Publications by authors named "Kristina Vatcheva"

24 Publications

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Modeling the effect of lockdown timing as a COVID-19 control measure in countries with differing social contacts.

Sci Rep 2021 02 8;11(1):3354. Epub 2021 Feb 8.

Department of Environmental and Occupational Health, Faculty of Public Health, Kuwait University, 13110, Safat, Kuwait.

The application, timing, and duration of lockdown strategies during a pandemic remain poorly quantified with regards to expected public health outcomes. Previous projection models have reached conflicting conclusions about the effect of complete lockdowns on COVID-19 outcomes. We developed a stochastic continuous-time Markov chain (CTMC) model with eight states including the environment (SEAMHQRD-V), and derived a formula for the basic reproduction number, R, for that model. Applying the [Formula: see text] formula as a function in previously-published social contact matrices from 152 countries, we produced the distribution and four categories of possible [Formula: see text] for the 152 countries and chose one country from each quarter as a representative for four social contact categories (Canada, China, Mexico, and Niger). The model was then used to predict the effects of lockdown timing in those four categories through the representative countries. The analysis for the effect of a lockdown was performed without the influence of the other control measures, like social distancing and mask wearing, to quantify its absolute effect. Hypothetical lockdown timing was shown to be the critical parameter in ameliorating pandemic peak incidence. More importantly, we found that well-timed lockdowns can split the peak of hospitalizations into two smaller distant peaks while extending the overall pandemic duration. The timing of lockdowns reveals that a "tunneling" effect on incidence can be achieved to bypass the peak and prevent pandemic caseloads from exceeding hospital capacity.
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http://dx.doi.org/10.1038/s41598-021-82873-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7870675PMC
February 2021

Association of Visceral Adipose Tissue and Subclinical Atherosclerosis in US-Born Mexican Americans but not First Generation Immigrants.

J Am Heart Assoc 2020 10 15;9(20):e017373. Epub 2020 Oct 15.

Division of Cardiology Department of Internal Medicine at The University of Texas Health Science Center at Houston Houston TX.

Background Excess visceral adipose tissue (VAT) is a primary driver for the cardiometabolic complications of obesity; VAT-associated cardiovascular disease risk varies by race, but most studies have been done on Non-Hispanics. This study aimed to evaluate the clinical and metabolic correlates of VAT, its association with subclinical atherosclerosis, and the factors affecting this association in Mexican Americans. Methods and Results Participants (n=527) were drawn from the Cameron County Hispanic Cohort (CCHC), on whom a carotid ultrasound to assess carotid intima media thickness and a dual-energy X-ray absorptiometry scan to assess for VAT were obtained. Those in the highest quartiles of VAT were more likely to have hypertension, hypertriglyceridemia, low high-density lipoprotein, diabetes mellitus, and metabolic syndrome. Increased carotid intima media thickness was more prevalent in those in the highest quartile for VAT (57.4% versus 15.4% for the lowest quartile; <0.001). There was a graded increase in mean carotid intima media thickness with increasing VAT, after adjusting for covariates; for every 10 cm increase in VAT, there was an increase of 0.004 mm (SE=0.002; =0.0299) in mean carotid intima media thickness. However, this association was only seen among second or higher generation US-born Mexican Americans but not among first generation immigrants (=0.024). Conclusions Excess VAT is associated with indicators of metabolic disorders and subclinical atherosclerosis in Mexican Americans regardless of body mass index. However, acculturation appears to be an important modulator of this association. Longitudinal follow-up with targeted interventions among second or higher generation Hispanics to lower VAT and improve cardiometabolic risk may help prevent premature cardiovascular disease in this cohort.
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http://dx.doi.org/10.1161/JAHA.120.017373DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7763390PMC
October 2020

Understanding the Intention to Use Telehealth Services in Underserved Hispanic Border Communities: Cross-Sectional Study.

J Med Internet Res 2020 09 3;22(9):e21012. Epub 2020 Sep 3.

Social, Economic and Housing Statistics Division, Health and Disability Statistics Branch, US Census Bureau, Washington, DC, United States.

Background: Despite the United States having one of the leading health care systems in the world, underserved minority communities face significant access challenges. These communities can benefit from telehealth innovations that promise to improve health care access and, consequently, health outcomes. However, little is known about the attitudes toward telehealth in these communities, an essential first step toward effective adoption and use.

Objective: The purpose of this study is to assess the factors that shape behavioral intention to use telehealth services in underserved Hispanic communities along the Texas-Mexico border and examine the role of electronic health (eHealth) literacy in telehealth use intention.

Methods: We used cross-sectional design to collect data at a community health event along the Texas-Mexico border. The area is characterized by high poverty rates, low educational attainment, and health care access challenges. Trained bilingual students conducted 322 in-person interviews over a 1-week period. The survey instrument assessed sociodemographic information and telehealth-related variables. Attitudes toward telehealth were measured by asking participants to indicate their level of agreement with 9 statements reflecting different aspects of telehealth use. For eHealth literacy, we used the eHealth Literacy Scale (eHEALS), an 8-item scale designed to measure consumer confidence in finding, evaluating, and acting upon eHealth information. To assess the intention to use telehealth, we asked participants about the likelihood that they would use telehealth services if offered by a health care provider. We analyzed data using univariate, multivariate, and mediation statistical models.

