Abstract
(1) Background: Cardio-metabolic diseases (CMD), including cardiovascular disease, stroke, and diabetes, have numerous common individual and environmental risk factors. Yet, few studies to date have considered how these multiple risk factors together affect CMD disparities between Blacks and Whites. (2) Methods: We linked daily fine particulate matter (PM2.5) measures with survey responses of participants in the Southern Community Cohort Study (SCCS). Generalized linear mixed modeling (GLMM) was used to estimate the relationship between CMD risk and social-demographic characteristics, behavioral and personal risk factors, and exposure levels of PM2.5. (3) Results: The study resulted in four key findings: (1) PM2.5 concentration level was significantly associated with reported CMD, with risk rising by 2.6% for each µg/m3 increase in PM2.5; (2) race did not predict CMD risk when clinical, lifestyle, and environmental risk factors were accounted for; (3) a significant variation of CMD risk was found among participants across states; and (4) multiple personal, clinical, and social-demographic and environmental risk factors played a role in predicting CMD occurrence. (4) Conclusions: Disparities in CMD risk among low social status populations reflect the complex interactions of exposures and cumulative risks for CMD contributed by different personal and environmental factors from natural, built, and social environments.
Highlights
Cardiovascular disease (CVD), stroke, and diabetes comprise a spectrum of related cardio-metabolic disease (CMD) conditions: CVD, congestive heart failure, myocardial infarction, atrial fibrillation, vascular endothelial dysfunction, stroke and atherosclerosis, and diabetes [1,2,3]
The present study examined the effects of PM2.5 exposure on Black:White disparities in CMD by linking daily measures of PM2.5 with survey responses of individual and environmental risk factors and CMD history taken at enrollment of participants of the Southern Community Cohort Study (SCCS) [57]
To account for state-dependent CMD variation, we modeled the random effects for the intercept using state of residence with fixed effects for individual risk factor characteristics and PM2.5 exposure of the participants
Summary
Cardiovascular disease (CVD), stroke, and diabetes comprise a spectrum of related cardio-metabolic disease (CMD) conditions: CVD (e.g., coronary heart disease), congestive heart failure, myocardial infarction, atrial fibrillation, vascular endothelial dysfunction, stroke and atherosclerosis, and diabetes (type 1, type 2, and metabolic syndrome) [1,2,3]. Together, they are the first, fifth, and seventh leading causes of death, respectively, for both men and women in the United States [4]. Metabolic risk factors for CMD include hypertension [7], allostatic load [8,9,10], dyslipidemia [11], decreased high density lipoprotein (HDL) and increased low density lipoprotein (LDL) cholesterol [12,13], triglycerides [14], fasting insulin [15], serum creatinine [16], serum uric acid [17] serum high-sensitivity C-reactive protein (hsCRP) [18], inflammation [19], hypertriglyceridemia [20], thrombosis [21,22], insulin resistance [23], serum lipids [24] and blood glucose [25,26], fibrinogen [27], and homocysteine [28] (see Table 1 for an extensive list of individual risk factors for CMD).
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