Search

Few national studies across the United States’ rural-urban continuum examine neighborhood effects on snacks and sweets intake among adults.

Background: The relationship between experienced discrimination and its effects on pain interference and management among racial disparities is not well explored. This research investigated these associations among Black and White U.S. adults. Methods: The analysis involved 9369 Black and White adults in the REasons for Geographic and Racial Differences in Stroke (REGARDS), assessing experiences of discrimination, pain interference (SF-12), and pain treatment, incorporating factors like demographics, comorbidities, and stress. Results: Black participants experiencing moderate discrimination were found to have a 41% increased likelihood of pain interference (aOR 1.41, 95% CI 1.02–1.95), similaritythose facing high levels of discrimination also showed a 41% increase (aOR 1.41, 95% CI 1.06–1.86) compared to those without such experiences. White individuals reporting moderate discrimination also faced a heightened risk, with a 21% greater chance of pain interference (aOR 1.21, 95% CI 1.01–1.45). Notably, the presence of moderate discrimination among Black participants correlated with a 12% reduced probability of receiving pain treatment (aOR 0.88, 95% CI 0.56–1.37). Furthermore, Black, and White individuals who reported discrimination when seeking employment had a 33% (aOR 0.67, 95% CI 0.45–0.98) and 32% (aOR 0.68, 95% CI 0.48–0.96) lower likelihood, respectively, of receiving treated pain. Conclusion: The study elucidates how discrimination exacerbates pain interference and restricts access to treatment, affecting Black and White individuals differently. These findings underscore an urgent need for strategies to counteract discrimination’s negative effects on healthcare outcomes. Addressing these disparities is crucial for advancing health equity and improving the overall quality of care.

Background: The prevalences of both hypertension and vitamin D insufficiency are high in the United States. Recent clinical trials and animal studies have suggested that vitamin D insufficiency may be associated with elevated blood pressure. Objective: With cross-sectional data, we sought to determine whether vitamin D concentrations were related to systolic blood pressure (SBP) in the third National Health and Nutrition Examination Survey (1988-1992). Design: Blood pressure was classified with 5 categories from the Joint National Committee 7 with a sixth category added to distinguish participants with normotensive SBP ( Results: Lower 25(OH)D concentrations were associated with a higher blood pressure category in whites (P < 0.001); however, when controlling for age, the association was no longer significant. Concentrations of 25(OH)D > 80 nmol/L decreased the age-related increase in SBP by 20% compared with participants having 25(OH)D concentrations < 50 nmol/L (P < 0.001). Only 8% of blacks had 25(OH)D concentrations > 80 nmol/L. Conclusions: SBP is inversely associated with serum vitamin D concentrations in nonhypertensive white persons in the United States. This observation provides a rationale for studies on the potential effects of vitamin D supplementation as a method to reduce SBP in persons at risk of hypertension. KEY WORDS Systolic blood pressure, vitamin D, hypovitaminosis D, hypertension, aging, NHANES

ObjectiveAssociations between atrial fibrillation (AF) and heart failure (HF) have been established. We compared the extent to which AF is associated with each primary subtype of HF, with reduced (HFrEF) versus preserved ejection fraction (HFpEF).MethodsWe included 25 787 participants free of baseline HF from the REGARDS (REasons for Geographic And Racial Differences in Stroke) cohort. Baseline AF was ascertained from ECG and self-reported history of physician diagnosis. Incident HF events were determined from physician-adjudicated review of hospitalisation medical records and HF deaths. Based on left ventricular ejection fraction (LVEF) at the time of HF event, HFrEF, HFpEF, and mid-range HF were defined as LVEF <40%, ≥50% and 40%–49%, respectively. Multivariable Cox proportional-hazards models examined the association between AF and HF. The Lunn-McNeil method was used to compare associations of AF with incident HFrEF versus HFpEF.ResultsOver a median of 9 years of follow-up, 1109 HF events occurred (356 HFpEF, 388 HFrEF, 77 mid-range and 288 unclassified). In a model adjusted for sociodemographics, cardiovascular risk factors, and incident coronary heart disease, AF was associated with increased risk of all HF events (HR 1.67, 95% CI 1.38 to 2.01). The associations of AF with HFrEF versus HFpEF events did not differ significantly (HR 1.87 (95% CI 1.38 to 2.54) and HR 1.65 (95% CI 1.20 to 2.28), respectively; p value for difference=0.581). These associations were consistent in sex and race subgroups.ConclusionsAF is associated with both HFrEF and HFpEF events, with no significant difference in the strength of association among these subtypes.

