Self-reported Hypertension Research Articles

Self-reported periodontal health and incident hypertension: longitudinal evidence from the NutriNet-Santé e-cohort.

An association between periodontitis and arterial hypertension has been suggested recently. This study aimed at investigating the hypothesis that periodontal health is linked to incident arterial hypertension. We analyzed data from the French population-based e-cohort NutriNet-Santé, selecting participants who had completed two oral health questionnaires in 2011-2012. Pregnant women, participants with diabetes, cancer, arterial hypertension and cardiovascular diseases at inclusion were excluded. Incident cases of arterial hypertension were self-reported and/or based on the use of antihypertensive therapy. Periodontal health was evaluated by estimating the modified and validated PEriodontal Screening Score (mPESS), with mPESS at least 5 corresponding to a high probability of severe periodontitis. Descriptive statistics and Cox proportional hazards regression models, taking into account sociodemographic and lifestyle confounders, were used. The study population consisted of 32 285 participants (mean age: 45.79 ± 13.87 years); 78.5% were women. Two thousand one hundred and sixteen incident cases of arterial hypertension were identified during a median follow-up of 8 years (April 2012--December 2019). In the fully adjusted model, an mPESS at least 5 [hazard ratio: 1.84; 95% confidence interval (CI): 1.66-2.03] and the presence of nonreplaced missing teeth (hazard ratio: 1.13; 95% CI: 1.03-1.23) were significantly associated with a greater risk of incident arterial hypertension, whereas a regular annual visit to the dentist was associated with a lower risk (hazard ratio: 0.88; 95% CI: 0.80-0.97). Self-reported assessed periodontitis was associated with incident arterial hypertension over an 8-year period. The present results highlight the importance of considering periodontal health when assessing an individual's risk of arterial hypertension. # NCT03335644.

Heart failure care and outcomes in a Tanzanian emergency department: A prospective observational study.

BackgroundThe burden of heart failure is growing in sub-Saharan Africa, but there is a dearth of data characterizing care and outcomes of heart failure patients in the region, particularly in emergency department settings.MethodsIn a prospective observational study, adult patients presenting with shortness of breath or chest pain to an emergency department in northern Tanzania were consecutively enrolled. Participants with a physician-documented clinical diagnosis of heart failure were included in the present analysis. Standardized questionnaires regarding medical history and medication use were administered at enrollment, and treatments given in the emergency department were recorded. Thirty days after enrollment, a follow-up questionnaire was administered to assess mortality and medication use. Multivariate logistic regression was performed to identify baseline predictors of thirty-day mortality.ResultsOf 1020 enrolled participants enrolled from August 2018 through October 2019, 267 patients (26.2%) were diagnosed with heart failure. Of these, 139 (52.1%) reported a prior history of heart failure, 168 (62.9%) had self-reported history of hypertension, and 186 (69.7%) had NYHA Class III or IV heart failure. At baseline, 40 (15.0%) reported taking a diuretic and 67 (25.1%) reported taking any antihypertensive. Thirty days following presentation, 63 (25.4%) participants diagnosed with heart failure had died. Of 185 surviving participants, 16 (8.6%) reported taking a diuretic, 24 (13.0%) reported taking an antihypertensive, and 26 (14.1%) were rehospitalized. Multivariate predictors of thirty-day mortality included self-reported hypertension (OR = 0.42, 95% CI: 0.21–0.86], p = 0.017) and symptomatic leg swelling at presentation (OR = 2.69, 95% CI: 1.35–5.56, p = 0.006).ConclusionIn a northern Tanzanian emergency department, heart failure is a common clinical diagnosis, but uptake of evidence-based outpatient therapies is poor and thirty-day mortality is high. Interventions are needed to improve care and outcomes for heart failure patients in the emergency department setting.

Mean blood pressure according to the hypertension care cascade: Analysis of six national health surveys in Peru

BackgroundWhile we have good evidence about the hypertension care cascade, we do not know the mean blood pressure (BP) in these groups. We described the mean BP in four groups based on the hypertension care cascade at the national and sub-national levels in Peru. MethodsDescriptive analysis of six national health surveys. Blood pressure was measured twice and the second record herein analysed. We defined four groups: i) people with self-reported hypertension diagnosis receiving antihypertensive medication; ii) people with self-reported hypertension diagnosis not receiving antihypertensive medication; iii) people unaware they have hypertension with blood pressure ≥140 or 90 mmHg; and iv) otherwise healthy people. FindingsThere were 125,066 people; mean age was 49.8 years and there were more women (51.7%). At the national level, in men and women and throughout the study period, we observed that the mean systolic BP (SBP) was the highest in people unaware they have hypertension; the mean SBP was similar between those with and without antihypertension medication, yet slightly higher in the former group. At the sub-national level, even though the mean SBP in the unaware group was usually the highest, there were some regions and years in which the mean SBP was the highest in the untreated and treated groups. InterpretationThese results complement the hypertension care cascade with a clinically relevant parameter: mean BP. The results point where policies may be needed to secure effective interventions to control hypertension in Peru, suggesting that improving early diagnosis and treatment coverage could be priorities. FundingWellcome Trust (214185/Z/18/Z).

