Peter John D De Chavez

Neighborhood-Level Racial/Ethnic Residential Segregation and Incident Cardiovascular Disease: The Multi-Ethnic Study of Atherosclerosis

Background— Previous research suggests that neighborhood-level racial/ethnic residential segregation is linked to health, but it has not been studied prospectively in relation to cardiovascular disease (CVD). Methods and Results— Participants were 1595 non-Hispanic black, 2345 non-Hispanic white, and 1289 Hispanic adults from the Multi-Ethnic Study of Atherosclerosis free of CVD at baseline (aged 45–84 years). Own-group racial/ethnic residential segregation was assessed by using the Gi* statistic, a measure of how the neighborhood racial/ethnic composition deviates from surrounding counties’ racial/ethnic composition. Multivariable Cox proportional hazards modeling was used to estimate hazard ratios for incident CVD (first definite angina, probable angina followed by revascularization, myocardial infarction, resuscitated cardiac arrest, coronary heart disease death, stroke, or stroke death) over 10.2 median years of follow-up. Among blacks, each standard deviation increase in black segregation was associated with a 12% higher hazard of developing CVD after adjusting for demographics (95% confidence interval, 1.02–1.22). This association persisted after adjustment for neighborhood-level characteristics, individual socioeconomic position, and CVD risk factors (hazard ratio, 1.12; 95% confidence interval, 1.02–1.23). For whites, higher white segregation was associated with lower CVD risk after adjusting for demographics (hazard ratio, 0.88; 95% confidence interval, 0.81–0.96), but not after further adjustment for neighborhood characteristics. Segregation was not associated with CVD risk among Hispanics. Similar results were obtained after adjusting for time-varying segregation and covariates. Conclusions— The association of residential segregation with cardiovascular risk varies according to race/ethnicity. Further work is needed to better characterize the individual- and neighborhood-level pathways linking segregation to CVD risk.

Disparities in sleep characteristics by race/ethnicity in a population-based sample: Chicago Area Sleep Study

BACKGROUND Prior studies report less favorable sleep characteristics among non-Whites as compared with non-Hispanic Whites. However, few population-based studies have used objective measures of sleep duration, especially in more than two racial/ethnic groups. We tested whether objectively estimated sleep duration and self-reported sleep quality varied by race and whether differences were at least partially explained by the variability in clinical, psychological, and behavioral covariates. METHODS Adults aged 35-64 years who self-identified as White, Black, Asian, or Hispanic were randomly sampled from Chicago, IL, and the surrounding suburbs. Our analytic sample included adults who had an apnea-hypopnea index <15 after one night of screening and who completed seven nights of wrist actigraphy for determination of sleep duration, sleep percentage, minutes of wake after sleep onset, and sleep fragmentation (n = 495). Daytime sleepiness was estimated using the Epworth Sleepiness Scale (ESS), and sleep quality was estimated from the Pittsburgh Sleep Quality Index (PSQI). RESULTS Following statistical adjustment for age, gender, education, work schedule (ie, day vs. night shift), smoking status, depressive symptoms, body mass index (BMI), hypertension, and diabetes, sleep duration (minutes) was significantly (all p < 0.01) shorter in Black (mean = 399.5), Hispanic (mean = 411.7), and Asian (mean = 409.6) participants than in White participants (mean = 447.4). All remaining sleep characteristics were significantly less favorable among Black participants as compared with White participants. Asian participants also reported significantly more daytime sleepiness than did White participants. CONCLUSIONS Differences in sleep characteristics by race/ethnicity are apparent in a sample of adults with a low probability of sleep apnea and following adjustment for known confounders.

Translating a heart disease lifestyle intervention into the community: the South Asian Heart Lifestyle Intervention (SAHELI) study; a randomized control trial

BackgroundSouth Asians (Asian Indians and Pakistanis) are the second fastest growing ethnic group in the United States (U.S.) and have an increased risk of atherosclerotic cardiovascular disease (ASCVD). This pilot study evaluated a culturally-salient, community-based healthy lifestyle intervention to reduce ASCVD risk among South Asians.MethodsThrough an academic-community partnership, medically underserved South Asian immigrants at risk for ASCVD were randomized into the South Asian Heart Lifestyle Intervention (SAHELI) study. The intervention group attended 6 interactive group classes focused on increasing physical activity, healthful diet, weight, and stress management. They also received follow-up telephone support calls. The control group received translated print education materials about ASCVD and healthy behaviors. Primary outcomes were feasibility and initial efficacy, measured as change in moderate/vigorous physical activity and dietary saturated fat intake at 3- and 6-months. Secondary clinical and psychosocial outcomes were also measured.ResultsParticipants’ (n = 63) average age was 50 (SD = 8) years, 63 % were female, 27 % had less than or equal to a high school education, one-third were limited English proficient, and mean BMI was 30 kg/m2 (SD ± 5). There were no significant differences in change in physical activity or saturated fat intake between the intervention and control group. Compared to the control group, the intervention group showed significant weight loss (−1.5 kg, p-value = 0.04) and had a greater sex-adjusted decrease in hemoglobin A1C (−0.43 %, p-value <0.01) at 6 months. Study retention was 100 %.ConclusionsThis pilot study suggests that a culturally-salient, community-based lifestyle intervention was feasible for engaging medically underserved South Asian immigrants and more effective at addressing ASCVD risk factors than print health education materials.Trial registrationNCT01647438, Date of Trial Registration: July 19, 2012