Achieving optimal cardiovascular health in rural populations can be challenging for several reasons including decreased access to care with limited availability of imaging modalities, specialist physicians, and other important health care team members. Therefore, innovative solutions are needed to optimize health care and address cardiovascular health disparities in rural areas. Mobile examination units can bring imaging technology to underserved or remote communities with limited access to health care services. Mobile examination units can be equipped with a wide array of assessment tools and multiple imaging modalities such as computed tomography scanning and echocardiography. The detailed structural assessment of cardiovascular and lung pathology, as well as the detection of extracardiac pathology afforded by computed tomography imaging combined with the functional and hemodynamic assessments acquired by echocardiography, yield deep phenotyping of heart and lung disease for populations historically underrepresented in epidemiological studies. Moreover, by bringing the mobile examination unit to local communities, innovative approaches are now possible including engagement with local professionals to perform these imaging assessments, thereby augmenting local expertise and experience. However, several challenges exist before mobile examination unit–based examinations can be effectively integrated into the rural health care setting including standardizing acquisition protocols, maintaining consistent image quality, and addressing ethical and privacy considerations. Herein, we discuss the potential importance of cardiac multimodality imaging to improve cardiovascular health in rural regions, outline the emerging experience in this field, highlight important current challenges, and offer solutions based on our experience in the RURAL (Risk Underlying Rural Areas Longitudinal) cohort study.

Supplemental Digital Content is available in the text.

IMPORTANCE: Sedentary behavior is associated with several health outcomes, including diabetes, cardiovascular disease, and all-cause mortality. Less is known about the association between objectively measured sedentary behavior and cancer mortality, as well as the association with physical activity. OBJECTIVE: To examine the association between accelerometer-measured sedentary behavior (total volume and accrual in prolonged, uninterrupted bouts) and cancer mortality. DESIGN, SETTING, AND PARTICIPANTS: A prospective cohort study conducted in the contiguous US included 8002 black and white adults aged 45 years or older enrolled in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. The present analysis was performed from April 18, 2019, to April 21, 2020. EXPOSURES: Sedentary time, light-intensity physical activity (LIPA), and moderate- to vigorous-intensity physical activity (MVPA) were measured using a hip-mounted accelerometer worn for 7 consecutive days. MAIN OUTCOMES AND MEASURES: Cancer mortality. RESULTS: Of the 8002 study participants, 3668 were men (45.8%); mean (SD) age was 69.8 (8.5) years. Over a mean (SD) follow-up of 5.3 (1.5) years, 268 participants (3.3%) died of cancer. In multivariable-adjusted models, including MVPA, greater total sedentary time was associated with a greater risk of cancer mortality (tertile 2 vs tertile 1: hazard ratio [HR], 1.45; 95% CI, 1.00-2.11; tertile 3 vs tertile 1: HR, 1.52; 95% CI, 1.01-2.27). Longer sedentary bout duration was not significantly associated with greater cancer mortality risk: after adjustment for MVPA (tertile 2 vs tertile 1: HR, 1.26; 95% CI, 0.90-1.78; tertile 3 vs tertile 1: HR, 1.36; 95% CI, 0.96-1.93). Replacing 30 minutes of sedentary time with LIPA was significantly associated with an 8% (per 30 minutes: HR, 0.92; 95% CI, 0.86-0.97) lower risk of cancer mortality; MVPA was significantly associated with a 31% (per 30 minutes: HR, 0.69; 95% CI, 0.48-0.97) lower risk of cancer mortality. CONCLUSIONS AND RELEVANCE: In this cohort study, greater sedentary time, as measured with accelerometry, appeared to be independently associated with cancer mortality risk. Replacing sedentary time with either LIPA or MVPA may be associated with a lower risk of cancer mortality. These findings suggest that the total volume of sedentary behavior is a potential cancer mortality risk factor and support the public health message that adults should sit less and move more to promote longevity.

Purpose: This study aims to test the hypothesis that in addition to a direct effect of food environment on obesity, food environment is indirectly associated with obesity through consuming Mediterranean diet (MD).Design: Cross-sectional secondary data analysis.Setting: Nationwide community-dwelling residency.Sample: A total of 20 897 non-Hispanic black and white adults aged ≥45 years who participated in the REasons for Geographic and Racial Differences in Stroke study and completed baseline assessment during January 2003 and October 2007.Measures: The Modified Retail Food Environment Index (mRFEI; 0-100) was used as food environment indicator. The MD score (0-9) was calculated to indicate the dietary pattern adherence. Body mass index (BMI; kg/m2) was used to estimate obesity.Analysis: Path analysis was used to quantify the pathways between food environment, MD adherence, and obesity. Proper data transformation was made using Box–Cox power transformation to meet certain analysis assumptions.Results: The participants were from 49 states of the United States, with the majority (64.42%) residing in the South. Most of the participants were retired, female, white, married, having less than college graduate education, having annual household income ≤75 000, and having health insurance. The means of mRFEI was 10.92 (standard deviation [SD] = 10.19), MD score was 4.36 (SD = 1.70), and the BMI was 28.96 kg/m2(SD = 5.90). Access to healthy food outlets (β = .04, P< .0001) and MD adherence (β = .08, P< .0001) had significant and inverse relationships with BMI, respectively. Mediterranean diet adherence mediated the relationship between food environment and obesity among a subpopulation who had an annual household income of <$75 000 (β = −.02, P= .0391).Conclusion: Population-tailored interventions/policies to modify food environment and promote MD consumption are needed in order to combat the obesity crisis in the United States.