Results: Participants were primarily Hispanic (310/319, 97.2%) and female (261/322, 81.1%), with an average age of 43 years. Almost three-quarters (219/298) reported annual household incomes below $20,000. Health-wise, 42.2% (136/322) self-rated their health as fair or poor, and 79.7% (255/320) were uninsured. The overwhelming majority (289/319, 90.6%) had never heard of telehealth. Once we defined the term, participants exhibited positive attitudes toward telehealth, and 78.9% (254/322) reported being somewhat likely or very likely to use telehealth services if offered by a health care provider. Based on multivariate proportional odds regression analysis, a 1-point increase in telehealth attitudes reduced the odds of lower versus higher response in the intention to use telehealth services by 23% (OR 0.77, 95% CI 0.73-0.81). Mediation analysis revealed that telehealth attitudes fully mediated the association between eHealth literacy and intention to use telehealth services. For a 1-point increase in eHEALS, the odds of lower telehealth use decreased by a factor of 0.95 (5%; OR 0.95, 95% CI 0.93-0.98; P<.001) via the increase in the score of telehealth attitudes.

Conclusions: Telehealth promises to address many of the access challenges facing ethnic and racial minorities, rural communities, and low-income populations. Findings underscore the importance of raising awareness of telehealth and promoting eHealth literacy as a key step in fostering positive attitudes toward telehealth and furthering interest in its use.
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http://dx.doi.org/10.2196/21012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7499162PMC
September 2020

Sex and age differences in prevalence and risk factors for prediabetes in Mexican-Americans.

Diabetes Res Clin Pract 2020 Jan 2;159:107950. Epub 2019 Dec 2.

School of Public Health, University of Texas Health Science Center at Houston, Brownsville Regional Campus, One West University Boulevard, Brownsville, TX 78520, USA.

Aims: Over 1/3 of Americans have prediabetes, while 9.4% have type 2 diabetes. The aim of our study was to estimate the prevalence of prediabetes in Mexican Americans, with known 28.2% prevalence of type 2 diabetes, by age and sex and to identify critical socio-demographic and clinical factors associated with prediabetes.

Methods: Data were collected between 2004 and 2017 from the Cameron County Hispanic Cohort in Texas. Weighted crude and sex- and age- stratified prevalences were calculated. Survey weighted logistic regression analyses were conducted to identify risk factors for prediabetes.

Results: The prevalence of prediabetes (32%) was slightly higher than the alarmingly high rate of type 2 diabetes (28.2%). Hispanic men had the highest overall (37.8%) and highest age stratified prevalence of prediabetes. Males had higher odds of prediabetes than females 1.56 (1.19, 2.06), controlling for the effect of family history of diabetes, age, BMI, and high-density lipoprotein. Family history of diabetes was a strong independent risk factor for prediabetes in all men, and in men and women in the age group 40-64 years. Elevated triglycerides (p = 0.003) was an independent risk factor for men and women in the age group 18-39 years.

Conclusions: Despite the very high prevalence of type 2 diabetes, prediabetes prevalence among Mexican Americans is only marginally less than national prediabetes rates. This suggests that progression to type 2 diabetes is more rapid and occurs earlier than nationally. Earlier screening and interventions for prediabetes, especially for men, are necessary to slow the transition to diabetes.
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http://dx.doi.org/10.1016/j.diabres.2019.107950DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7002264PMC
January 2020

Diabetes and Its Effect on Abdominal Aortic Aneurysm Growth Rate in Hispanic Patients.

Ann Vasc Surg 2019 Nov 5;61:254-260. Epub 2019 Aug 5.

Research Institute, Doctors Hospital at Renaissance Health System, Edinburg, TX; Department of Surgery, University of Texas Rio Grande Valley School of Medicine, Edinburg, TX.

Background: The growth rate of abdominal aortic aneurysms (AAA) can vary depending on age, baseline diameter, blood pressure, race, and history of smoking. Paradoxically, previous studies show evidence of a protective effect of diabetes on the rate of AAA expansion despite its well-established role in the morbidity and mortality of cardiovascular disease. This study aims to investigate the impact diabetes plays on AAA growth within a Hispanic population.

Methods: Data were collected from patients who were predominantly Mexican-American at a single hospital site. Baseline and follow-up measures for AAA diameter were obtained from serial imaging studies. Demographics, medical history, the presence of type 2 diabetes, and medication use were extracted from hospital records. Linear mixed-effects growth models were used to calculate the overall AAA growth rate and to assess the difference in AAA growth rate between demographics, comorbidities, and medication use.

Results: The study comprised 201 patients (70.4% male) with a mean baseline age of 79.1 years, of whom 43.2% were diabetic. The average monthly AAA growth rate across all study participants was 0.15 mm (SE = 0.02 mm). Independently, the average AAA expansion rate for the diabetic and nondiabetic groups was 0.07 mm (SE = 0.04 mm) and 0.21 mm (SE = 0.03 mm) per month, respectively. This demonstrates a 65% lower linear AAA expansion rate per month in patients with diabetes.

Conclusions: This study confirms a difference of AAA physiology between diabetics and nondiabetics in the Hispanic community. The observed significant difference in AAA growth rate may be a combination of factors associated with race/ethnicity, prevalence of diabetes mellitus, and low compliance with diabetic control exhibited in the Mexican-American population.
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http://dx.doi.org/10.1016/j.avsg.2019.06.004DOI Listing
November 2019

Statin Prescription for Patients With Atherosclerotic Cardiovascular Disease from National Survey Data.

Am J Cardiol 2019 07 8;124(1):1-7. Epub 2019 Apr 8.

Division of Cardiology, Department of Internal Medicine, McGovern Medical School at The University of Texas Health Science Center-Houston, Houston, Texas.

