Publications by authors named "R Frank Gillum"

347 Publications

Geographic Variation in Racial Disparities in Mortality from Influenza and Pneumonia in the US in the Pre-COVID-19 Era.

Chest 2021 Jan 2. Epub 2021 Jan 2.

Division of Pulmonary and Critical Care, Howard University Hospital; Department of Internal Medicine, Howard University College of Medicine.

Background: In 2018, influenza and pneumonia was the 8th leading cause of death in the United States (US). Since 1950, non-Hispanic blacks (NHB) have experienced higher rates of mortality than non-Hispanic whites (NHW). Previous studies revealed geographic variation in mortality rates by race. The identification of areas with the greatest disparity in influenza and pneumonia mortality may assist policy makers in the allocation of resources including for the COVID-19 pandemic.

Research Question: Does geographic variation in racial disparity in influenza and pneumonia mortality exist?

Study Design: and Methods: The Centers for Disease Control and Prevention (CDC) database for multiple cause of death between 1999-2018 for NHB and NHW decedents aged ≥ 25 years with an ICD-10 code for influenza (J09-J11) and pneumonia (J12-J18) was used. Age-adjusted mortality rates (AAMR) with 95% confidence intervals (CI)were computed by race for Health & Human Services (HHS) regions and urbanization in non-Hispanics RESULTS: In 1999-2018, there were 540,476 deaths among NHB and NHW aged 25-84 years. AAMR was higher in NHB than NHW in each age group and in 7 of 10 HHS regions. The greatest disparity was in HHS regions 2 (NY, NJ) and 9 (Arizona, California, Hawaii, Nevada). In HHS region 2, NHB [24.6 (95% CI 24.1-25.1)] were more likely to die than NHW [15.7 (95% CI 15.6-15.9)]. Similarly, in region 9, NHB [23.2 (95% CI 22.7-23.8)] had higher mortality than NHW [16.1 (95% CI 15.9-16.2)]. Within these regions, disparities were greatest in the core of major metropolitan areas. Much of the disparity was due to very high mortality rates in NHB in these areas: region 2 large central metro areas NHB 28.2 (95% CI 27.6-28.9).

Interpretation: In 1999-2018 the NHB-NHW disparity in AAMR from influenza and pneumonia was greatest in central metro areas of HHS regions 2 and 9.
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http://dx.doi.org/10.1016/j.chest.2020.12.029DOI Listing
January 2021

Frequency of Attendance at Religious Services and Exposure to Environmental Tobacco Smoke.

J Relig Health 2021 Jan 2. Epub 2021 Jan 2.

Department of Medicine, Howard University College of Medicine, 1112 Nora Drive, Silver Spring, MD, 20904, USA.

Exposure to environmental tobacco smoke (ETS) is associated with increased risk of disease and death. Reports on ETS and religion are lacking. Data from the National Health and Nutrition Examination Survey were used to test this association. In 4,712 nonsmokers, serum cotinine level of 0.05-3.99 ng/mL indicated ETS exposure. Frequency of attendance at religious services was categorized as >  = weekly or less. In bivariate analysis, ETS exposure occurred in 28.6% of those with >  = weekly attendance but 36.4% of less frequent attenders (p = 0.0004). In logistic regression controlling for multiple confounders OR = 0.72, 95%CI 0.61-0.85. ETS exposure was negatively associated with religion.
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http://dx.doi.org/10.1007/s10943-020-01130-4DOI Listing
January 2021

Common Injuries in Whitewater Rafting, Kayaking, Canoeing, and Stand-Up Paddle Boarding.

Curr Sports Med Rep 2020 Oct;19(10):422-429

Strauss Health Sciences Library, University of Colorado Anschutz Medical Campus, Aurora, CO.

Paddle sports continue to be popular forms of outdoor recreation in the United States and around the world. This includes not only the more traditional sports of rafting, kayaking, and canoeing but also the newer and growing sport of stand-up paddle boarding. Because these sports are based in an aquatic environment, and frequently whitewater, there are unique, significant risks of injury. Overall, injuries in paddling sports are mostly musculoskeletal and are both acute and chronic in nature. Some injuries, such as environmental and head injuries, are especially problematic because they can lead to serious morbidity and mortality, most importantly drowning. This review describes the epidemiology, type, and location of injuries across paddle sports. It not only focuses on whitewater injuries but also includes information on injuries sustained in other aquatic paddling environments.
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http://dx.doi.org/10.1249/JSR.0000000000000763DOI Listing
October 2020

Atherosclerotic Peripheral Artery Disease in the United States: Gender and Ethnic Variation in a Multiple Cause-of-Death Analysis.

Vasc Endovascular Surg 2020 Aug 29;54(6):482-486. Epub 2020 May 29.

Department of Surgery, Howard University College of Medicine, Washington, DC, USA.

Background: Atherosclerotic peripheral artery disease (PAD) is an important cause of morbidity in the United States. In this article, we conducted a multiple cause-of-death analysis of PAD to determine patterns and trends in its contribution to mortality.

Methods: The Centers for Disease Control and Prevention statistics data were used to determine the number of deaths with the following 10th revision of the codes selected as an underlying cause of death (UCOD) or a contributing cause considering multiple causes of death (MCOD): 170.2, 170.9, 173.9, 174.3, and 174.4. The age-adjusted death rates per 100 000 population by age, gender, race, ethnicity, and region were computed for the United States between the years 1999 and 2017. In these years, there were 47 728 569 deaths from all causes.

Results: In 1999 to 2017 combined, there were a total of 311 175 deaths associated with PAD as an UCOD. However, there were 1 361 253 deaths with PAD listed as an UCOD or a contributing cause in MCOD, which is 4.3 times higher than UCOD. Age-adjusted MCOD rates were higher in males (25.6) than in females (19.4). Among non-Hispanics, the rate in African American males and females was 1.2 times higher than in Caucasians. Age-adjusted MCOD rates have declined in African Americans and Caucasians irrespective of gender from 2000 to 2017.

Conclusion: Peripheral artery disease is mentioned 4 times as often on death certificates as a contributing cause of death as it is chosen as the UCOD. Overall, age-adjusted MCOD rates were higher in African Americans than Caucasians, males than females, and declined between 2000 and 2017.
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http://dx.doi.org/10.1177/1538574420928158DOI Listing
August 2020

A Resource for Planning for Disasters and Outbreaks: Lessons From the West African Ebola Epidemic.

Disaster Med Public Health Prep 2020 May 26. Epub 2020 May 26.

Howard University College of Medicine, Washington, DC.

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http://dx.doi.org/10.1017/dmp.2020.73DOI Listing
May 2020

Exercise Training Induced Changes In Nuclear Magnetic Resonance-Measured Lipid Particles In Mild Cognitively Impaired Elderly African American Volunteers: A Pilot Study.

Clin Interv Aging 2019 5;14:2115-2123. Epub 2019 Dec 5.

Division of Geriatrics, Department of Medicine and Clinical, Howard University Hospital, Washington, DC, USA.