This study examined the association between urinary albumin excretion and incident heart failure (HF) hospitalization.

Supplemental Digital Content is available in the text.

IMPORTANCE: Race-specific and sex-specific stroke risk varies across the lifespan, yet few reports describe sex differences in stroke risk separately in black individuals and white individuals. OBJECTIVE: To examine incidence and risk factors for ischemic stroke by sex for black and white individuals. DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study included participants 45 years and older who were stroke-free from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort, enrolled from the continental United States 2003 through 2007 with follow-up through October 2016. Data were analyzed from March 2018 to September 2018. EXPOSURES: Sex and race. MAIN OUTCOMES AND MEASURES: Physician-adjudicated incident ischemic stroke, self-reported race/ethnicity, and measured and self-reported risk factors. RESULTS: A total of 25 789 participants (14 170 women [54.9%]; 10 301 black individuals [39.9%]) were included. Over 222 120 person-years of follow-up, 939 ischemic strokes occurred: 159 (16.9%) in black men, 326 in white men (34.7%), 217 in black women (23.1%), and 237 in white women (25.2%). Between 45 and 64 years of age, white women had 32% lower stroke risk than white men (incidence rate ratio [IRR], 0.68 [95% CI, 0.49-0.94]), and black women had a 28% lower risk than black men (IRR, 0.72 [95% CI, 0.52-0.99]). Lower stroke risk in women than men persisted at age 65 through 74 years in white individuals (IRR, 0.71 [95% CI, 0.55-0.94]) but not in black individuals (IRR, 0.94 [95% CI, 0.68-1.30]); however, the race-sex interaction was not significant. At 75 years and older, there was no sex difference in stroke risk for either race. For white individuals, associations of systolic blood pressure (women: hazard ratio [HR], 1.13 [95% CI, 1.05-1.22]; men: 1.04 [95% CI, 0.97-1.11]; P = .099), diabetes (women: HR, 1.84 [95% CI, 1.35-2.52]; men: 1.13 [95% CI, 0.86-1.49]; P = .02), and heart disease (women: HR, 1.76 [95% CI, 1.30-2.39]; men, 1.26 [95% CI, 0.99-1.60]; P = .09) with stroke risk were larger for women than men, while antihypertensive medication use had a smaller association in women than men (women: HR, 1.17 [95% CI, 0.89-1.54]; men: 1.61 [95% CI, 1.29-2.03]; P = .08). In black individuals, there was no evidence of a sex difference for any risk factors. CONCLUSIONS AND RELEVANCE: For both races, at age 45 through 64 years, women were at lower stroke risk than men, and there was no sex difference at 75 years or older; however, the sex difference pattern may differ by race from age 65 through 74 years. The association of risk factors on stroke risk differed by race-sex groups. While the need for primordial prevention, optimal management, and control of risk factors is universal across all age, racial/ethnic, and sex groups, some demographic subgroups may require earlier and more aggressive strategies.

BackgroundEmerging studies have investigated the contribution of food environment to obesity in the USA. However, the findings were inconsistent. Methodological explanations for the inconsistent findings included: (1) using individual store/restaurant exposure as food environment indicator, and (2) not accounting for non-stationarity assumption. This study aimed to describe the spatial distribution of obesity and examine the association between community food environment and obesity, and the variation of magnitude and direction of this association across the USA.MethodsData from 20 897 adults who participated in the REasons for Geographic and Racial Differences in Stroke study and completed baseline assessment between January 2003 and October 2007 were eligible in analysis. Hot Spot analysis was used to assess the spatial distribution of obesity. The association between community food environment and obesity and the variation of this association across the USA were examined using global ordinary least squares regression and local geographically weighted regression.ResultsHigher body mass index (BMI) clusters were more likely to locate in socioeconomically disadvantaged, rural, minority neighbourhoods with a smaller population size, while lower BMI clusters were more likely to appear in more affluent, urban neighbourhoods with a higher percentage of non-Hispanic white residences. There was an overall significant, inverse association between community food environment and obesity (β=−0.0210; p<0.0001). Moreover, the magnitude and direction of this association varied significantly across the US regions.ConclusionsThe findings underscored the need for geographically tailored public health interventions and policies to address unique local food environment issues to achieve maximum effects on obesity prevention.