The association between sleep characteristics and prothrombotic markers in a population-based sample: Chicago Area Sleep Study

BACKGROUND AND AIM Short sleep duration and poor quality sleep are associated with coronary heart disease (CHD) mortality; however, the underlying pathophysiologic process remains unclear. Sleep apnea may confound the association because of its relationship with formation of thrombi, the vascular occlusive process in CHD. We tested whether sleep duration and quality were associated with prothrombotic biomarkers in adults with a low probability of apnea. METHODS We included adults aged 35-64 years recruited from the community and who had an apnea hypopnea index <15 after one night of screening (n=506). Sleep duration and maintenance were determined from 7 days of wrist actigraphy; daytime sleepiness was estimated using the Epworth Sleepiness Scale. Factor VIII (FVIII), von Willebrand factor (vWF), thrombin antithrombin (TAT) complexes, and plasminogen activator inhibitor-1 (PAI-1) were measured in fasting blood. RESULTS Sleep duration, maintenance, and daytime sleepiness were not associated with FVIII, vWf, or TAT. Sleep maintenance was modestly inversely associated with higher levels of log-transformed PAI-1 (β = -0.07, standard error (SE)=0.03 per 4.8%, p=0.04) following adjustment for demographic characteristics, cardiovascular risk factors, and body mass index (BMI). CONCLUSIONS Mild impairment in sleep was modestly associated with activation of coagulation; further study is needed to evaluate the role of fibrinolytic factors in sleep-mediated coronary thrombosis.

Relationship between obesity and anti-Müllerian hormone in reproductive-aged African American women

To determine whether there is an association between obesity and anti‐Müllerian hormone (AMH) among reproductive‐aged African American women (AAW).

The Mediation of Racial Differences in Hypertension by Sleep Characteristics: Chicago Area Sleep Study.

BACKGROUND Racial disparities in hypertension prevalence in the United States are established. Given our understanding of racial and ethnic disparities in sleep characteristics and demonstrated associations between sleep characteristics and hypertension, we tested whether sleep characteristics mediated racial disparities in hypertension. METHODS Analyses were performed in the Chicago Area Sleep Study, a population-based cohort study of 154 Blacks, 128 Whites, 103 Hispanics, and 109 Asians without obstructive sleep apnea. Participants underwent 7 days of wrist actigraphy monitoring. Algorithms were used to determine sleep duration and sleep maintenance (the percent of sleep in the sleep period). Hypertension was determined as systolic blood pressure >140mm Hg or diastolic blood pressure >90mm Hg or the use of antihypertensive medications. We estimated sample prevalence ratios for hypertension before and after adjustment for sleep characteristics and also conducted mediation analysis. RESULTS The sample prevalence of hypertension was highest in Blacks (36%), followed by Hispanics (14%), Asians (8%), and Whites (5%). The sample prevalence ratio for hypertension for Blacks vs. Whites was 5.52 (95% confidence interval (CI): 2.36, 13.23) after adjusting for age, sex, and education. Adjustment for sleep duration had no influence on the effect estimate, but adjustment for sleep maintenance attenuated the sample prevalence ratio to 4.55 (95% CI: 1.91, 11.14). Sleep maintenance mediated 11.4% of the difference in hypertension prevalence between Blacks and Whites in this sample. CONCLUSIONS Sleep maintenance mediated a small but significant portion of the disparity in hypertension between Blacks and Whites. Future research should investigate the mechanisms underlying these findings.

Limitations in Using Multiple Imputation to Harmonize Individual Participant Data for Meta-Analysis

Individual participant data (IPD) meta-analysis is a meta-analysis in which the individual-level data for each study are obtained and used for synthesis. A common challenge in IPD meta-analysis is when variables of interest are measured differently in different studies. The term harmonization has been coined to describe the procedure of placing variables on the same scale in order to permit pooling of data from a large number of studies. Using data from an IPD meta-analysis of 19 adolescent depression trials, we describe a multiple imputation approach for harmonizing 10 depression measures across the 19 trials by treating those depression measures that were not used in a study as missing data. We then apply diagnostics to address the fit of our imputation model. Even after reducing the scale of our application, we were still unable to produce accurate imputations of the missing values. We describe those features of the data that made it difficult to harmonize the depression measures and provide some guidelines for using multiple imputation for harmonization in IPD meta-analysis.