Purpose: Poor cardiorespiratory fitness (CRF) is linked to cognitive deterioration, but its effects on lipid heterogeneity and functional properties in older African American (AA) subjects with mild cognitive impairment (MCI) need elucidation. This study determined whether exercise training-induced changes in blood lipid particle sizes (LPS) were associated with CRF determined by VOMax in elderly AAs with MCI. Given the pivotal role of brain-derived neurotrophic factor (BDNF) on glucose metabolism, and therefore, "diabetic dyslipidemia", we also determined whether changes in LPS were associated with the levels of serum BDNF.

Methods: This analysis included 17 of the 29 randomized elderly AAs with MCI who had NMR data at baseline and after a 6-month training. We used Generalized Linear Regression (GLM) models to examine cardiorespiratory fitness (VOMax) effects on training-induced change in LPS in the stretch and aerobic groups. Additionally, we determined whether the level of BDNF influenced change in LPS.

Results: Collectively, mean VOMax (23.81±6.17) did not differ significantly between aerobic and stretch groups (difference=3.17±3.56, =0.495). Training-related changes in very low-density lipoprotein, chylomicrons, and total low-density lipoprotein (LDL) particle sizes correlated significantly with VOMax, but not after adjustment for age and gender. However, increased VOMax significantly associated with reduced total LDL particle size after similar adjustments ( = 0.046). While stretch exercise associated with increased protective large high-density lipoprotein particle size, the overall effect was not sustained following adjustments for gender and age. However, changes in serum BDNF were associated with changes in triglyceride and cholesterol transport particle sizes ( < 0.051).

Conclusion: Promotion of stretch and aerobic exercise to increase CRF in elderly AA volunteers with MCI may also promote beneficial changes in lipoprotein particle profile. Because high BDNF concentration may reduce CVD risk, training-related improvements in BDNF levels are likely advantageous. Large randomized studies are needed to confirm our observations and to further elucidate the role for exercise therapy in reducing CVD risk in elderly AAs with MCI.
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http://dx.doi.org/10.2147/CIA.S195878DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6900999PMC
March 2020

Disparities in Sarcoidosis Mortality by Region, Urbanization, and Race in the United States: A Multiple Cause of Death Analysis.

Am J Med 2019 09 30;132(9):1062-1068.e3. Epub 2019 Apr 30.

Howard University Hospital, Washington, DC.

Purpose: Sex, race/ethnicity, and geographic disparities in sarcoidosis-associated mortality were assessed for the most recent period.

Methods: US data for multiple causes of death for 1999-2016 were used to determine numbers of deaths and age-adjusted rates for sarcoidosis as an underlying or a contributing cause of death using International Classification of Diseases, 10th Revision code D86 for Hispanics, non-Hispanic blacks, and non-Hispanic whites.

Results: For persons of all ages in the United States in 1999-2016, there were a total of 28,923 sarcoidosis-associated deaths. In 2008-2016, 9112 deaths had sarcoidosis as the underlying cause (56%) compared with 16,129 with sarcoidosis listed as any cause. Age-adjusted annual death rates per 100,000 were 5.7 (95% confidence interval [CI], 5.6-5.8) for females and 4.1 (95% CI, 4.0-4.2) for males. Age-adjusted annual death rates were 1.5 (95% CI, 1.4-1.6) for Hispanics and 5.4 (95% CI, 5.3-5.4) for non-Hispanics. Rates in non-Hispanic blacks were 8 times those in non-Hispanic whites. Among females, the highest rate was in non-Hispanic blacks in the East-Central division. Between 1999-2007 and 2008-2016, rates increased most in non-Hispanic white males (52.5%) and least in non-Hispanic black females (5.8%).

Conclusions: Sarcoidosis-related multiple cause of death mortality rates were highest in females and in non-Hispanic blacks, and they varied geographically.
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http://dx.doi.org/10.1016/j.amjmed.2019.03.048DOI Listing
September 2019

Disparities in Sepsis Mortality by Region, Urbanization, and Race in the USA: a Multiple Cause of Death Analysis.

J Racial Ethn Health Disparities 2019 06 3;6(3):546-551. Epub 2019 Jan 3.

Howard University College of Medicine, Washington, DC, USA.

Purpose: To assess gender, race/ethnicity, and geographic disparities in sepsis-associated mortality.

Materials And Methods: The US data for multiple causes of death (MCOD) for years 2013-2016 were used to determine numbers of deaths and age-adjusted rates for sepsis as underlying or contributing cause of death using the International Classification of Diseases-10 (ICD-10) codes for non-Hispanic blacks (NHB) and whites (NHW) aged 15 years and older.

Results: There were a total of 746,725 sepsis-associated deaths. Among females, age-adjusted death rate for NHB was 88.6 (95% CI 87.8-89.3) and for NHW, 55.4 (95% CI 55.1-55.6). Among males, age-adjusted death rate for NHB was 115.2 (95% CI 114.1-116.3) and for NHW, 69.5 (95% CI 69.2-69.8). Rates were generally higher in divisions of the south region (West South Central in NHB). Within the South, NHW and NHB who resided in non-metropolitan areas had the highest rates, while the lowest were in suburban metropolitan areas.

Conclusions: Sepsis-related MCOD mortality rates were highest in males, in NHB, in the South region, and, within the South, non-metropolitan areas.
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http://dx.doi.org/10.1007/s40615-018-00553-wDOI Listing
June 2019

Global, Regional, and Country-Specific Lifetime Risks of Stroke, 1990 and 2016.