Little information exists on the incidence of and risk factors for chronic kidney disease (CKD) in contemporary US cohorts and whether risk factors differ by race, sex, or region in the United States.

IMPORTANCE: African Americans and individuals of African ancestry have a higher risk of stroke compared with non-Hispanic white individuals. Identifying the source of this disparity could provide an opportunity for clinical stroke risk stratification and more targeted therapy. Whether sickle cell trait (SCT) is an indicator of increased risk of ischemic stroke among African Americans is still unclear. OBJECTIVE: To examine whether SCT is associated with a higher risk of incident ischemic stroke among African Americans. DESIGN, SETTING, AND PARTICIPANTS: This meta-analysis assessed the association of SCT with the risk of incident ischemic stroke. Four large, prospective, population-based studies with African American cohorts were assessed: Jackson Heart Study (September 1, 2005, through December 31, 2012), Multi-Ethnic Study of Atherosclerosis (July 1, 2002, through December 31, 2012), Reasons for Geographic and Racial Differences in Stroke (January 1, 2003, through December 31, 2014), and Women’s Health Initiative (October 1, 1998, through December 31, 2012). Using a Cox proportional hazards regression model adjusted for major stroke risk factors, this study estimated the hazard ratio for incident ischemic stroke associated with SCT. Data analysis was performed from July 10, 2016, to February 2, 2017. INTERVENTIONS OR EXPOSURES: Participants’ SCT status determined by polymerase chain reaction assay genotyping or a combination of whole-exome sequencing and imputation. MAIN OUTCOMES AND MEASURES: Incident ischemic stroke. RESULTS: This meta-analysis included 19 464 African American individuals (1520 with SCT, 17 944 without SCT, and 620 with ischemic stroke) from 4 studies, with a mean (SD) age of 60.0 (13.0) years (5257 [27.0%] men and 14 207 [73.0%] women). No differences were found in the distribution of risk factors for ischemic stroke comparing participants with and those without SCT at study visit 1 in each cohort. The crude incidence of ischemic stroke was 2.9 per 1000 person-years (95% CI, 2.2-4.0 per 1000 person-years) among those with SCT and 3.2 per 1000 person-years (95% CI, 2.7-3.8 per 1000 person-years) among those without SCT. After stroke risk factors were adjusted for, the hazard ratio of incident ischemic stroke independently associated with SCT in the meta-analysis of all 4 cohorts was 0.80 (95% CI, 0.47-1.35; P = .82). The results of the meta-analysis were similar to those of individual cohorts, in which the results were also similar. CONCLUSIONS AND RELEVANCE: Sickle cell trait may not be associated with incidence of ischemic stroke among African Americans. The results of this study suggest performing a more thorough clinical evaluation of a stroke patient with SCT rather than assuming that SCT is the etiologic factor for the stroke.

IMPORTANCE: Higher circulating fibroblast growth factor 23 (FGF23) concentrations are associated with cardiovascular disease events linked to heart failure, but associations of FGF23 with coronary heart disease (CHD) have been less consistent. OBJECTIVE: To determine the association of plasma FGF23 concentrations with incident CHD and whether this association differs by race, sex, or chronic kidney disease status. DESIGN, SETTING, AND PARTICIPANTS: We examined the association of FGF23 concentrations with incident CHD risk within the Reasons for Geographic and Racial Differences in Stroke study, a prospective cohort of black and white adults 45 years and older enrolled between January 2003 and October 2007 with follow-up through December 31, 2011. Using a case-cohort design, we measured FGF23 concentrations in 829 participants who developed incident CHD and in 812 participants randomly selected from the Reasons for Geographic and Racial Differences in Stroke study cohort (cohort random sample). To account for the stratified sampling design, the cohort random sample was weighted back to the original cohort overall (n = 22 127). Cox proportional hazards models were used to examine the association of FGF23 concentration with incident CHD, adjusting for CHD risk factors and kidney function. In prespecified analyses, we examined whether race, sex, or chronic kidney disease modified the association of FGF23 concentration with incident CHD. EXPOSURES: Plasma C-terminal FGF23 concentrations. MAIN OUTCOMES AND MEASURES: Investigator-adjudicated incident CHD events. RESULTS: Of the 22 127 participants in the weighted cohort random sample, 13 059 (58.9%) were female and 9435 (42.6%) were black, and the mean age was 64.3 (95% CI, 63.7-64.9) years. Greater age, lower estimated glomerular filtration rate, higher urine albumin to creatinine ratio, and female sex were associated with higher FGF23 concentration at baseline. In multivariable models adjusted for established CHD risk factors and kidney function, higher FGF23 concentrations were associated with greater risk of CHD (hazard ratio [HR] comparing fourth with first quartile, 2.15; 95% CI, 1.35-3.42). The magnitude and strength of these associations differed by sex. However, these differences were no longer observed when adjusting for hormone therapy in women (men: HR comparing fourth with first quartile, 2.40; 95% CI, 1.30-4.42; women: HR comparing fourth with first quartile, 2.34; 95% CI, 1.04-5.27) or when using sex-specific FGF23 quartiles (men: HR comparing fourth with first quartile, 2.65; 95% CI, 1.43-4.90; women: HR comparing fourth with first quartile, 2.26; 95% CI, 1.02-5.03). CONCLUSIONS AND RELEVANCE: Higher FGF23 concentrations were associated with greater risk of CHD. Heterogeneity in the association by sex may be caused by differences in the distribution of plasma FGF23 concentrations or the use of hormone therapy in men vs women.