Despite strong evidence for the use of statins for patients with atherosclerotic cardiovascular disease (ASCVD), statin prescription is still suboptimal. We aimed to determine the rates and factors that influence statin prescription using national survey data. This is a cross-sectional retrospective study on 8,468 patients with clinical ASCVD who were drawn from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey from years 2011 to 2015. Survey-weighted analysis was conducted to estimate weighted prevalence and odds ratios for statin prescription. There was a significant increase in statin prescription from the years 2011 to 2015. Nevertheless, only 52% of ASCVD patients (55.4% in coronary heart disease and 37.7% in noncoronary heart disease) were prescribed a statin. Based on multivariable regression analysis, after adjusting for covariates, males had 1.28 (1.06, 1.55) higher odds of statin prescription, in coronary heart disease patients only. In the overall study population, Black n on-Hispanics had 31% lower odds of statin prescription compared with White non-Hispanics, and patients seen only by a healthcare provider other than a physician were 80% less likely to have a statin prescribed to them. In conclusion, the disparity in statin prescription in patients with ASCVD exists across minority groups, and our findings underscore existing variations in healthcare delivery.
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http://dx.doi.org/10.1016/j.amjcard.2019.03.048DOI Listing
July 2019

Assessment of Gestational Diabetes Mellitus Outcomes for Hispanic Women Living in the Rio Grande Valley.

Hisp Health Care Int 2019 09 28;17(3):111-117. Epub 2019 Mar 28.

2 The University of Texas Rio Grande Valley, Edinburg, TX, USA.

Introduction: Gestational diabetes mellitus (GDM) among women living along the U.S.-Mexico border are approximately twice that of the general population of pregnant U.S. women. This study compared outcomes for Hispanic pregnant women diagnosed and treated for GDM (i.e., two abnormal 3-hour oral glucose tolerance tests [OGTT]) with those who were screened but had only one abnormal 3-hour OGTT and therefore received no treatment.

Methods: Retrospective chart review of pregnant Hispanic women of Mexican origin ( = 95), with GDM ( = 41) or one abnormal 3-hour OGTT value ( = 54) who delivered between January 1, 2015, and December 31, 2017.

Results: No significant differences were found between the two groups with regard to sociodemographic variables, hyperbilirubinemia, or other adverse neonatal outcomes. Comparisons identified differences between women with and without adverse neonatal outcomes concerned type of delivery; there were more C-sections among women with GDM.

Conclusion: Pregnant women with one abnormal 3-hour OGTT value are at risk of giving birth to neonates with biomarkers similar to those diagnosed and treated for GDM. The treatment of hyperglycemia in Hispanic women of Mexican origin with one abnormal 3-hour OGTT value may improve the health outcomes and quality of life of the mother and the neonate. More research is warranted to clarify the risk of adverse outcomes of diverse pregnant women who do not meet guidelines for diagnosis of GDM.
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http://dx.doi.org/10.1177/1540415319833996DOI Listing
September 2019

The effect of Hispanic ethnicity on surgical outcomes: An analysis of the NSQIP database.

Am J Surg 2019 04 10;217(4):618-633. Epub 2018 Oct 10.

Research Institute, Doctors Hospital at Renaissance Health System, Edinburg, TX, USA; Department of Surgery, University of Texas Rio Grande Valley School of Medicine, Edinburg, TX, USA.

Background: Existing literature has shown racial/ethnic disparities between white and black surgical populations, however, surgical outcomes for Hispanic patients are limited in both scope and quantity.

Methods: Data from the American College of Surgeons National Surgical Quality Improvement Program from 2007 to 2015 was used to analyze surgical outcomes in approximately 3.5 million patients.

Results: Overall, Hispanics experienced lower odds of mortality compared to non-Hispanic White, non-Hispanic Black, and non-Hispanic American Indian or Alaska Native patients (all P < 0.0001). No difference was found in mortality odds between Hispanics and non-Hispanic Asian or Native Hawaiian patients. Hispanics experienced minimal disparities in complications as compared to non-Hispanic White and non-Hispanic Black but had a higher rate of select complications when compared to Non-Hispanic Asian, Native Hawaiian, or Pacific Islander.

Conclusion: Hispanics, in general, had lower odds of 30-day postoperative mortality and major morbidity compared to most of the races/ethnicities included in the ACS NSQIP database.
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http://dx.doi.org/10.1016/j.amjsurg.2018.10.004DOI Listing
April 2019

Frequency of Nonalcoholic Fatty Liver Disease and Subclinical Atherosclerosis Among Young Mexican Americans.

Am J Cardiol 2017 06 16;119(11):1717-1722. Epub 2017 Mar 16.

Division of Cardiology, Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, Texas. Electronic address:

Nonalcoholic fatty liver disease (NAFLD) is considered as the hepatic manifestation of the metabolic syndrome, whose criteria are risk factors for atherosclerotic cardiovascular disease. We aimed to evaluate the prevalence of NAFLD, its association with subclinical atherosclerosis, and factors that may account for this association in Mexican Americans. In a population-based cross-sectional sample drawn from the Cameron County Hispanic Cohort in Texas, carotid intima media thickness (cIMT), an indicator of subclinical atherosclerosis, was measured. Abnormal carotid ultrasound study was defined as mean cIMT >75th percentile for age and gender and/or plaque presence. NAFLD was defined as steatosis by ultrasound in the absence of other causes of liver disease. Multivariable weighted regression analyses were performed to evaluate associations between NAFLD and cIMT. Mean age was 50.4 ± 1.2 years with 58.3% women. Mean body mass index was 31.0 ± 0.4 kg/m, and 54.0% had the metabolic syndrome. NAFLD was highly prevalent (48.80%); subjects with NAFLD had greater body mass index, central obesity, fasting glucose levels, and dyslipidemia and were more likely to have the metabolic syndrome. Nearly 1/3 of subjects with NAFLD also had evidence of subclinical atherosclerosis (31.2%). After adjusting for covariates, there was an independent association between NAFLD and increased cIMT only in younger subjects <45 years (p = 0.0328). Subjects with both abnormal liver and carotid ultrasound studies tended to be obese, diabetic and have the metabolic syndrome. In conclusion, NAFLD is highly prevalent in this Mexican American cohort, with an independent association between NAFLD and subclinical atherosclerosis among younger subjects; clustering of diabetes, obesity, and metabolic syndrome in this health disparity cohort increases the risk of both liver disease and early atherosclerosis in young adults.
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http://dx.doi.org/10.1016/j.amjcard.2017.03.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6132248PMC
June 2017

The Precarious Health of Young Mexican American Men in South Texas, Cameron County Hispanic Cohort, 2004-2015.

Prev Chronic Dis 2016 08 25;13:E113. Epub 2016 Aug 25.

University of Texas School of Public Health, Brownsville Regional Campus, Brownsville, Texas.

Introduction: Hispanic men have higher rates of illness and death from various chronic conditions than do non-Hispanic men. We aimed to characterize the health of Mexican American men living on the US-Mexico border in South Texas and elucidate indications of chronic disease in young men.

Methods: We sampled all male participants from the Cameron County Hispanic Cohort, an ongoing population-based cohort of Mexican Americans in Brownsville, Texas. We calculated descriptive statistics and stratified the sample into 3 age groups to estimate the prevalence of sociodemographic, behavioral, and clinical factors by age group and evaluated differences between age groups.

Results: Obesity prevalence was approximately 50% across all age groups (P = .83). Diabetes prevalence was high overall (26.8%), and 16.9% (95% confidence interval [CI], 10.1%-23.8%) of men younger than 35 had diabetes. More than 70% of these young men had elevated liver enzymes, and mean values of aspartate aminotransferase were significantly higher in younger men (45.0 u/L; 95% CI, 39.5-50.6 u/L) than in both older age groups. Less than 20% of young men had any form of health insurance. Current smoking was higher in young men than in men in the other groups, and the rate was higher than the national prevalence of current smoking among Hispanic men.

Conclusions: We suggest a need for obesity and diabetes prevention programs and smoking cessation programs for men in this region. Opportunities exist to expand current intervention programs and tailor them to better reach this vulnerable population of young Hispanic men. Elevated liver enzymes in men younger than 35 suggest a substantial burden of liver abnormalities, a finding that warrants further study.
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http://dx.doi.org/10.5888/pcd13.160020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5003530PMC
August 2016

Multicollinearity in Regression Analyses Conducted in Epidemiologic Studies.

Epidemiology (Sunnyvale) 2016 Apr 7;6(2). Epub 2016 Mar 7.

Division of Epidemiology, Human Genetics and Environmental Sciences, University of Texas School of Public Health, Division of Clinical and Translational Sciences, Department of Internal Medicine, University of Texas Medical School at Houston, and Center for Clinical and Translational Sciences at The University of Texas Health Science Center at Houston, Houston, TX.

The adverse impact of ignoring multicollinearity on findings and data interpretation in regression analysis is very well documented in the statistical literature. The failure to identify and report multicollinearity could result in misleading interpretations of the results. A review of epidemiological literature in PubMed from January 2004 to December 2013, illustrated the need for a greater attention to identifying and minimizing the effect of multicollinearity in analysis of data from epidemiologic studies. We used simulated datasets and real life data from the Cameron County Hispanic Cohort to demonstrate the adverse effects of multicollinearity in the regression analysis and encourage researchers to consider the diagnostic for multicollinearity as one of the steps in regression analysis.
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http://dx.doi.org/10.4172/2161-1165.1000227DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4888898PMC
April 2016

Cirrhosis and Advanced Fibrosis in Hispanics in Texas: The Dominant Contribution of Central Obesity.

PLoS One 2016 7;11(3):e0150978. Epub 2016 Mar 7.

Department of Molecular and Cellular Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America.

Liver cirrhosis is a leading cause of death in Hispanics and Hispanics who live in South Texas have the highest incidence of liver cancer in the United States. We aimed at determining the prevalence and associated risk factors of cirrhosis in this population. Clinical and demographic variables were extracted for 2466 participants in the community-based Cameron County Hispanic Cohort in South Texas. Aspartate transaminase to Platelet Ratio Index (APRI) was used to predict cirrhosis in Cameron County Hispanic Cohort. The prevalence of cirrhosis using APRI≥2 was 0.94%, which is nearly 4-fold higher than the national prevalence. Using APRI≥1, the overall prevalence of cirrhosis/advanced fibrosis was 3.54%. In both analyses, highest prevalence was observed in males, specifically in the 25-34 age group. Risk factors independently associated with APRI≥2 and APRI≥1 included hepatitis C, diabetes and central obesity with a remarkable population attributable fraction of 52.5% and 65.3% from central obesity, respectively. Excess alcohol consumption was also independently associated with APRI≥2. The presence of patatin-like phospholipase domain-containing-3 gene variants was independently associated with APRI≥1 in participants >50 years old. Males with both central obesity and excess alcohol consumption presented with cirrhosis/advanced fibrosis at a young age. Alarmingly high prevalence of cirrhosis and advanced fibrosis was identified in Hispanics in South Texas, affecting young males in particular. Central obesity was identified as the major risk factor. Public health efforts are urgently needed to increase awareness and diagnosis of advanced liver fibrosis in Hispanics.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0150978PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4780836PMC
July 2016

Liver and Other Gastrointestinal Cancers Are Frequent in Mexican Americans.