Authors:
Valery L Feigin Grant Nguyen Kelly Cercy Catherine O Johnson Tahiya Alam Priyakumari G Parmar Amanuel A Abajobir Kalkidan H Abate Foad Abd-Allah Ayenew N Abejie Gebre Y Abyu Zanfina Ademi Gina Agarwal Muktar B Ahmed Rufus O Akinyemi Rajaa Al-Raddadi Leopold N Aminde Catherine Amlie-Lefond Hossein Ansari Hamid Asayesh Solomon W Asgedom Tesfay M Atey Henok T Ayele Maciej Banach Amitava Banerjee Aleksandra Barac Suzanne L Barker-Collo Till Bärnighausen Lars Barregard Sanjay Basu Neeraj Bedi Masoud Behzadifar Yannick Béjot Derrick A Bennett Isabela M Bensenor Derbew F Berhe Dube J Boneya Michael Brainin Ismael R Campos-Nonato Valeria Caso Carlos A Castañeda-Orjuela Jacquelin C Rivas Ferrán Catalá-López Hanne Christensen Michael H Criqui Albertino Damasceno Lalit Dandona Rakhi Dandona Kairat Davletov Barbora de Courten Gabrielle deVeber Klara Dokova Dumessa Edessa Matthias Endres Emerito J A Faraon Maryam S Farvid Florian Fischer Kyle Foreman Mohammad H Forouzanfar Seana L Gall Tsegaye T Gebrehiwot Johanna M Geleijnse Richard F Gillum Maurice Giroud Alessandra C Goulart Rahul Gupta Rajeev Gupta Vladimir Hachinski Randah R Hamadeh Graeme J Hankey Habtamu A Hareri Rasmus Havmoeller Simon I Hay Mohamed I Hegazy Desalegn T Hibstu Spencer L James Panniyammakal Jeemon Denny John Jost B Jonas Jacek Jóźwiak Rizwan Kalani Amit Kandel Amir Kasaeian Andre P Kengne Yousef S Khader Abdur R Khan Young-Ho Khang Jagdish Khubchandani Daniel Kim Yun J Kim Mika Kivimaki Yoshihiro Kokubo Dhaval Kolte Jacek A Kopec Soewarta Kosen Michael Kravchenko Rita Krishnamurthi G Anil Kumar Alessandra Lafranconi Pablo M Lavados Yirga Legesse Yongmei Li Xiaofeng Liang Warren D Lo Stefan Lorkowski Paulo A Lotufo Clement T Loy Mark T Mackay Hassan Magdy Abd El Razek Mahdi Mahdavi Azeem Majeed Reza Malekzadeh Deborah C Malta Abdullah A Mamun Lorenzo G Mantovani Sheila C O Martins Kedar K Mate Mohsen Mazidi Suresh Mehata Toni Meier Yohannes A Melaku Walter Mendoza George A Mensah Atte Meretoja Haftay B Mezgebe Tomasz Miazgowski Ted R Miller Norlinah M Ibrahim Shafiu Mohammed Ali H Mokdad Mahmood Moosazadeh Andrew E Moran Kamarul I Musa Ruxandra I Negoi Minh Nguyen Quyen L Nguyen Trang H Nguyen Tung T Tran Thanh T Nguyen Dina Nur Anggraini Ningrum Bo Norrving Jean J Noubiap Martin J O’Donnell Andrew T Olagunju Oyere K Onuma Mayowa O Owolabi Mahboubeh Parsaeian George C Patton Michael Piradov Martin A Pletcher Farshad Pourmalek V Prakash Mostafa Qorbani Mahfuzar Rahman Muhammad A Rahman Rajesh K Rai Annemarei Ranta David Rawaf Salman Rawaf Andre MN Renzaho Stephen R Robinson Ramesh Sahathevan Amirhossein Sahebkar Joshua A Salomon Paola Santalucia Itamar S Santos Benn Sartorius Aletta E Schutte Sadaf G Sepanlou Azadeh Shafieesabet Masood A Shaikh Morteza Shamsizadeh Kevin N Sheth Mekonnen Sisay Min-Jeong Shin Ivy Shiue Diego A S Silva Eugene Sobngwi Michael Soljak Reed J D Sorensen Luciano A Sposato Saverio Stranges Rizwan A Suliankatchi Rafael Tabarés-Seisdedos David Tanne Cuong Tat Nguyen J S Thakur Amanda G Thrift David L Tirschwell Roman Topor-Madry Bach X Tran Luong T Nguyen Thomas Truelsen Nikolaos Tsilimparis Stefanos Tyrovolas Kingsley N Ukwaja Olalekan A Uthman Yuri Varakin Tommi Vasankari Narayanaswamy Venketasubramanian Vasiliy V Vlassov Wenzhi Wang Andrea Werdecker Charles D A Wolfe Gelin Xu Yuichiro Yano Naohiro Yonemoto Chuanhua Yu Zoubida Zaidi Maysaa El Sayed Zaki Maigeng Zhou Boback Ziaeian Ben Zipkin Theo Vos Mohsen Naghavi Christopher J L Murray Gregory A Roth

N Engl J Med 2018 12;379(25):2429-2437

Background: The lifetime risk of stroke has been calculated in a limited number of selected populations. We sought to estimate the lifetime risk of stroke at the regional, country, and global level using data from a comprehensive study of the prevalence of major diseases.

Methods: We used the Global Burden of Disease (GBD) Study 2016 estimates of stroke incidence and the competing risks of death from any cause other than stroke to calculate the cumulative lifetime risks of first stroke, ischemic stroke, or hemorrhagic stroke among adults 25 years of age or older. Estimates of the lifetime risks in the years 1990 and 2016 were compared. Countries were categorized into quintiles of the sociodemographic index (SDI) used in the GBD Study, and the risks were compared across quintiles. Comparisons were made with the use of point estimates and uncertainty intervals representing the 2.5th and 97.5th percentiles around the estimate.

Results: The estimated global lifetime risk of stroke from the age of 25 years onward was 24.9% (95% uncertainty interval, 23.5 to 26.2); the risk among men was 24.7% (95% uncertainty interval, 23.3 to 26.0), and the risk among women was 25.1% (95% uncertainty interval, 23.7 to 26.5). The risk of ischemic stroke was 18.3%, and the risk of hemorrhagic stroke was 8.2%. In high-SDI, high-middle-SDI, and low-SDI countries, the estimated lifetime risk of stroke was 23.5%, 31.1% (highest risk), and 13.2% (lowest risk), respectively; the 95% uncertainty intervals did not overlap between these categories. The highest estimated lifetime risks of stroke according to GBD region were in East Asia (38.8%), Central Europe (31.7%), and Eastern Europe (31.6%), and the lowest risk was in eastern sub-Saharan Africa (11.8%). The mean global lifetime risk of stroke increased from 22.8% in 1990 to 24.9% in 2016, a relative increase of 8.9% (95% uncertainty interval, 6.2 to 11.5); the competing risk of death from any cause other than stroke was considered in this calculation.

Conclusions: In 2016, the global lifetime risk of stroke from the age of 25 years onward was approximately 25% among both men and women. There was geographic variation in the lifetime risk of stroke, with the highest risks in East Asia, Central Europe, and Eastern Europe. (Funded by the Bill and Melinda Gates Foundation.).
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http://dx.doi.org/10.1056/NEJMoa1804492DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6247346PMC
December 2018

Equalization of four cardiovascular risk algorithms after systematic recalibration: individual-participant meta-analysis of 86 prospective studies.

Authors:
Lisa Pennells Stephen Kaptoge Angela Wood Mike Sweeting Xiaohui Zhao Ian White Stephen Burgess Peter Willeit Thomas Bolton Karel G M Moons Yvonne T van der Schouw Randi Selmer Kay-Tee Khaw Vilmundur Gudnason Gerd Assmann Philippe Amouyel Veikko Salomaa Mika Kivimaki Børge G Nordestgaard Michael J Blaha Lewis H Kuller Hermann Brenner Richard F Gillum Christa Meisinger Ian Ford Matthew W Knuiman Annika Rosengren Debbie A Lawlor Henry Völzke Cyrus Cooper Alejandro Marín Ibañez Edoardo Casiglia Jussi Kauhanen Jackie A Cooper Beatriz Rodriguez Johan Sundström Elizabeth Barrett-Connor Rachel Dankner Paul J Nietert Karina W Davidson Robert B Wallace Dan G Blazer Cecilia Björkelund Chiara Donfrancesco Harlan M Krumholz Aulikki Nissinen Barry R Davis Sean Coady Peter H Whincup Torben Jørgensen Pierre Ducimetiere Maurizio Trevisan Gunnar Engström Carlos J Crespo Tom W Meade Marjolein Visser Daan Kromhout Stefan Kiechl Makoto Daimon Jackie F Price Agustin Gómez de la Cámara J Wouter Jukema Benoît Lamarche Altan Onat Leon A Simons Maryam Kavousi Yoav Ben-Shlomo John Gallacher Jacqueline M Dekker Hisatomi Arima Nawar Shara Robert W Tipping Ronan Roussel Eric J Brunner Wolfgang Koenig Masaru Sakurai Jelena Pavlovic Ron T Gansevoort Dorothea Nagel Uri Goldbourt Elizabeth L M Barr Luigi Palmieri Inger Njølstad Shinichi Sato W M Monique Verschuren Cherian V Varghese Ian Graham Oyere Onuma Philip Greenland Mark Woodward Majid Ezzati Bruce M Psaty Naveed Sattar Rod Jackson Paul M Ridker Nancy R Cook Ralph B D'Agostino Simon G Thompson John Danesh Emanuele Di Angelantonio

Eur Heart J 2019 02;40(7):621-631

Department of Public Health and Primary Care, University of Cambridge, 2 Worts' Causeway, Cambridge, UK.