IMPORTANCE: Recent studies have suggested that the natriuretic peptide system may be endogenously suppressed in black individuals who are free of prevalent cardiovascular disease. Whether natriuretic peptide levels contribute to racial disparities in clinical outcomes is unknown. OBJECTIVE: To examine racial differences in N-terminal pro–B-type natriuretic peptide (NTproBNP) levels and their association with all-cause mortality and cause-specific mortality in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. DESIGN, SETTING, AND PARTICIPANTS: Baseline NTproBNP levels were measured in a randomly selected sample of 4415 REGARDS study participants. Those with prevalent cardiovascular disease and renal dysfunction were excluded. From July 1, 2003, to September 12, 2007, among the remaining 1998 individuals, racial differences in NTproBNP levels were estimated, and the percentage difference in NTproBNP levels by race was meta-analyzed and compared with published results on participants free of prevalent cardiovascular disease from the Dallas Heart Study and Atherosclerosis Risk in Communities study, using random effects modeling. The association of NTproBNP levels, race, all-cause mortality, and cause-specific mortality in the REGARDS study was studied using appropriate modeling techniques. Data analysis was conducted from July 1, 2003, to March 31, 2016. MAIN OUTCOMES AND MEASURES: Racial differences in NTproBNP levels and association with all-cause mortality and cause-specific mortality. RESULTS: Among the 1998 participants studied (972 women and 1026 men; median age, 63 years [interquartile range, 54-72 years]), median NTproBNP levels in black individuals were significantly lower than those in white individuals (46 pg/mL [interquartile range, 23-91] vs 60 pg/mL [interquartile range, 33-106]; P &lt; .001). With multivariable adjustment, NTproBNP levels were up to 27% lower in black individuals as compared with white individuals (β, –0.32; 95% CI, –0.40 to –0.24; P &lt; .001) in the REGARDS study. In meta-analysis of the 3 cohorts, NTproBNP levels were 35% lower in black individuals than white individuals. Among the REGARDS study participants, for every 1-SD higher log NTproBNP, there was a 31% increased risk of death in the multivariable-adjusted model (hazard ratio, 1.31; 95% CI, 1.11-1.54). This increase was driven primarily by association of NTproBNP with cardiovascular mortality (hazard ratio, 1.69; 95% CI, 1.19-2.41). No interaction between race and NTproBNP levels was observed with all-cause mortality and cause-specific mortality. CONCLUSIONS AND RELEVANCE: Plasma NTproBNP levels are significantly lower in black individuals as compared with white individuals in the REGARDS study and in pooled results from the REGARDS study, Dallas Heart Study, and Atherosclerosis Risk in Communities study. Higher NTproBNP levels were associated with higher incidence of all-cause mortality and cardiovascular mortality in healthy black and white individuals, and this association did not differ by race.

Kidney disease has been associated with venous thromboembolism (VTE) risk, but results conflict and there is little information regarding blacks.

Supplemental Digital Content is available in the text.

Vitamin D deficiency is highly prevalent in children and adults with cystic fibrosis (CF). Recent studies have found an association between vitamin D status and risk of pulmonary exacerbations in children and adults with CF. The ongoing Vitamin D for enhancing the Immune System in Cystic fibrosis (DISC) study, a multi-center, double-blind, randomized, placebo-controlled trial, will test the hypothesis of whether high dose vitamin D given as a single oral bolus of 250,000 IU to adults with CF during a pulmonary exacerbation followed by a maintenance dose of vitamin D will improve time to next pulmonary exacerbation and re-hospitalization, improve survival and lung function compared to placebo and reduce the rates of pulmonary exacerbation. Subjects will be randomized 1:1 at each clinical site to vitamin D or placebo within 72 h of hospital admission for pulmonary exacerbation. Clinical follow-up visits will occur at 1, 2, 3, and 7 days, and 1, 3, 6 and 12 months after randomization. Blood and sputum will be collected and determination of clinical outcomes will be assessed at each visit. The primary endpoint will be the time to next pulmonary exacerbation requiring antibiotics, re-hospitalization or death. The secondary endpoints will include lung function assessed by forced expiratory volume in 1 s (FEV1), blood markers of inflammatory cytokines, anti-microbial peptide expression by peripheral blood mononuclear cells and circulating concentrations in blood. Other exploratory endpoints will examine the phenotype of neutrophils and monocyte/macrophages in sputum. Nutritional status will be assessed by 3 day food records and food frequency questionnaire.