The Effect of Changes in Physical Activity on Sedentary Behavior: Results From a Randomized Lifestyle Intervention Trial.

Purpose. To investigate whether changes in physical activity (PA) have an impact on sedentary behavior (SB) during a lifestyle intervention. Design. Study design was a randomized trial. Setting/Subjects. Participants (n = 204) were individuals with low PA and high sedentary leisure screen time from the Chicago area. Intervention. Participants were randomized to either increase PA (iPA) or decrease sedentary leisure (dSED). The intervention consisted of decision support, coaching, and financial incentives. For iPA participants, the goal was at least 60 min/d of self-reported moderate-tovigorous-intensity PA (MVPA). For dSED participants the goal was less than 90 min/d of sedentary leisure screen time. Measures. Daily accelerometer-based measures of SB and bout-corrected MVPA were obtained. Analysis. Linear mixed-effects models were fit to estimate the effect of the intervention on MVPA and total SB and to estimate the effect of daily changes in MVPA on daily SB. Results. The iPA participants increased their bout-corrected MVPA by 14 min/d (p < .001) and decreased their total SB by 18 min/d (p < .001). The dSED participants did not significantly change their PA or their total SB. On days when participants exercised, each 10-minute bout of MVPA was associated with a 6-minute decrease in SB on the same day (p < .001). Conclusion. In an intervention study designed to increase MVPA, participants who increase their time spent exercising will obtain much of this time by reducing their SB.

A Longitudinal Relationship Between Depressive Symptoms and Development of Metabolic Syndrome: The Coronary Artery Risk Development in Young Adults Study.

Objective Despite variability in the burden of elevated depressive symptoms by sex and race and differences in the incidence of metabolic syndrome, few prior studies describe the longitudinal association of depressive symptoms with metabolic syndrome in a diverse cohort. We tested whether baseline and time-varying depressive symptoms were associated with metabolic syndrome incidence in black and white men and women from the Coronary Artery Risk Development in Young Adults study. Methods Participants reported depressive symptoms using the Center for Epidemiologic Studies Depression Scale at four examinations between 1995 and 2010. At those same examinations, metabolic syndrome was determined. Cox proportional hazards models were used to examine the associations of depressive symptoms on the development of metabolic syndrome in 3208 participants without metabolic syndrome at baseline. Results For 15 years, the incidence rate of metabolic syndrome (per 10,000 person-years) varied by race and sex, with the highest rate in black women (279.2), followed by white men (241.9), black men (204.4), and white women (125.3). Depressive symptoms (per standard deviation higher) were associated with incident metabolic syndrome in white men (hazard ratio = 1.25, 95% confidence interval = 1.08–1.45) and white women (hazard ratio = 1.17, 95% confidence interval = 1.00–1.37) after adjustment for demographic characteristics and health behaviors. There was no significant association between depression and metabolic syndrome among black men or black women. Conclusions Higher depressive symptoms contribute modestly to the onset of metabolic syndrome among white adults.

Health-care access and weight change among young adults: the Coronary Artery Risk Development in Young Adults (CARDIA) Study

OBJECTIVE Health-care access is associated with improved control of multiple chronic diseases, but the association between health-care access and weight change is unclear. The present study aims to test the association between health-care access and weight change. DESIGN The Coronary Artery Risk Development in Young Adults (CARDIA) Study is a multicentre population-based prospective study. Weight change was calculated at 3 and 13 years after CARDIA year 7 (1992-1993). Health-care access was defined as no barriers or one or more barriers to access (health insurance gap, no usual source of care, not seeking care due to expense). Intermediary variables evaluated included history of dieting and use of diet pills, meal replacements or weight-control programmes. SETTING Four cities in the USA. SUBJECTS Participants were aged 18-30 years at baseline (1985-1986). Analyses include 3922 black and white men and women with relevant data from CARDIA years 7, 10 and 20 (1992-1993, 1995-1996 and 2005-2006, respectively). RESULTS Mean weight change was +2.22 kg (+4.9 lb) by 3 years and +8.48 kg (+18.7 lb) by 13 years, with no differences by health-care access. Being on a weight-reducing diet was not consistently associated with health-care access across examinations. Use of diet pills, meal replacements or organized weight-control programmes was low, and did not vary by health-care access. CONCLUSIONS Weight gain was high irrespective of health-care access. Public health and clinical approaches are needed to address weight gain.