Aims: There is debate about the optimum algorithm for cardiovascular disease (CVD) risk estimation. We conducted head-to-head comparisons of four algorithms recommended by primary prevention guidelines, before and after 'recalibration', a method that adapts risk algorithms to take account of differences in the risk characteristics of the populations being studied.

Methods And Results: Using individual-participant data on 360 737 participants without CVD at baseline in 86 prospective studies from 22 countries, we compared the Framingham risk score (FRS), Systematic COronary Risk Evaluation (SCORE), pooled cohort equations (PCE), and Reynolds risk score (RRS). We calculated measures of risk discrimination and calibration, and modelled clinical implications of initiating statin therapy in people judged to be at 'high' 10 year CVD risk. Original risk algorithms were recalibrated using the risk factor profile and CVD incidence of target populations. The four algorithms had similar risk discrimination. Before recalibration, FRS, SCORE, and PCE over-predicted CVD risk on average by 10%, 52%, and 41%, respectively, whereas RRS under-predicted by 10%. Original versions of algorithms classified 29-39% of individuals aged ≥40 years as high risk. By contrast, recalibration reduced this proportion to 22-24% for every algorithm. We estimated that to prevent one CVD event, it would be necessary to initiate statin therapy in 44-51 such individuals using original algorithms, in contrast to 37-39 individuals with recalibrated algorithms.

Conclusion: Before recalibration, the clinical performance of four widely used CVD risk algorithms varied substantially. By contrast, simple recalibration nearly equalized their performance and improved modelled targeting of preventive action to clinical need.
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http://dx.doi.org/10.1093/eurheartj/ehy653DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6374687PMC
February 2019

Multidimensional measure of immigrant integration.

Proc Natl Acad Sci U S A 2018 11 22;115(45):11483-11488. Epub 2018 Oct 22.

Immigration Policy Lab, Stanford University, Stanford, CA 94305.

The successful integration of immigrants into a host country's society, economy, and polity has become a major issue for policymakers in recent decades. Scientific progress in the study of immigrant integration has been hampered by the lack of a common measure of integration, which would allow for the accumulation of knowledge through comparison across studies, countries, and time. To address this fundamental problem, we propose the Immigration Policy Lab (IPL) Integration Index as a pragmatic and multidimensional measure of immigrant integration. The measure, both in the 12-item short form (IPL-12) and the 24-item long form (IPL-24), captures six dimensions of integration: psychological, economic, political, social, linguistic, and navigational. The measure can be used across countries, over time, and across different immigrant groups and can be administered through short questionnaires available in different modes. We report on four surveys we conducted to evaluate the empirical performance of our measure. The tests reveal that the measure distinguishes among immigrant groups with different expected levels of integration and also correlates with well-established predictors of integration.
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http://dx.doi.org/10.1073/pnas.1808793115DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6233107PMC
November 2018

The United States Virgin Islands and Hurricanes of 2017.

Authors:
Richard F Gillum

Disaster Med Public Health Prep 2019 02 8;13(1). Epub 2018 Oct 8.

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http://dx.doi.org/10.1017/dmp.2018.105DOI Listing
February 2019

Levels and Trends of Esophageal and Stomach Cancer Mortality in Sub-Saharan Africa and the Caribbean.

J Glob Oncol 2018 09;4:1-2

Temitayo Ogundipe and Mustafa Mustafa, Howard University Hospital; and Richard Gillum, Howard University College of Medicine, Washington, DC.

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http://dx.doi.org/10.1200/JGO.17.00204DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6223467PMC
September 2018

Does Low FEV1 in Addition to Fixed Ratio and/or Lower Limit of Normal of FEV1/FVC Improve Prediction of Mortality in COPD? The NHANES-III-linked-mortality Cohort.

J Natl Med Assoc 2019 Feb 29;111(1):94-100. Epub 2018 Jul 29.

Department of Internal Medicine, Howard University College of Medicine, Washington, DC, USA; Division of Pulmonary Diseases, Howard University Hospital, Washington, DC, USA.

Purpose: There is presently an ongoing debate on the relative merits of suggested criteria for spirometric airway obstruction. This study tests the null hypothesis that no superiority exists with the use of fixed ratio (FR) of forced expiratory volume in the first second (FEV1)/forced vital capacity (FVC) < 0.7 versus less than lower limit predicted (LLN) criteria with or without FEV1 <80% predicted in regards to future mortality.

Methods: In 1988-1994 the Third National Health and Nutrition Examination Survey (NHANES III) measured FEV1 and FVC with mortality follow-up data through December 31, 2011. For this survival analysis 7472 persons aged 40 and over with complete data formed the analytic sample.

Results: There were a total of 3554 deaths. Weighted Cox proportional hazards regression revealed an increased hazard ratio in persons with both fixed ratio and lower limit of normal with a low FEV1 (1.79, p < 0.0001), in those with fixed ratio only with a low FEV1 (1.77, p < 0.0001), in those with abnormal fixed ratio only with a normal FEV1 (1.28, p < 0.0001) compared with persons with no airflow obstruction (reference group). These remained significant after adjusting for demographic variables and other confounding variables.

Conclusions: The addition of FEV1 < 80% of predicted increased the prognostic power of the fixed ratio <0.7 and/or below the lower limit of predicted criteria for airway obstruction.
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http://dx.doi.org/10.1016/j.jnma.2018.06.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6349529PMC
February 2019

The US Virgin Islands: The Ninth Ward of 2017?

Authors:
Richard F Gillum

Am J Public Health 2018 08;108(8):e1

Richard F. Gillum is with the Department of Community and Family Medicine, College of Medicine, Howard University, Washington, DC.

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http://dx.doi.org/10.2105/AJPH.2018.304508DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6050837PMC
August 2018

Burden of Peripheral Artery Disease in Sub-Saharan Africa and the Caribbean 1990 to 2015.

Vasc Endovascular Surg 2018 Oct 26;52(7):520-526. Epub 2018 Jun 26.

3 Department of Internal Medicine, Howard University College of Medicine, Washington, DC, USA.

Background: The estimated global prevalence of Peripheral artery disease (PAD) increased by 24% in span of 10 years (2000-2010) from 164 to 202 million. Despite scarcity of data on PAD in sub-Saharan Africa (SSA) and the Caribbean, estimates for PAD from these regions may be helpful for health-care providers.

Methods: The Global Burden of Disease Study 2015 quantified health loss from hundreds of diseases using systematic reviews and multilevel computer modeling. Estimated rates with 95% uncertainty intervals (UI) for PAD (ICD-10 I70.2) were examined for SSA and the Caribbean and compared to high-income North America (HINA). Disability-adjusted life years (DALYs) are years of healthy life lost representing total disease burden by combining years of life lost and years lived disabled.