J Racial Ethn Health Disparities 2016 Mar 28;3(1):1-10. Epub 2015 Mar 28.

Division of Epidemiology, Human Genetics and Environmental Science, University of Texas Health Science Center at Houston School of Public Health, Brownsville Campus, 80 Fort Brown, Brownsville, TX, 78520, USA.

Background: Disease patterns in Mexican American health-disparity populations differ from larger US populations.

Aims: This study is aimed to determine frequency of gastrointestinal cancers in Mexican Americans.

Methods: We analyzed self-reported data from the Cameron County Hispanic Cohort where we find high rates of risk factors for cancer: obesity (48.5 %) and diabetes (30.7 %). Participants provided cancer histories about themselves and first- and second-degree relatives. Logistic regression models assessed risk factors. Frequencies of cancer sites were ranked and validated using concurrent age local cancer registry data.

Results: Among 9,249 individuals (participants and their relatives), there were 1,184 individuals with reports of cancer. Among cohort participants under 70 years of age, the most significant risk factor for all-cause cancers was diabetes (OR 3.57, 95 % CI 1.32, 9.62). Participants with metabolic syndrome were significantly more likely to report cancer in relatives [1.73 (95 % CI 1.26, 2.37]. Among cancers in fathers, liver cancer was ranked third, stomach fourth, colorectal sixth, and pancreas tenth. In mothers, stomach was third, liver fourth, colorectal seventh, and pancreas eleventh. The unusual prominence of these cancers in Mexican Americans, including liver cancer, was supported by age-adjusted incidence in local registry data.

Conclusions: Gastrointestinal system cancers, particularly, liver cancer, in a Mexican American health disparity cohort and their relatives rank higher than in other ethnicities and are associated with high rates of diabetes and metabolic syndrome. Effective prevention of diabetes and low-tech, high-quality screening strategies for gastrointestinal cancers are needed in health disparity communities.
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http://dx.doi.org/10.1007/s40615-015-0104-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5676561PMC
March 2016

Metabolic Health Has Greater Impact on Diabetes than Simple Overweight/Obesity in Mexican Americans.

J Diabetes Res 2016 10;2016:4094876. Epub 2016 Jan 10.

Division of Epidemiology, School of Public Health, University of Texas Health Science Center at Houston, Brownsville Campus, Brownsville, TX 78520, USA.

Purpose: To compare the risk for diabetes in each of 4 categories of metabolic health and BMI.

Methods: Participants were drawn from the Cameron County Hispanic Cohort, a randomly selected Mexican American cohort in Texas on the US-Mexico border. Subjects were divided into 4 phenotypes according to metabolic health and BMI: metabolically healthy normal weight, metabolically healthy overweight/obese, metabolically unhealthy normal weight, and metabolically unhealthy overweight/obese. Metabolic health was defined as having less than 2 metabolic abnormalities. Overweight/obese status was assessed by BMI higher than 25 kg/m(2). Diabetes was defined by the 2010 ADA definition or by being on a diabetic medication.

Results: The odds ratio for diabetes risk was 2.25 in the metabolically healthy overweight/obese phenotype (95% CI 1.34, 3.79), 3.78 (1.57, 9.09) in the metabolically unhealthy normal weight phenotype, and 5.39 (3.16, 9.20) in metabolically unhealthy overweight/obese phenotype after adjusting for confounding factors compared with the metabolically healthy normal weight phenotype.

Conclusions: Metabolic health had a greater effect on the increased risk for diabetes than overweight/obesity. Greater focus on metabolic health might be a more effective target for prevention and control of diabetes than emphasis on weight loss alone.
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http://dx.doi.org/10.1155/2016/4094876DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4736910PMC
December 2016

Depression, obesity, and metabolic syndrome: prevalence and risks of comorbidity in a population-based representative sample of Mexican Americans.

J Clin Psychiatry 2015 Oct;76(10):e1300-5

Department of Psychiatry, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229

Introduction: We examined the prevalence of depression, obesity, and metabolic syndrome and associations between them in a population-based representative cohort of Mexican Americans living on the United States-Mexico border.

Method: The sample in this cross-sectional analysis consisted of 1,768 Mexican American adults (≥ 18 years of age) assessed between the years 2004 and 2010, with whom we tested our central hypothesis of a significant relationship between obesity and depression. Depression was measured using the Center for Epidemiologic Studies-Depression scale (CES-D) with a cutoff score of ≥ 16 for depression and a cutoff score of ≥ 27 for severe depression. We categorized body mass index (BMI) values as obese (≥ 30kg/m(2)) and later subdivided the obese subjects into obese (30-39 kg/m(2)[inclusive]) and morbidly obese (≥ 40 kg/m(2)). Metabolic syndrome was defined using the American Heart Association definition requiring at least 3 of the following: increased waist circumference, elevated triglycerides, reduced high-density lipoprotein (HDL) cholesterol, elevated blood pressure, and elevated fasting glucose. Weighted data were analyzed to establish prevalence of depression, obesity, and metabolic syndrome. Univariate and multivariable weighted regression models were used to test potential associations between these disorders.

