronary heart disease appears to develop through multiple pathways, whose association with cardiovascular risk is mediated by complex processes involving numerous factors ranging from genetic predisposition to unfavorable socioeconomic circumstances. Although some attention has been paid to the latter, more effort has been put into controlling isolated risk factors. For example, numerous large studies have involved looking at the effect of singledrug therapies aimed at specific targets rather than examining more comprehensive approaches to managing multiple risk factors. In conclusion, an effective strategy for controlling modifiable risk factors in both individuals and populations must address this complex scenario and should consider significant socioeconomic factors such as education, income and the built environment. The unfavorable trend observed in cardiovascular health makes it essential that current preventive strategies are reassessed.

Do Gender and Race/Ethnicity Influence Acute Myocardial Infarction Quality of Care in a Hospital with a Large Hispanic Patient and Provider Representation?

Background. Disparities in acute myocardial infarction (AMI) care for women and minorities have been extensively reported in United States but with limited information on Hispanics. Methods. Medical records of 287 (62%) Hispanic and 176 (38%) non-Hispanic white (NHW) patients and 245 women (53%) admitted with suspected AMI to a southern California nonprofit community hospital with a large Hispanic patient and provider representation were reviewed. Baseline characteristics, outcomes (mortality, CATH, PCI, CABG, and use of pertinent drug therapy), and medical insurance were analyzed according to gender, Hispanic and NHW race/ethnicity when AMI was confirmed. For categorical variables, 2 × 2 chi-square analysis was conducted. Odds ratio and 95% confidence interval for outcomes adjusted for gender, race/ethnicity, cardiovascular risk factors, and insurance were obtained. Results. Women and Hispanics had similar drug therapy, CATH, PCI, and mortality as men and NHW when AMI was confirmed (n = 387). Hispanics had less private insurance than NHW (31.4% versus 56.3%, P < 0.001); no significant differences were found according to gender. Conclusions. No differences in quality measures and outcomes were found for women and between Hispanic and NHW in AMI patients admitted to a facility with a large Hispanic representation. Disparities in medical insurance showed no influence on these findings.