Results: In 2015, estimated age-standardized DALYs per 100,000 due to PAD for males were as follows: Caribbean (34, UI: 29-39), HINA (36, UI: 30-42), and SSA (20, UI: 14-30). In contrast, DALYs in females were as follows: Caribbean (25, UI: 20-30), HINA (28, UI: 22-36), and SSA (17, UI: 11-26). For both sexes combined, the rate in Southern SSA was 55 (46-67). This reflects the extremely high rates in South Africa (males 90, UI: 77-107; females 63, UI: 53-75).

Conclusion: Estimated rate of DALYs per 100,000 was lowest in SSA. Within SSA, the rate in South Africa was highest, exceeding even HINA. Caribbean rates were intermediate.
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http://dx.doi.org/10.1177/1538574418784709DOI Listing
October 2018

Mortality Related to Chronic Obstructive Pulmonary Disease and Co-morbidities in the United States, A Multiple Causes of Death Analysis.

COPD 2018 04 26;15(2):200-205. Epub 2018 Apr 26.

b Department of Internal Medicine , Howard University College of Medicine , Washington, DC , USA.

Chronic obstructive pulmonary disease (COPD) mortality based on the underlying cause of death (UCOD) underestimates disease burden. We aimed to determine the current COPD mortality rate, trends and the distribution of co-morbidities using United States (US) multiple-cause of death (MCOD) records. All 38,905,575 death certificates of decedents aged ≥45 years in the United States were analyzed for 1999-2015. COPD was defined by ICD-10 codes J40-J44 and J47 based either on the UCOD or up to 20 contributing causes coded. Annual age-standardized COPD death rates were computed by age, gender and race/ethnicity for those with any mention of COPD. In 2015, COPD was mentioned in 11.59% (292,572 deaths) in MCOD, compared to 11.13% (243,617 deaths) in 1999, a 4% increase. However, it was reported as the UCOD for only 5.56% and 4.97% in 2015 and 1999 respectively, an 11% increase. The most common UCOD in subjects with any mention of COPD was respiratory disorders in 49% of males and 55% of females. The relative change in death rates differed between MCOD and UCOD. For example, among non-Hispanic white females aged 65-74 years the UCOD rate per 100,000 (95% CI) decreased from 163 (160-166) to 147 (145-150), average annual percent decrease (AAPD) -0.26, while the MCOD rate decreased from 308 (304-311) to 263 (260-267), AAPD -0.87. Statistics based on UCOD understated the burden of COPD in the United States. MCOD rates were twice as high as UCOD rates. The relative change in death percent or rates differed between MCOD and UCOD. MCOD analysis should be repeated periodically to help evaluate the burden of COPD-related mortality.
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http://dx.doi.org/10.1080/15412555.2018.1454897DOI Listing
April 2018

Associations of Pulse and Blood Pressure with Hippocampal Volume by APOE and Cognitive Phenotype: The Alzheimer's Disease Neuroimaging Initiative (ADNI).

Dement Geriatr Cogn Disord 2018 25;45(1-2):66-78. Epub 2018 Apr 25.

Division of Geriatrics, Department of Medicine and Clinical/Translational Science Program, Howard University College of Medicine/Hospital, Washington, District of Columbia, USA.

Background: It is increasingly evident that high blood pressure can promote reduction in global and regional brain volumes. While these effects may preferentially affect the hippocampus, reports are inconsistent.

Methods: Using data from the Alzheimer's Disease Neuroimaging Initiative (ADNI), we examined the relationships of hippocampal volume to pulse pressure (PPR) and systolic (SBP) and diastolic (DBP) blood pressure according to apolipoprotein (APOE) ɛ4 positivity and cognitive status. The ADNI data included 1,308 participants: Alzheimer disease (AD = 237), late mild cognitive impairment (LMCI = 454), early mild cognitive impairment (EMCI = 254), and cognitively normal (CN = 365), with up to 24 months of follow-up.

Results: Higher quartiles of PPR were significantly associated with lower hippocampal volumes (Q1 vs. Q4, p = 0.034) in the CN and AD groups, but with increasing hippocampal volume (Q1, p = 0.008; Q2, p = 0.020; Q3, p = 0.017; Q4 = reference) in the MCI groups. In adjusted stratified analyses among non-APOE ɛ4 carriers, the effects in the CN (Q1 vs. Q4, p = 0.006) and EMCI groups (Q1, p = 0.002; Q2, p = 0.013; Q3, p = 0.002; Q4 = reference) remained statistically significant. Also, higher DBP was significantly associated with higher hippocampal volume (p = 0.002) while higher SBP was significantly associated with decreasing hippocampal volume in the EMCI group (p = 0.015).

Conclusion: Changes in PPR, SBP, and DBP differentially influenced hippocampal volumes depending on the cognitive and APOE genotypic categories.
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http://dx.doi.org/10.1159/000486955DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6143389PMC
October 2018

Risk thresholds for alcohol consumption: combined analysis of individual-participant data for 599 912 current drinkers in 83 prospective studies.

Authors:
Angela M Wood Stephen Kaptoge Adam S Butterworth Peter Willeit Samantha Warnakula Thomas Bolton Ellie Paige Dirk S Paul Michael Sweeting Stephen Burgess Steven Bell William Astle David Stevens Albert Koulman Randi M Selmer W M Monique Verschuren Shinichi Sato Inger Njølstad Mark Woodward Veikko Salomaa Børge G Nordestgaard Bu B Yeap Astrid Fletcher Olle Melander Lewis H Kuller Beverley Balkau Michael Marmot Wolfgang Koenig Edoardo Casiglia Cyrus Cooper Volker Arndt Oscar H Franco Patrik Wennberg John Gallacher Agustín Gómez de la Cámara Henry Völzke Christina C Dahm Caroline E Dale Manuela M Bergmann Carlos J Crespo Yvonne T van der Schouw Rudolf Kaaks Leon A Simons Pagona Lagiou Josje D Schoufour Jolanda M A Boer Timothy J Key Beatriz Rodriguez Conchi Moreno-Iribas Karina W Davidson James O Taylor Carlotta Sacerdote Robert B Wallace J Ramon Quiros Rosario Tumino Dan G Blazer Allan Linneberg Makoto Daimon Salvatore Panico Barbara Howard Guri Skeie Timo Strandberg Elisabete Weiderpass Paul J Nietert Bruce M Psaty Daan Kromhout Elena Salamanca-Fernandez Stefan Kiechl Harlan M Krumholz Sara Grioni Domenico Palli José M Huerta Jackie Price Johan Sundström Larraitz Arriola Hisatomi Arima Ruth C Travis Demosthenes B Panagiotakos Anna Karakatsani Antonia Trichopoulou Tilman Kühn Diederick E Grobbee Elizabeth Barrett-Connor Natasja van Schoor Heiner Boeing Kim Overvad Jussi Kauhanen Nick Wareham Claudia Langenberg Nita Forouhi Maria Wennberg Jean-Pierre Després Mary Cushman Jackie A Cooper Carlos J Rodriguez Masaru Sakurai Jonathan E Shaw Matthew Knuiman Trudy Voortman Christa Meisinger Anne Tjønneland Hermann Brenner Luigi Palmieri Jean Dallongeville Eric J Brunner Gerd Assmann Maurizio Trevisan Richard F Gillum Ian Ford Naveed Sattar Mariana Lazo Simon G Thompson Pietro Ferrari David A Leon George Davey Smith Richard Peto Rod Jackson Emily Banks Emanuele Di Angelantonio John Danesh

Lancet 2018 04;391(10129):1513-1523

Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK. Electronic address:

Background: Low-risk limits recommended for alcohol consumption vary substantially across different national guidelines. To define thresholds associated with lowest risk for all-cause mortality and cardiovascular disease, we studied individual-participant data from 599 912 current drinkers without previous cardiovascular disease.