Results: Using weighted prevalence, we observed high rates of depression (30%), obesity (52%), and metabolic syndrome (45%). Univariate models revealed female gender (P = .0004), low education (P = .003), low HDL level (P = .009), and increased waist circumference (P = .03) were associated with depression. Female gender (P = .01), low education (P = .003), and morbid obesity (P = .002) were risk factors for severe depression and remained significant in multivariable models.

Conclusions: In this large cohort of Mexican Americans, obesity, female gender, and low education were identified risk factors for depression. These indicators may serve as targets for early detection, prevention, and intervention in this population.
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http://dx.doi.org/10.4088/JCP.14m09118DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5836315PMC
October 2015

Barriers to Disaster Preparedness among Medical Special Needs Populations.

Front Public Health 2015 2;3:205. Epub 2015 Sep 2.

University of Texas Health Science Center at Houston - School of Public Health, Brownsville Regional Campus , Brownsville, TX , USA.

A medical special needs (MSN) assessment was conducted among 3088 respondents in a hurricane prone area. The sample was female (51.7%), Hispanic (92.9%), aged >45 years (51%), not insured for health (59.2%), and with an MSN (33.2%). Barriers to preparedness were characterized for all households, including those with inhabitants reporting MSN ranging from level 0 (mild) to level 4 (most severe). Multivariable logistic regression tested associations between hurricane preparedness and barriers to evacuation by level of MSN. A significant interaction effect between number of evacuation barriers and MSN was found. Among households that reported individuals with level 0 MSN, the odds of being unprepared increased 18% for each additional evacuation barrier [OR = 1.18, 95% CI (1.08, 1.30)]. Among households that reported individuals with level 1 MSN, the odds of being unprepared increased 29% for each additional evacuation barrier [OR = 1.29, 95% CI (1.11, 1.51)]. Among households that reported individuals with level 3 MSN, the odds of being unprepared increased 68% for each additional evacuation barrier [OR = 1.68, 95% CI (1.21, 1.32)]. MSN alone did not explain the probability of unpreparedness, but rather MSN in the presence of barriers helped explain unpreparedness.
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http://dx.doi.org/10.3389/fpubh.2015.00205DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4557096PMC
September 2015

ASSOCIATION OF TOTAL AND DIFFERENTIAL WHITE BLOOD CELL COUNTS TO DEVELOPMENT OF TYPE 2 DIABETES IN MEXICAN AMERICANS IN CAMERON COUNTY HISPANIC COHORT.

Diabetes Res 2015 Sep 23;1(4):103-112. Epub 2015 Sep 23.

Division of Epidemiology, University of Texas Health Science Center-Houston, School of Public Health, Brownsville Campus, Brownsville, TX.

Objective: To evaluate the relationship between total and differential White Blood Cell (WBC) counts with time to transition to type 2 diabetes in Mexican Americans using prospective data from the Cameron County Hispanic Cohort (CCHC).

Results: Multivariable Cox proportional hazards regression models revealed that obese Mexican-American cohort participants whose total WBC or granulocyte count increased over time had 1.39 and 1.35 times higher risk respectively of transition to type 2 diabetes when compared to overweight participants. The granulocyte or total WBC count in participants with BMI≥35 were significant risk factors for transition to type 2 diabetes.

Conclusions: Increased total WBC and WBC differential counts, particularly lymphocytes and granulocytes, are associated with risk of transition to type 2 diabetes in obese Mexican Americans, after adjusting for other potential confounders. Screening and monitoring the WBC counts, including lymphocytes and granulocytes can help with monitoring potential transition to type 2 diabetes.
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http://dx.doi.org/10.17140/DROJ-1-117DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5226365PMC
September 2015

Undiagnosed Diabetes and Pre-Diabetes in Health Disparities.

PLoS One 2015 17;10(7):e0133135. Epub 2015 Jul 17.

Division of Epidemiology, University of Texas Health Science Center, Houston, School of Public Health, Brownsville Campus, Brownsville, Texas, United States of America.

Globally half of all diabetes mellitus is undiagnosed. We sought to determine the extent and characteristics of undiagnosed type 2 diabetes mellitus and pre-diabetes in Mexican Americans residing in the United States. This disadvantaged population with 50% lifetime risk of diabetes is a microcosm of the current pandemic. We accessed baseline data between 2004 and 2014 from 2,838 adults recruited to our Cameron County Hispanic Cohort (CCHC); a two-stage randomly selected 'Framingham-like' cohort of Mexican Americans on the US Mexico border with severe health disparities. We examined prevalence, risk factors and metabolic health in diagnosed and undiagnosed diabetes and pre-diabetes. Two thirds of this Mexican American population has diabetes or pre-diabetes. Diabetes prevalence was 28.0%, nearly half undiagnosed, and pre-diabetes 31.6%. Mean BMI among those with diabetes was 33.5 kg/m2 compared with 29.0 kg/m2 for those without diabetes. Significant risk factors were low income and educational levels. Most with diabetes had increased waist/hip ratio. Lack of insurance and access to health services played a decisive role in failure to have diabetes diagnosed. Participants with undiagnosed diabetes and pre-diabetes had similar measures of poor metabolic health similar but generally not as severe as those with diagnosed diabetes. More than 50% of a minority Mexican American population in South Texas has diabetes or pre-diabetes and is metabolically unhealthy. Only a third of diabetes cases were diagnosed. Sustained efforts are imperative to identify, diagnose and treat individuals in underserved communities.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0133135PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4505949PMC
May 2016

Anxiety, depression and smoking status among adults of Mexican heritage on the Texas-Mexico Border.