Several reports have suggested that particulate matter (PM) exposure increases the risk for atrial arrhythmias. However, data from large-scale epidemiologic studies supporting this hypothesis are lacking. We examined the association of PM <2.5 μm in diameter (PM2.5) concentration with premature atrial contractions (PACs) in 26,609 (mean age=65±9.4 years; 55% female; 41% black) participants from the REGARDS (REasons for Geographic And Racial Differences in Stroke) study. Estimates of short- (2 weeks) and long-term (1 year) PM2.5exposure were computed before each participant’s baseline visit using geographic information system data on the individual level at the coordinates of study participants’ residences. PACs were identified from baseline electrocardiograms. A total of 2140 (8.2%) participants had evidence of PACs on the baseline electrocardiogram. Short-term PM2.5(per 10 μg/m3) exposure was not associated with PACs (OR=1.09, 95% CI=0.98, 1.23). Increases in long-term PM2.5(per 10 μg/m3) were associated with PACs (OR=1.40, 95% CI=1.10, 1.78). Interactions were not detected for short- and long-term PM2.5exposure by age, sex, or race. Long- but not short-term PM2.5exposure is associated with PACs. This suggests a role for long-term PM2.5exposure in initiating supraventricular arrhythmias that are triggered by PACs.

Background:Black adults have a disproportionate hypertension burden. While some excess risk is mediated by diet and sociodemographics factors (e.g., income, education) much remains unexplained. Pro-thrombotic and pro-inflammatory states are associated with hypertension risk; higher coagulation factor VIII (FVIII) is associated with thrombosis, inflammation, and cardiovascular disease. Black adults have higher FVIII than White adults. We sought to estimate incident hypertension risk among Black and White REGARDS adults by FVIII level, and determine if FVIII mediates some of the excess hypertension burden in Black REGARDS participants.Methods:Hypertension was use of blood pressure (BP)-lowering medications or 140/90 mm Hg BP threshold. We included Black and White participants from REGARDS without Visit 1 (2003-2007) hypertension, and hypertension assessment at visit 2 (2013-2016), and Visit 1 ELISA-measured FVIII. Modified Poisson regression estimated risk ratios (RR) of incident hypertension by FVIII level in models controlling for known confounders, stratified by race given a significant race*FVIII interaction on incident hypertension. Inverse odds ratio weighting estimated % mediation of the Black-White hypertension risk in each model that was due to FVIII.Results:Among the 1,870 included participants, mean (SD) age was 62 (8), 51% were female and 36% were Black participants. Relative to White participants, Black participants had higher mean FVIII level (114% vs. 103%; P<0.001) and 46% greater hypertension risk (95% CI 30-65%) in the crude model. Higher FVIII did not associate with greater hypertension risk in any model (Figure). Factor VIII did not mediate excess burden of hypertension among Black participants in any models.Conclusions:FVIII was not associated with greater hypertension risk and did not mediate any of the excess burden of incident hypertension seen among Black participants.

People living in poor rural communities, particularly in the South, live shorter and less healthy lives than those residing elsewhere in the United States. The basis of this very high rural burden of heart, lung, and blood disease, which does not spare any race, is unclear. We hypothesized that a potential contribution to this phenomenon is differential selection of healthy individuals to migrate out of rural communities. We examined how county-level migration patterns relate to county-level mortality with a specific focus on rural counties. We compiled nationally representative county-level data migration data from Internal Revenue Services for years 2011-2019 and mortality data from National Center for Health Statistics at the Centers for Disease Control and Prevention for years 2018-2019. We standardized characteristics to a mean=0 and standard deviation=1 and modeled county-level age-adjusted death rate in 2019 using 2-level hierarchical linear regression. Out- and in-migration in 2019 was not significantly associated with age-adjusted death rate in 2019 after adjustment for social, economic and population factors at the county-level. However, when stratified by 6 categories of urban/rural, greater out-migration in the smallest rural counties (non-core) was associated with higher age-adjusted death rate after adjustment for other county factors [Beta (95% CI); 7.2 (0.11,14.28)] (Table 1). When including lagged out-migration rates for years prior to 2019, previous out-migration was associated with age-adjusted death rate in the second smallest rural county categorization (micropolitan). These findings help to ascertain another component potentially contributing to differentially poorer health in rural communities. Future work at the conference will further evaluate decade trends in migration across the US by county.