Methods: We did a combined analysis of individual-participant data from three large-scale data sources in 19 high-income countries (the Emerging Risk Factors Collaboration, EPIC-CVD, and the UK Biobank). We characterised dose-response associations and calculated hazard ratios (HRs) per 100 g per week of alcohol (12·5 units per week) across 83 prospective studies, adjusting at least for study or centre, age, sex, smoking, and diabetes. To be eligible for the analysis, participants had to have information recorded about their alcohol consumption amount and status (ie, non-drinker vs current drinker), plus age, sex, history of diabetes and smoking status, at least 1 year of follow-up after baseline, and no baseline history of cardiovascular disease. The main analyses focused on current drinkers, whose baseline alcohol consumption was categorised into eight predefined groups according to the amount in grams consumed per week. We assessed alcohol consumption in relation to all-cause mortality, total cardiovascular disease, and several cardiovascular disease subtypes. We corrected HRs for estimated long-term variability in alcohol consumption using 152 640 serial alcohol assessments obtained some years apart (median interval 5·6 years [5th-95th percentile 1·04-13·5]) from 71 011 participants from 37 studies.

Findings: In the 599 912 current drinkers included in the analysis, we recorded 40 310 deaths and 39 018 incident cardiovascular disease events during 5·4 million person-years of follow-up. For all-cause mortality, we recorded a positive and curvilinear association with the level of alcohol consumption, with the minimum mortality risk around or below 100 g per week. Alcohol consumption was roughly linearly associated with a higher risk of stroke (HR per 100 g per week higher consumption 1·14, 95% CI, 1·10-1·17), coronary disease excluding myocardial infarction (1·06, 1·00-1·11), heart failure (1·09, 1·03-1·15), fatal hypertensive disease (1·24, 1·15-1·33); and fatal aortic aneurysm (1·15, 1·03-1·28). By contrast, increased alcohol consumption was log-linearly associated with a lower risk of myocardial infarction (HR 0·94, 0·91-0·97). In comparison to those who reported drinking >0-≤100 g per week, those who reported drinking >100-≤200 g per week, >200-≤350 g per week, or >350 g per week had lower life expectancy at age 40 years of approximately 6 months, 1-2 years, or 4-5 years, respectively.

Interpretation: In current drinkers of alcohol in high-income countries, the threshold for lowest risk of all-cause mortality was about 100 g/week. For cardiovascular disease subtypes other than myocardial infarction, there were no clear risk thresholds below which lower alcohol consumption stopped being associated with lower disease risk. These data support limits for alcohol consumption that are lower than those recommended in most current guidelines.

Funding: UK Medical Research Council, British Heart Foundation, National Institute for Health Research, European Union Framework 7, and European Research Council.
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http://dx.doi.org/10.1016/S0140-6736(18)30134-XDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5899998PMC
April 2018

The Burden of Cardiovascular Disease in Sub-Saharan Africa and the Black Diaspora.

Authors:
Richard F Gillum

J Racial Ethn Health Disparities 2018 12 19;5(6):1155-1158. Epub 2018 Mar 19.

Howard University College of Medicine, Washington, D.C., USA.

For over four decades the National Medical Association (NMA) and the Association of Black Cardiologists (ABC) have sought to bring to national attention the disparate burden of cardiovascular disease (CVD) among African Americans. However, systematic inquiry has been inadequate into the burden of CVD in the poor countries of Sub-Saharan Africa (SSA) and the African diaspora in the Americas outside the USA. However, recently, the Global Burden of Disease Study (GBD) has offered new tools for such inquiry. Several initial efforts in that direction using 2010 data have been published. This article highlights some new findings for SSA for 2016. It also suggests that NMA and ABC further this effort by direct advocacy and collaboration with the GBD to make estimates of CVD burden in African Americans and South American Blacks explicitly available in future iterations.
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http://dx.doi.org/10.1007/s40615-018-0474-1DOI Listing
December 2018

Asthma-related mortality in the United States, 1999 to 2015: A multiple causes of death analysis.

Ann Allergy Asthma Immunol 2018 06 13;120(6):614-619. Epub 2018 Mar 13.

Department of Internal Medicine, Howard University Hospital, Washington, DC.

Background: Asthma mortality based on the underlying cause of death (UCOD) underestimates disease burden.

Objective: To analyze asthma mortality in the United States from 1999 to 2015 and the pattern of reporting of asthma and its comorbidities in death certificates, using multiple cause of death (MCOD) records.

Methods: All 156,517 death certificates with any mention of asthma were analyzed for 1999 to 2015. Asthma was defined by International Classification of Diseases, 10th Revision code J45 based on the UCOD or MCOD. Annual age-adjusted asthma death rates were computed according to age, sex, and race/ethnicity. The 6,304 MCOD coded status asthmaticus cases (J46) were also examined.

Results: From 1999 to 2015 a total of 59,067 deaths with a UCOD of asthma occurred; 37,832 deaths occurred in females and 21,235 in males (female-male ratio = 1.78). A total of 156,517 deaths with MCOD of asthma occurred; 101,371 deaths occurred in females and 55,146 in males (female-male ratio = 1.83). Hence, 37.7% of deaths with any mention of asthma had asthma as the UCOD (37.3% in females and 38.45% in males). Of these deaths, 41.7% occurred in non-Hispanic blacks and 36% in non-Hispanic whites. Between 1999 and 2015, age-adjusted MCOD death rates changed as follows: 38.1% in Hispanic white females, 34.1% in non-Hispanic black females, 15.1% in non-Hispanic white females, 28.5% in Hispanic white males, 21.3% in non-Hispanic black males, and 25.0% in non-Hispanic white males. Non-Hispanic black females and males had the highest MCOD and UCOD rates throughout the period.

Conclusion: Among deaths with any mention of asthma, asthma was chosen as the UCOD most often in non-Hispanic black males and least often in non-Hispanic white females. Age-adjusted MCOD rates decreased most in non-Hispanic white males and least in non-Hispanic white females.
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http://dx.doi.org/10.1016/j.anai.2018.03.005DOI Listing
June 2018

Toxocara species exposure, symptoms of asthma, and fractional exhaled nitric oxide in the US population.

Ann Allergy Asthma Immunol 2017 12;119(6):569-570

Division of Pulmonary Diseases, Howard University Hospital, Washington, DC.

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http://dx.doi.org/10.1016/j.anai.2017.09.063DOI Listing
December 2017

Strategies to Improve Stroke Care Services in Low- and Middle-Income Countries: A Systematic Review.