Hisp J Behav Sci 2014 Aug;36(3):316-328

University of Texas Health Science at Houston, Center School of Public Health, Brownsville Regional Campus.

The goal of the current analysis is to examine relationships between smoking status and anxiety and depression among adults of Mexican heritage to inform the development of culturally relevant smoking cessations efforts. Mexican heritage residents (N=1,791) of the city of Brownsville, TX, aged 18 years or older, enrolled in the Cameron County Hispanic Cohort, were selected through two stage cluster sampling of randomly selected census tracts from the first and third quartile of SES using Census 2000. Among current smokers, anxiety and depression scores were highest among women who had not completed high school (p<0.05). Former smoking women, but not men, with at least a high school education and former smoking women born in the United States reported higher levels of anxiety and depression than never smoking women. Negative affective states may represent a greater barrier to smoking cessation among women than men.
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http://dx.doi.org/10.1177/0739986314540455DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4479298PMC
August 2014

Non-communicable diseases and preventive health behaviors: a comparison of Hispanics nationally and those living along the US-Mexico border.

BMC Public Health 2015 Jun 19;15:564. Epub 2015 Jun 19.

University of Texas Health Science Center - School of Public Health, Brownsville Regional Campus, One West University Blvd, RAHC, Brownsville, TX, 78520, USA.

Background: Non-communicable diseases (NCDs) are rising among US Hispanics, but few studies have examined the preventive health behaviors for these NCDs among Hispanics. This study compared the preventive health behaviors of smoke-free living, physical activity, fruit and vegetable consumption, and avoidance of heavy alcohol use in Hispanics in the United States and Hispanics living along the US-Mexico border.

Methods: Two weighted data sets with information on Hispanic populations were analyzed: 1) the national Behavioral Risk Factor Surveillance Survey (n = 29,942) from 2009; and 2) the Cameron County Hispanic Cohort (n = 1,439) recruited from the US-Mexico border between 2008-2011. To compare the preventive health behaviors of the samples, within a generalized estimating equation framework, weighted univariate and multivariate logistic regression analyses were conducted controlling for age, educational attainment, employment, language, and insurance status. Statistical tests were two-sided with a significance level set at 0.05.

Results: Both samples reported low engagement in preventive behaviors. However, Hispanic males and females from the US-Mexico border were significantly less likely than the national sample to meet physical activity and fruit and vegetable consumption guidelines. Also, Hispanic males from the US-Mexico border were more likely to engage in heavy alcohol use.

Conclusion: The lack of preventive health behaviors among Hispanics living along the US-Mexico border presents a dire prospect for NCD control in the region. Multipronged approaches to address multiple behaviors should be considered.
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http://dx.doi.org/10.1186/s12889-015-1850-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4474463PMC
June 2015

Subclinical atherosclerosis and obesity phenotypes among Mexican Americans.

J Am Heart Assoc 2015 Mar 18;4(3):e001540. Epub 2015 Mar 18.

Division of Epidemiology, School of Public Health, University of Texas Health Science Center-Houston, Brownsville, TX (K.P.V., B.R., J.B.M.C., S.P.F.H.).

Background: Data on the influence of obesity on atherosclerosis in Hispanics are inconsistent, possibly related to varying cardiometabolic risk among obese individuals. We aimed to determine the association of obesity and cardiometabolic risk with subclinical atherosclerosis in Mexican-Americans.

Methods And Results: Participants (n=503) were drawn from the Cameron County Hispanic Cohort. Metabolic health was defined as <2 of the following: blood pressure ≥130/85; triglyceride ≥150 mg/dL; high-density lipoprotein cholesterol <40 mg/dL (men) or <50 mg/dL (women); fasting glucose ≥100 mg/dL; homeostasis model assessment of insulin resistance value >5.13; or high-sensitivity C-reactive protein >3 mg/L. Carotid intima media thickness (cIMT) was measured. A high proportion of participants (77.8%) were metabolically unhealthy; they were more likely to be male, older, with fewer years of education, and less likely to meet daily recommendations regarding fruit and vegetable servings. One-third (31.8%) had abnormal carotid ultrasound findings. After adjusting for covariates, mean cIMT varied across the obesity phenotypes (P=0.0001); there was no difference among the metabolically unhealthy regardless of whether they were obese or not. In multivariable analysis, after adjusting for covariates, cardiometabolic risk (P=0.0159), but not obesity (P=0.1446), was significantly associated with subclinical atherosclerosis.

Conclusions: In Mexican-Americans, cardiometabolic risk has a greater effect on early atherosclerosis development than body mass index. Non-obese but metabolically unhealthy participants had similar development of subclinical atherosclerosis as their obese counterparts. Interventions to maintain metabolic health among obese and non-obese patients may be a more important goal than weight loss alone.
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http://dx.doi.org/10.1161/JAHA.114.001540DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4392436PMC
March 2015

ELECTROCARDIOGRAPHIC ABNORMALITIES AMONG MEXICAN AMERICANS: CORRELATIONS WITH DIABETES, OBESITY, AND THE METABOLIC SYNDROME.

World J Cardiovasc Dis 2012 Apr;2(2):50-56

Division of Cardiology, Department of Internal Medicine, University of Texas Health Science Center-Houston, Houston, TX.

Background: Resting ischemic electrocardiographic abnormalities have been associated with cardiovascular mortality. Simple markers of abnormal autonomic tone have also been associated with diabetes, obesity, and the metabolic syndrome in some populations. Data on these electrocardiographic abnormalities and correlations with coronary risk factors are lacking among Mexican Americans wherein these conditions are prevalent.

