Introduction: A team-based care approach to hypertension care in low-resource settings is an effective strategy for improving hypertension control. Objective: In this multi-country survey, we assessed the extent to which team-based care is operationalized for hypertension care in low- and middle-income countries (LMICs), and the perception of hypertension program experts and health care workers (HCWs). Methods: Two surveys were administered; the first survey (Country Profile Survey), administered in 25 countries, sought to identify the current tasks of HCWs from perspectives of national representatives involved in public health programming. The second survey (HCW Survey), administered among HCWs in four LMICs; Bangladesh, China, Ethiopia, and Nigeria, aimed to understand current practices of HCWs, perspectives on team-based management of hypertension, and barriers and facilitators. Results: In the Country Profile Survey, all countries surveyed allowed team-based care for basic clinical hypertension management tasks, but less for advanced tasks (9/25, 36%). In the HCW survey, 854 HCWs from four countries participated: 47% (401/854) work in rural settings. Although there were slight variations by country, overall, barriers to team-based hypertension care were similar, including: inadequate training of HCWs (83%), regulatory issues (76%), resistance by patients (56%), and opposition by physicians (42%) and nurses (40%). Perceived facilitators of team-based hypertension care were use of treatment algorithms (94%), telehealth/m-health technology (92%), and adequate compensation for HCWs (80%) ( Figure A-B ). Conclusions: These surveys revealed key targets for health systems and governments to facilitate team-based care implementation. Specifically, policies to provide additional training, optimize HCWs roles within the care team, and establish hypertension treatment protocols and telehealth/m-health are essential.
Background: Racial/ethnic disparities in cardiovascular disease (CVD) deaths continue to persist, despite advances in preventive strategies. Few studies have examined disparities in CVD deaths by nativity status (US- vs. foreign-born). Objective: To assess differences in CVD deaths by nativity status across racial/ethnic groups in the US. Methods: Using a cross-sectional design, we pooled data from 1999-2018 National Health Interview Survey, with linked death records through 2019. Outcome, cardiovascular related deaths (CVD & CVA) was modelled, in years, as time from interview till year of death, or last date of follow-up (December 31, 2019). Nativity status was defined as US- or foreign-born. We used Cox proportional hazards regression to estimate differences in CVD deaths across racial/ethnic groups (White, Black, Asian, Indigenous American, and Hispanic adults) stratifying by nativity status. Models were sequentially adjusted for sociodemographic and CVD risk factors. Results: We included 172,896,665 adults (16% US-born, 84% foreign-born). During median 10 follow-up years, 3.41 CVD deaths /1,000person-years occurred. Among US-born adults, age-and sex-adjusted CVD death rates were 34% higher among Non-Hispanic Black adults (Hazard Ratio: 1.34; 95% CI, 1.29–1.39), 23% higher among Indigenous Americans (HR: 1.23; 95% CI, 1.00–1.52) compared to Non-Hispanic White adults [Table] . In the fully adjusted models, CVD death rates were 6% and 23% lower among Black (HR: 0.94 [95% CI, 0.89–0.99]) and Hispanic (HR: 0.77 [95% CI, 0.70–0.84]) adults. Compared to US-born White adults, CVD death was lower in foreign-born White (HR: 0.74; 95% CI, 0.66–0.82), Black (HR: 0.57; 95% CI, 0.45-0.73), Hispanic (HR: 0.55; 95% CI, 0.50–0.61), and Asian (HR: 0.61; 95% CI, 0.53–0.71) adults, respectively. Conclusions: Overall, CVD deaths were lower among foreign- than US-born adults. Although, there were some racial/ethnic differences in CVD deaths, we found evidence of persistent survival advantage among foreign-born adults.
Introduction: Post-acute sequelae of SARS-CoV-2 infection (PASC), a constellation of disabling symptoms, persisting after COVID-19, is an emerging health issue affecting substantial number of persons globally and in the US. Cardiac PASC refers to the wide range of cardiovascular-specific PASC symptoms. The psychological impact of PASC, cardiac PASC is poorly characterized. Objective: To examine whether PASC and cardiac PASC symptoms are associated with depressive symptoms and high levels of perceived stress. Methods: We conducted cross-sectional analyses among persons with history of COVID-19. Exposures were self-reported PASC and cardiac PASC symptoms. Outcomes were depressive symptoms and perceived stress measured using Patient Health Questionnaire (PHQ8) and Perceived Stress Scale (PSS4), respectively. Scores on PHQ8 ranged from 0-24, and clinical cutoff for depressive symptoms was ≥10. Scores on PHQ8 were dichotomized as minimal-mild (<10) and moderate-severe (≥10). Scores on PSS4 ranged from 0 to 16 with higher scores suggesting greater perceived stress. PSS4 scores were dichotomized as low/moderate (<6) and high (≥6) stress. We performed logistic regression analyses, adjusting for age, sex, race and comorbidities. Results: Of 197 participants, mean age was 47.3 (±15.9) years, 74% were female, 77% were White. About 48% (95/197) reported PASC, 46% (90/197 participants) reported cardiac PASC. The odds for moderate-severe depressive symptoms (adjusted Odds Ratio [aOR]: 5.03, 95%CI: 2.43-10.41, Table ) and high perceived stress (aOR: 4.19, 95%CI: 2.17-9.08) were higher compared to those who did not report PASC. Similarly, the odds for moderate-severe depression (aOR: 2.42, 95%CI: 1.25-4.70) and high perceived stress (aOR: 2.68, 95%CI: 1.43-5.02) was higher compared to those who did not report cardiac PASC. Conclusion: PASC and cardiac PASC are associated with clinical depressive symptoms and high perceived stress. Psychological and mental health interventions should be integrated into PASC care models.