Neuroepidemiology 2017 19;49(1-2):45-61. Epub 2017 Aug 19.

Stroke Unit, Department of Neurology, Christian Medical College, Ludhiana, India.

Background: The burden of stroke in low- and middle-income countries (LMICs) is large and increasing, challenging the already stretched health-care services.

Aims And Objectives: To determine the quality of existing stroke-care services in LMICs and to highlight indigenous, inexpensive, evidence-based implementable strategies being used in stroke-care.

Methods: A detailed literature search was undertaken using PubMed and Google scholar from January 1966 to October 2015 using a range of search terms. Of 921 publications, 373 papers were shortlisted and 31 articles on existing stroke-services were included.

Results: We identified efficient models of ambulance transport and pre-notification. Stroke Units (SU) are available in some countries, but are relatively sparse and mostly provided by the private sector. Very few patients were thrombolysed; this could be increased with telemedicine and governmental subsidies. Adherence to secondary preventive drugs is affected by limited availability and affordability, emphasizing the importance of primary prevention. Training of paramedics, care-givers and nurses in post-stroke care is feasible.

Conclusion: In this systematic review, we found several reports on evidence-based implementable stroke services in LMICs. Some strategies are economic, feasible and reproducible but remain untested. Data on their outcomes and sustainability is limited. Further research on implementation of locally and regionally adapted stroke-services and cost-effective secondary prevention programs should be a priority.
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http://dx.doi.org/10.1159/000479518DOI Listing
May 2018

Global, Regional, and National Burden of Cardiovascular Diseases for 10 Causes, 1990 to 2015.

Authors:
Gregory A Roth Catherine Johnson Amanuel Abajobir Foad Abd-Allah Semaw Ferede Abera Gebre Abyu Muktar Ahmed Baran Aksut Tahiya Alam Khurshid Alam François Alla Nelson Alvis-Guzman Stephen Amrock Hossein Ansari Johan Ärnlöv Hamid Asayesh Tesfay Mehari Atey Leticia Avila-Burgos Ashish Awasthi Amitava Banerjee Aleksandra Barac Till Bärnighausen Lars Barregard Neeraj Bedi Ezra Belay Ketema Derrick Bennett Gebremedhin Berhe Zulfiqar Bhutta Shimelash Bitew Jonathan Carapetis Juan Jesus Carrero Deborah Carvalho Malta Carlos Andres Castañeda-Orjuela Jacqueline Castillo-Rivas Ferrán Catalá-López Jee-Young Choi Hanne Christensen Massimo Cirillo Leslie Cooper Michael Criqui David Cundiff Albertino Damasceno Lalit Dandona Rakhi Dandona Kairat Davletov Samath Dharmaratne Prabhakaran Dorairaj Manisha Dubey Rebecca Ehrenkranz Maysaa El Sayed Zaki Emerito Jose A Faraon Alireza Esteghamati Talha Farid Maryam Farvid Valery Feigin Eric L Ding Gerry Fowkes Tsegaye Gebrehiwot Richard Gillum Audra Gold Philimon Gona Rajeev Gupta Tesfa Dejenie Habtewold Nima Hafezi-Nejad Tesfaye Hailu Gessessew Bugssa Hailu Graeme Hankey Hamid Yimam Hassen Kalkidan Hassen Abate Rasmus Havmoeller Simon I Hay Masako Horino Peter J Hotez Kathryn Jacobsen Spencer James Mehdi Javanbakht Panniyammakal Jeemon Denny John Jost Jonas Yogeshwar Kalkonde Chante Karimkhani Amir Kasaeian Yousef Khader Abdur Khan Young-Ho Khang Sahil Khera Abdullah T Khoja Jagdish Khubchandani Daniel Kim Dhaval Kolte Soewarta Kosen Kristopher J Krohn G Anil Kumar Gene F Kwan Dharmesh Kumar Lal Anders Larsson Shai Linn Alan Lopez Paulo A Lotufo Hassan Magdy Abd El Razek Reza Malekzadeh Mohsen Mazidi Toni Meier Kidanu Gebremariam Meles George Mensah Atte Meretoja Haftay Mezgebe Ted Miller Erkin Mirrakhimov Shafiu Mohammed Andrew E Moran Kamarul Imran Musa Jagat Narula Bruce Neal Frida Ngalesoni Grant Nguyen Carla Makhlouf Obermeyer Mayowa Owolabi George Patton João Pedro Dima Qato Mostafa Qorbani Kazem Rahimi Rajesh Kumar Rai Salman Rawaf Antônio Ribeiro Saeid Safiri Joshua A Salomon Itamar Santos Milena Santric Milicevic Benn Sartorius Aletta Schutte Sadaf Sepanlou Masood Ali Shaikh Min-Jeong Shin Mehdi Shishehbor Hirbo Shore Diego Augusto Santos Silva Eugene Sobngwi Saverio Stranges Soumya Swaminathan Rafael Tabarés-Seisdedos Niguse Tadele Atnafu Fisaha Tesfay J S Thakur Amanda Thrift Roman Topor-Madry Thomas Truelsen Stefanos Tyrovolas Kingsley Nnanna Ukwaja Olalekan Uthman Tommi Vasankari Vasiliy Vlassov Stein Emil Vollset Tolassa Wakayo David Watkins Robert Weintraub Andrea Werdecker Ronny Westerman Charles Shey Wiysonge Charles Wolfe Abdulhalik Workicho Gelin Xu Yuichiro Yano Paul Yip Naohiro Yonemoto Mustafa Younis Chuanhua Yu Theo Vos Mohsen Naghavi Christopher Murray

J Am Coll Cardiol 2017 Jul 17;70(1):1-25. Epub 2017 May 17.

University of Washington, Seattle, Washington.

Background: The burden of cardiovascular diseases (CVDs) remains unclear in many regions of the world.

Objectives: The GBD (Global Burden of Disease) 2015 study integrated data on disease incidence, prevalence, and mortality to produce consistent, up-to-date estimates for cardiovascular burden.

Methods: CVD mortality was estimated from vital registration and verbal autopsy data. CVD prevalence was estimated using modeling software and data from health surveys, prospective cohorts, health system administrative data, and registries. Years lived with disability (YLD) were estimated by multiplying prevalence by disability weights. Years of life lost (YLL) were estimated by multiplying age-specific CVD deaths by a reference life expectancy. A sociodemographic index (SDI) was created for each location based on income per capita, educational attainment, and fertility.

Results: In 2015, there were an estimated 422.7 million cases of CVD (95% uncertainty interval: 415.53 to 427.87 million cases) and 17.92 million CVD deaths (95% uncertainty interval: 17.59 to 18.28 million CVD deaths). Declines in the age-standardized CVD death rate occurred between 1990 and 2015 in all high-income and some middle-income countries. Ischemic heart disease was the leading cause of CVD health lost globally, as well as in each world region, followed by stroke. As SDI increased beyond 0.25, the highest CVD mortality shifted from women to men. CVD mortality decreased sharply for both sexes in countries with an SDI >0.75.