Background:The RURAL cohort study is a uniquely designed study using a Mobile Examination Unit (MEU) to study heart and lung disorders in rural counties in the southeastern US. Complete blood counts (CBC) are included in the participant baseline examination. We wanted to use an instrument in the MEU for onsite blood counts and chose the Pixcell Hemoscreen, a point-of-care instrument using a unique technology. Before using the Hemoscreen in the RURAL study, it was necessary to ensure that the CBC results would be comparable to laboratory generated results.Methods:We compared CBC results from the Hemoscreen to those from the Sysmex XN9000 at the University of Vermont Medical Center. CBC measurements include erythrocyte count (RBC), white blood cell count (WBC), hemoglobin concentration (HGB), hematocrit value (HCT), and platelet count (PLT). Blood from ten volunteers was analyzed on the Hemoscreen and the Sysmex. Statistics included average, standard deviation, and coefficient of variance (CV) for each of the parameters analyzed. Blood from ten volunteers was assayed on both the Hemoscreen and the Sysmex to compare for accuracy. Blood from three volunteers was analyzed ten times on the Hemoscreen to assess variability.Results:The Hemoscreen and Sysmex reported similar values for WBC, RBC, HCT, HGB and PLT counts, as shown in Figure 1. Between repeat measures conducted on the same sample on the Hemoscreen WBC, RBC, HCT, HGB and PLT showed little variance (%CV = 5.9, 2.7, 2.8, 2.7, and 4.0 respectively).Conclusions:The Hemoscreen data correlated with data generated in a hospital laboratory on the same samples. Variability between multiple measures of the same samples on the Hemoscreen showed acceptable variance. To date over 730 RURAL participants have been seen and the Hemoscreen has proven to be quick, accurate, and reliable.

Background:Type 2 diabetes mellitus (DM) is more common in Black than White adults in the US. The inflammatory cytokine interleukin-6 (IL-6) is implicated in DM pathogenesis and circulates at higher levels in Black people. Metabolic syndrome (MetS), a group of conditions related to insulin resistance, often precedes or coexists with DM. Little evidence is available on associations of IL-6 with these disorders in Black people.Methods:REGARDS enrolled 30,239 Black and White adults in 2003-07 and conducted a follow up visit 9.5 years later. Baseline IL-6 was measured in a sample of 4,400 participants (equal by race/sex groups) attending both visits. Modified Poisson regression estimated relative risk (RR) by level of baseline IL-6 for incident DM among those without prevalent DM; similar analyses were conducted for MetS. Inverse odds weighting estimated the percent mediation of the racial disparity in incident DM by IL-6.Results:Incident DM occurred in 460/3,399 (14%) at risk, and there were 384/1,957 (20%) cases of incident MetS. As shown in the Figure, DM and MetS incidence increased across baseline IL-6 quartiles overall, with a steeper rise and higher incidence among Black than White adults. Adjusting for confounders, the RR of DM for IL-6 in the 4thvs 1stquartile was 1.91 (95% CI 1.38-2.65). Higher IL-6 was also associated with MetS (RR 1.65 (95% CI 1.22-2.22)). In adjusted models there were no material differences in these associations by race. The RR of DM in Black compared with White people was 1.90 (95% CI 1.59-2.27); there was no association of race with MetS. IL-6 significantly mediated 13.4% of the racial disparity in DM adjusting for demographic factors.Conclusions:Higher IL-6 is a risk factor for incident DM and MetS in Black and White adults. The race disparity in DM was partly mediated by IL-6. Interventions to reduce IL-6 may lower risk of DM and MetS and lessen the racial disparity in DM.Figure:Diabetes and Metabolic Syndrome Incidence (bars) and Relative Risk (95% CI) by Baseline IL-6 Quartile

Introduction:Black adults experience the highest hypertension burden of any American group. Evidence indicates social factors adversely affecting Black people explain some of the excess hypertension burden. It’s unclear whether residential segregation, a key cause of health inequities, has a differential impact on Black and White people.Hypothesis:The magnitude of the association of residential segregation and risk of incident hypertension will be greater in Black than White people.Methods:Our sample included 6,143 Black and White REasons for Geographic And Racial Differences in Stroke (REGARDS) study participants without prevalent hypertension (2003-7), and with a follow-up visit 9.3 years later. Baseline county-level segregation was measured with the (1) dissimilarity index (DI, the difference in race distribution of census tracts relative to their county), (2) isolation index (ISI, the degree to which Black people are exposed only to one another in a county), and (3) interaction index (ITI, the degree to which Black people are exposed to White people in a county). Modified Poisson regression estimated the risk ratios (RR) of incident hypertension per SD increment of baseline residential segregation.Results:The mean (SD) age was 61(8) years for Black people and 62(8) years for White people. Hypertension incidence was 46% for Black people and 33% for White people. There was noassociation of any of the three measures of residential segregation (DI, ISI and ITI) with incident hypertension, with RRs all around 1.0 (Figure).Conclusions:Three measures of residential segregation were not associated with incident hypertension risk in Black and White participants of the REGARDS cohort. Findings differ from a previous study that reported that a measure of racial clustering was associated with higher risk of hypertension in Black people. Taken together, findings suggest that, in Black people, different domains of residential segregation capture factors related differently to hypertension development.