Background: Hypertension (HTN) and diabetes (DM) share common pathophysiological mechanisms and hence have a high likelihood of co-occurring. The co-existence of HTN and DM increase increases CVD risk and exponentially increases health spending. Little is known about the burden of HTN in people with DM in Africa. Objective: To estimate the pooled prevalence of HTN in people with DM in African countries. Methods: This review was registered in the International Prospective Register of Systematic Reviews. We searched PubMed, Embase, and Hinari databases to identify peer-reviewed articles which provided data on the prevalence of HTN in people diagnosed with DM in Africa. We included studies that defined DM diagnosis as hemoglobin A1(HbA1c) >7.0 and HTN diagnosis as BP≥140/90mmHg. We quantified the prevalence of HTN using random-effects models. We applied generalized linear mixed models with logit transformation to compute regional and overall pooled prevalence and estimated heterogeneity (I 2 ). Results: Out of 3810 studies retrieved from the databases, 27 met the inclusion criteria with sample size between (80 - 4122). The mean age was 58 (± 11) years and 56% were women. The pool prevalence of HTN in people diagnosed with DM was 59.8% [95% CI: 52.8% - 66.5%]. By African region, Central Africa recorded the highest 77.6% [95% CI: 53.01% - 91.4%], South Africa 74.5% [95% CI: 67.4% - 80.5%], North Africa 65.5% [95% CI: 54.7% - 75.0%], West Africa 55.7% [95% CI: 44.0% - 66.7%] and East Africa 50.7% [95% CI: 43.7% - 57.3%]. Increasing age, being overweight/obese, being employed, longer duration of DM, urban residence, and male sex were associated with a higher likelihood of HTN diagnosis. Conclusion: The high prevalence of HTN among people with DM in Africa, supports an integrated differentiated service delivery to improve primary healthcare-level cardiovascular disease response mechanisms. The data generated from this review may inform the delivery of interventions to avert premature cardiovascular disease mortality among Africans.
Introduction: Despite advances in diabetes care, racial disparities in diabetes care and outcomes remain. Moreover, better access to and utilization of healthcare is associated with optimal diabetes control. Yet, little is known about race and ethnicity disparities in diabetes care utilization in the US. Objective: To estimate racial/ethnic differences in access and utilization of health services among adults diagnosed with diabetes in the US population. Methods: In this cross-sectional analyses, we identified and analysed data of 3,563 adults diagnosed with diabetes from the National Health and Nutrition Examination Survey, 2011-2018. The sample (Whites N=1,100, Black N=1,002, Asian N=438, Hispanic N=1,023) included adults ≥18 years who had self-reported diagnosed diabetes. The exposure variable was race/ethnicity groups. Healthcare care access was defined as having a routine place of healthcare, health insurance, and provider for diabetes care; and utilization measures were defined as having checked HbA1c and received diabetes care ≥4 times in the past year. We fitted generalized linear models with Poisson distribution to examine disparities in healthcare access and utilization by race/ethnicity among adults with diabetes. Results: Participants had a mean age of 59 (SE .32) years old, 49% female. In the fully adjusted models, compared to White adults, Hispanic adults were less likely to have health insurance (adjusted Odds Ratio [aOR]: 0.96; 95% CI 0.91-0.99) and less likely to have their HbA1c checked in the past year (aOR: 0.92; 95% CI: 0.86-0.98) ( Table ). There were no significant differences in having a routine place for healthcare, provider for diabetes care, and diabetes care received (≥4 times) in the past year in the fully adjusted analyses. Conclusion: Racial differences exist with lower access and utilization of diabetes care particularly among Hispanic adults. Targeted health interventions to address access to diabetes care are needed.
Background: Black persons are an heterogenous group in the US and bear a disparate higher burden of worse cardiovascular disease (CVD) outcomes. Our objective was to examine ethnic differences in CVD mortality among Black subgroups; African Americans(AAs); African Immigrants(AIs); and Afro Caribbeans(ACs). Methods: We analyzed the 1999-2018 National Health Interview Survey data, prospectively linked to mortality records in the National Death Index on 23,169,679 Black adults. The outcomes was CVD mortality, defined as CVD and cerebrovascular deaths, which was modelled as time till death (in years). This was calculated from each survey year till time of death or December 31, 2019 (administrative censoring) for those who survived. Using multivariable Cox proportional hazards regression analyses to model the survival function, we evaluated differences in CVD-and cerebrovascular-cause specific deaths among the three groups with progressive adjustment for age, sex, socioeconomic status and CVD risk factors. Results: With median of 10 years of mortality follow-up, there were 2.44, and 1.86 CVD deaths per 1,000 person-years among AA, and foreign born black adults (AIs and ACs combined), respectively. CVD mortality hazard was 81% lower in AIs [hazard ratio [HR], 0.19 (95% CI, 0.13–0.29], Table ) and 54% lower in ACs [HR, 0.46 (95% CI, 0.40–0.53], than among AAs. Compared to AAs, age-and sex-adjusted CVD mortality hazard was lower among AIs by 66% [HR, 0.34 (95% CI, 0.23–0.51], Table ) and ACs (HR, 0.46 [95% CI, 0.40–0.53]) by 54% (unchanged from unadjusted). In the fully adjusted model with SES and CVD risk factors adjustment, ACs had 41% lower adjusted CVD mortality hazard than AA adults (HR, 0.59 [95% CI, 0.45–0.77]). Conclusions: Cardiovascular deaths were higher among US-born AAs than foreign-born ACs. Nativity status is an important determinant of CVD mortality, and the heterogeneity of this population should be considered in health disparities research and interventions.
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