Conclusions: CVDs remain a major cause of health loss for all regions of the world. Sociodemographic change over the past 25 years has been associated with dramatic declines in CVD in regions with very high SDI, but only a gradual decrease or no change in most regions. Future updates of the GBD study can be used to guide policymakers who are focused on reducing the overall burden of noncommunicable disease and achieving specific global health targets for CVD.
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http://dx.doi.org/10.1016/j.jacc.2017.04.052DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5491406PMC
July 2017

Screen Hours and Sleep Symptoms: The US National Health and Nutrition Examination Survey.

Fam Community Health 2017 Jul/Sep;40(3):231-235

Division of Pulmonary Disease (Drs Lewis, Odeyemi, and Mehari), Division of Geriatrics (Dr Gillum), and Department of Internal Medicine (Mr Joseph), Howard University College of Medicine, Washington, District of Columbia.

Few studies have examined the relationship between television viewing, computer use, and sleep symptoms. We hypothesized that television and computer time was associated with sleep symptoms. Screen hours were the sum of daily TV hours and computer hours. A total of 4342 participants 20 years and older had data on screen hours. After adjusting for confounders, 4 or more screen hours were significantly associated with increased odds of reporting long sleep latency, nighttime awakening, high sleep hours, and snoring (P < .05). These findings suggest that increased screen/TV time is an important risk factor for sleep symptoms.
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http://dx.doi.org/10.1097/FCH.0000000000000150DOI Listing
December 2017

Effect of sex on the association of isokinetic quadriceps strength with hypertension among older Americans.

Geriatr Gerontol Int 2017 05;17(5):856-857

Division of Geriatrics, Howard University College of Medicine, Washington, District of Columbia, USA.

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http://dx.doi.org/10.1111/ggi.12961DOI Listing
May 2017

Airflow obstruction, cognitive function and mortality in a US national cohort: NHANES-III.

Clin Respir J 2018 Mar 1;12(3):1141-1149. Epub 2017 Jun 1.

Division of Geriatrics, Department of Internal Medicine, Howard University Hospital, Washington, DC.

Objective: To test the hypothesis that cognitive impairment increases mortality independent of airflow obstruction.

Materials And Methods: In 1988-1994 the Third National Health and Nutrition Examination Survey (NHANES III) measured forced expiratory volume in the first second (FEV1) and the forced vital capacity (FVC) and selected items on cognitive function with mortality follow-up. For this survival analysis 4365 persons aged 60 and over with complete data formed the analytic sample.

Results: The FEV1/FVC less than the lower limit of predicted ratio (LLP) defined airflow obstruction and Composite Cognitive Function Score (CCF) ≤4, cognitive impairment. The percentage who died during follow up was 67% among those with neither FEV1/FVC < LLP nor CCF ≤4, 82% with FEV1/FVC < LLP only, 85% with CCF score ≤4 only and 93% with both FEV1/FVC LLP and CCF score ≤4 (P < .001). Weighted Cox proportional hazards regression revealed an increased hazard ratio (HR) in persons with FEV1/FVC
Conclusion: Elderly persons with either airflow obstruction or cognitive impairment or both had increased all-cause mortality when compared to those with neither after adjusting for confounders. However, cognitive impairment was not a predictor of increased mortality independent of airflow obstruction.
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http://dx.doi.org/10.1111/crj.12643DOI Listing
March 2018

Soul Mates: Religion, Sex, Love, and Marriage among African Americans and Latinos.

J Natl Med Assoc 2016 24;108(4):244-245. Epub 2016 Sep 24.

Department of Internal Medicine, Howard University College of Medicine, 2041 Georgia Ave. NW, Washington, DC 20060, USA. Electronic address:

Introduction: This book review analyzes the complex and profound impact active religious participation has on relationships and family outcomes among African Americans and Latinos. In Soul Mates, Wilcox and Wolfinger discuss the legacy of slavery and Jim Crow laws and the resulting devastating effects on African American and Latino families despite their high religious involvement. The authors make the case that many African American men are unlikely candidates for marriage or stable relationships due to trends of family instability driven by the declining income-power of working-class men as well as entry of more women into the labor force, government penalties for low-income couples, revolt against traditional values, increased access to birth control and abortion, and the persistence of discrimination and incarceration of minority men.

Methods: The authors examine data from six national surveys as well as additional data from interviews, focus groups, ethnographic field work, and an extensive literature review.

Results: Wilcox and Wolfinger find evidence that when African American couples actively participate in Christian churches, the men are more likely to adhere to a "code of decency" which decreases street behaviors, such as binge drinking, having multiple sex partners, and having multi-partner fertility, which are known to inhibit family stability.

Conclusions: This book will be helpful for health providers who would like to better understand and serve their African American and Latino patients. The findings suggest that health care providers can promote a healthy emotional environment for families by encouraging minority men to renew or maintain church involvement.
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http://dx.doi.org/10.1016/j.jnma.2016.08.007DOI Listing
October 2018

APOEε4 impacts up-regulation of brain-derived neurotrophic factor after a six-month stretch and aerobic exercise intervention in mild cognitively impaired elderly African Americans: A pilot study.

Exp Gerontol 2017 01 15;87(Pt A):129-136. Epub 2016 Nov 15.

Division of Geriatrics, Department of Medicine, Howard University Hospital, Washington, DC, USA. Electronic address:

Possession of the Apolipoprotein E (APOE) gene ε4 allele is the most prevalent genetic risk factor for late onset Alzheimer's disease (AD). Recent evidence suggests that APOE genotype differentially affects the expression of brain-derived neurotrophic factor (BDNF). Notably, aerobic exercise-induced upregulation of BDNF is well documented; and exercise has been shown to improve cognitive function. As BDNF is known for its role in neuroplasticity and survival, its upregulation is a proposed mechanism for the neuroprotective effects of physical exercise. In this pilot study designed to analyze exercise-induced BDNF upregulation in an understudied population, we examined the effects of APOEε4 (ε4) carrier status on changes in BDNF expression after a standardized exercise program. African Americans, age 55years and older, diagnosed with mild cognitive impairment participated in a six-month, supervised program of either stretch (control treatment) or aerobic (experimental treatment) exercise. An exercise-induced increase in VOMax was detected only in male participants. BDNF levels in serum were measured using ELISA. Age, screening MMSE scores and baseline measures of BMI, VOMax, and BDNF did not differ between ε4 carriers and non-ε4 carriers. A significant association between ε4 status and serum BDNF levels was detected. Non-ε4 carriers showed a significant increase in BDNF levels at the 6month time point while ε4 carriers did not. We believe we have identified a relationship between the ε4 allele and BDNF response to physiologic adaptation which likely impacts the extent of neuroprotective benefit gained from engagement in physical exercise. Replication of our results with inclusion of diverse racial cohorts, and a no-exercise control group will be necessary to determine the scope of this association in the general population.
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http://dx.doi.org/10.1016/j.exger.2016.11.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5193139PMC
January 2017

Pet Ownership and the Risk of Dying.

Authors:
Richard F Gillum

High Blood Press Cardiovasc Prev 2016 09 3;23(3):261-2. Epub 2016 Aug 3.

Department of Medicine, Howard University College of Medicine, Washington, DC, 20060, USA.

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http://dx.doi.org/10.1007/s40292-016-0164-1DOI Listing
September 2016