Introduction:In the United States, the risk of stroke is greater among Black compared to White adults. Furthermore, hypertension has a greater impact on stroke risk among Black adults. We hypothesized that race-specific metabolites may account for some of this observed disparity.Methods:This was a case-cohort study nested in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study. Incident ischemic stroke cases (n=1,075) were compared with a random cohort sample (n=968). Metabolites were measured by liquid chromatography-tandem mass spectrometry. Weighted logistic regression and Cox proportional hazard model were used to identify race-specific metabolites in association with prevalent hypertension and incident stroke respectively. Candidate metabolites were assessed for mediation between hypertension and incident ischemic stroke. Linear regression was used to explore the association of metabolites with lifestyle factors.Results:A total of 162 plasma metabolites were quantified. Of these, gluconic acid was associated with prevalent hypertension in Black adults (OR=1.86, 95% CI=1.39-2.47, P=2.58x10-5) but not in White adults (OR=1.00, 95% CI=0.80-1.24, P=0.97; Pfor interaction=4.57x10-4). Gluconic acid was also associated with incident ischemic stroke among Black adults (HR=1.53, 95% CI=1.28-1.81, P=1.76x10-6) but not White adults (HR=1.16, 95% CI=1.00-1.34, P=0.057; Pfor interaction=0.019). Gluconic acid mediated 25.4% (95% CI=4.1%-46.8%, P=0.02) of the association between hypertension and ischemic stroke among Black adults. Specific lifestyle factors were linked to elevated gluconic acid level among Black adults in multivariable analysis, including a Southern diet (β=0.18, 95% CI=0.08-0.28, P<0.001), lower educational attainment (β=0.45, 95% CI=0.19-0.72, P=0.001), and lack of exercise (β=0.26, 95% CI=0.01-0.51, P=0.045).Conclusions:Gluconic acid is a lifestyle-related biomarker that is associated with prevalent hypertension, incident ischemic stroke, and mediates the relationship between hypertension and ischemic stroke in Black adults. Key factors linked to gluconic acid include Southern diet, low educational attainment, and low physical activity.

Worse neighborhood socioeconomic environment (NSEE) may contribute to an increased risk of type 2 diabetes (T2D). We examined whether the relationship between NSEE and T2D differs by sex and age in three study populations.

Background:Use of artificial intelligence-guided echocardiography (AI echo) may increase access to imaging, but there is little experience of its application in rural and low resource settings. The Risk Underlying Rural Areas Longitudinal (RURAL) cohort is the first NHLBI population-based cohort study to employ AI echo.Hypothesis:AI echo is feasible and produces adequate quality images to assess cardiac structure and function among rural populations.Methods:The RURAL study, in partnership with Caption Health (Brisbane, CA), is using AI echo in a multiethnic cohort of 4600 participants, performed in a mobile exam unit (MEU) in 10 rural U.S. communities. Non-sonographer MEU technicians underwent 10 hrs in-person competency-based training before scanning. Cardiac structure and function were analyzed in an independent core laboratory. Ejection fraction (EF) was visually estimated and calculated using Caption Health’s Auto EF technology.Results:Overall, 138 participants had AI echoes analyzed from Sept 2021 to May 2022 of whom 62% were women, with 70% obese (body mass index (BMI) ≥ 30kg/m2), median BMI 33.8kg/m2(Table 1). Median time per scan was 20.0mins (15.5, 29.7). Image quality was adequate for visual EF in 97%, with left ventricular dimensions measurable in 88% and left atrial diameter in 91%. Adequate images of the right heart and ascending aorta were less common: base of the right ventricle measurable in 62%, right atrium 61% and ascending aorta 60%. Most participants (96%) had LVEF ≥ 50% by visual estimation, and there was 96% agreement between visual and Auto EF for this group. Image quality, but not measurability, varied with BMI.Conclusion:AI echo imaging technology can be used by non-sonographers to acquire adequate quality images characterizing cardiac structure and function in a rural and predominantly obese population, suggesting utility across the spectrum of BMI and applicability in low resource environments with limited access to healthcare.

Supplemental Digital Content is available in the text.