Objective: This study aimed to evaluate the prevalent resting electrocardiographic abnormalities among community-dwelling Mexican Americans, and correlate these findings with coronary risk factors, particularly diabetes, obesity, and the metabolic syndrome.

Methods: Study subjects (n=1280) were drawn from the Cameron County Hispanic Cohort comprised of community-dwelling Mexican Americans living in Brownsville, Texas at the United States-Mexico border. Ischemic electrocardiographic abnormalities were defined as presence of ST/T wave abnormalities suggestive of ischemia, abnormal Q waves, and left bundle branch block. Parameters that reflect autonomic tone, such as heart rate-corrected QT interval and resting heart rate, were also measured.

Results: Ischemic electrocardiographic abnormalities were more prevalent among older persons and those with hypertension, diabetes, obesity, and the metabolic syndrome. Subjects in the highest quartiles of QTc interval and resting heart rate were also more likely to be diabetic, hypertensive, obese, or have the metabolic syndrome.

Conclusions: Among Mexican Americans, persons with diabetes, obesity, and the metabolic syndrome were more likely to have ischemic electrocardiographic abnormalities, longer QTc intervals, and higher resting heart rates. A resting electrocardiogram can play a complementary role in the comprehensive evaluation of cardiovascular risk in this minority population.
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http://dx.doi.org/10.4236/wjcd.2012.22009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3600844PMC
April 2012

Missed opportunities for diagnosis and treatment of diabetes, hypertension, and hypercholesterolemia in a Mexican American population, Cameron County Hispanic Cohort, 2003-2008.

Prev Chronic Dis 2012 ;9:110298

University of Texas School of Public Health, 80 Fort Brown, Brownsville, TX 78597, USA.

Introduction: Diabetes, hypertension, and hypercholesterolemia are common chronic diseases among Hispanics, a group projected to comprise 30% of the US population by 2050. Mexican Americans are the largest ethnically distinct subgroup among Hispanics. We assessed the prevalence of and risk factors for undiagnosed and untreated diabetes, hypertension, and hypercholesterolemia among Mexican Americans in Cameron County, Texas.

Methods: We analyzed cross-sectional baseline data collected from 2003 to 2008 in the Cameron County Hispanic Cohort, a randomly selected, community-recruited cohort of 2,000 Mexican American adults aged 18 or older, to assess prevalence of diabetes, hypertension, and hypercholesterolemia; to assess the extent to which these diseases had been previously diagnosed based on self-report; and to determine whether participants who self-reported having these diseases were receiving treatment. We also assessed social and economic factors associated with prevalence, diagnosis, and treatment.

Results: Approximately 70% of participants had 1 or more of the 3 chronic diseases studied. Of these, at least half had had 1 of these 3 diagnosed, and at least half of those who had had a disease diagnosed were not being treated. Having insurance coverage was positively associated with having the 3 diseases diagnosed and treated, as were higher income and education level.

Conclusions: Although having insurance coverage is associated with receiving treatment, important social and cultural barriers remain. Failure to provide widespread preventive medicine at the primary care level will have costly consequences.
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http://dx.doi.org/10.5888/pcd9.110298DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3475522PMC
November 2012

High prevalence of subclinical atherosclerosis by carotid ultrasound among Mexican Americans: discordance with 10-year risk assessment using the Framingham risk score.

Echocardiography 2012 Nov 2;29(10):1224-32. Epub 2012 Jul 2.

Division of Cardiology, Department of Internal Medicine, University of Texas Health Science Center-Houston, Houston, TexasDivision of Epidemiology, School of Public Health, Brownsville Campus, University of Texas Health Science Center-Houston, Brownsville, TexasCollege of Nursing, University of Texas at Brownsville, Brownsville, Texas.

Background: Framingham risk scores (FRS) were validated in a mostly Caucasian population. Evaluation of subclinical atherosclerosis by carotid ultrasound may improve ascertainment of risk in nonwhite populations. This study aimed to evaluate carotid intima-media thickness (cIMT) and carotid plaquing among Mexican Americans, and to correlate these markers with coronary risk factors and the FRS.

Methods/results: Participants (n = 141) were drawn from the Cameron County Hispanic Cohort. Carotid artery ultrasound was performed and cIMT measured. Carotid plaque was defined as areas of thickening >50% of the thickness of the surrounding walls. Mean age was 53.1 ± 11.7 years (73.8% female). Most were overweight or obese (88.7%) and more than half (53.2%) had the metabolic syndrome. One third (34.8%) had abnormal carotid ultrasound findings (either cIMT ≥75th percentile for gender and age or presence of plaque). Among those with abnormal carotid ultrasound, the majority were classified as being at low 10-year risk for cardiovascular events. Carotid ultrasound reclassified nearly a third of the cohort as being at high risk. This discordance between 10-year FRS and carotid ultrasound was noted whether risk was assessed for hard coronary events or global risk. Concordance between FRS and carotid ultrasound findings was best when long-term (30-year) risk was assessed and no subject with an abnormal carotid ultrasound was categorized as low risk by the 30-year FRS algorithm.

Conclusions: Integration of carotid ultrasound findings to coronary risk assessments and use of longer term prediction models may provide better risk assessment in this minority population, with earlier initiation of appropriate therapies.
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http://dx.doi.org/10.1111/j.1540-8175.2012.01774.xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3687003PMC
November 2012