Hypertension and the Risk of All-Cause and Cause-Specific Mortality: An Outcome-Wide Association Study of 67 Causes of Death in the National Health Interview Survey.

Background Few studies have assessed the association between hypertension and risk of detailed causes of death. We investigated the association between hypertension and all-cause mortality and 67 causes of death in a large cohort. Methods Multivariable Cox regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) for self-reported hypertension vs. no hypertension and mortality. Adults aged ≥18 years (n = 213798) were recruited in 1997-2004 and followed through December 31, 2006. Results During 5.81 years of follow-up, 11254 deaths occurred. Self-reported hypertension vs. no hypertension was associated with increased risk of all-cause mortality (HR = 1.25, 95% CI: 1.19-1.31) and mortality from septicemia (HR =1.66, 1.06-2.59), other infectious parasitic diseases (HR = 2.67, 1.09-6.51), diabetes mellitus (HR = 1.97, 1.45-2.67), circulatory disease (HR = 1.49, 1.37-1.61), hypertensive heart disease (HR = 3.23, 2.00-5.20), ischemic heart disease (HR = 1.35, 1.23-1.49), acute myocardial infarction (HR = 1.50, 1.27-1.77), other chronic ischemic heart diseases (HR = 1.35, 1.17-1.56), all other forms of heart disease (HR = 1.51, 1.21-1.89), primary hypertension and renal disease (HR = 3.11, 1.82-5.30), cerebrovascular disease (HR = 1.64, 1.37-1.97), other circulatory system diseases (HR = 1.71, 1.09-2.69), other chronic lower respiratory diseases (HR = 1.39, 1.12-1.73), other chronic liver disease (HR = 1.89, 1.06-3.37), renal failure (HR = 1.91, 1.33-2.74), motor vehicle accidents (HR = 1.60, 1.07-2.37), and all other diseases (HR =1.30, 1.10-1.54), but with lower risk of uterine cancer (HR = 0.37, 95% CI: 0.15-0.90) and Alzheimer's disease (HR = 0.65, 95% CI: 0.47-0.92). Conclusion Hypertension was associated with increased risk of all-cause mortality and 17 out of 67 causes of death, with most of these being circulatory disease outcomes, however, some of the remaining associations are unlikely to be causal. Further studies are needed to clarify associations with less common causes of death and potential causality across outcomes.

Long-term All-Cause Mortality Risk in Obstructive Sleep Apnea Using Hypopneas Defined by a ≥3 Percent Oxygen Desaturation or Arousal.

Some prior studies have demonstrated an increase in mortality associated with obstructive sleep apnea (OSA) utilizing a definition of OSA that requires a minimum 4% oxygen desaturation to identify a hypopnea. No large community-based studies have determined the risk of long-term mortality with OSA with hypopneas defined by a ≥3% O2 desaturation or arousal (AHI3%A). Data from 5591 Sleep Heart Health Study participants without prevalent cardiovascular disease at baseline who underwent polysomnography were analyzed regarding OSA diagnosed using the AHI3%A criteria and all-cause mortality over a mean follow up period of 10.9±3.2 years. There were 1050 deaths in this group during the follow-up period. A Kaplan-Meir plot of survival revealed a reduction in survival with increasing AHI severity. Cox proportional hazards regression models revealed significantly increased all-cause mortality risk with increasing AHI, hazard ratio (HR, 95% CI) 1.13 (1.04-1.23), after adjusting for age, sex, race, BMI, cholesterol, HDL, self-reported hypertension and/or diabetes and smoking status. In categorical models, the mortality risk was significantly higher with severe OSA [adjusted HR 1.38 (1.09-1.76)]. When stratified by gender or age, severe OSA was associated with increased risk of death in men [adjusted HR 1.14 (1.01-1.28)] and in those <70 years of age [adjusted HR 1.51 (1.02-2.26)]. In contrast, AHI severity was not associated with increased mortality in women or those ≥70 years of age in fully adjusted models. Severe AHI3%A OSA is associated with significantly increased mortality risk, especially in men and those <70 years of age.

Assessing the Relationship Between History of Arrest and Self-reported Cardiovascular Conditions.

Formerly incarcerated Americans are believed to have increased risk of hypertension and cardiovascular disease, yet the impact of lower-level criminal legal system exposures, such as arrests, on cardiovascular health are less clear. We explored the relationship between lifetime history of arrest and self-report of ever having been diagnosed with hypertension or a heart condition using data from the 2018 National Survey on Drug Use and Health (NSDUH). Survey-weighted Poisson regression models with robust variance, adjusted for age group, sex, race/ethnicity, education, past year mental illness, smoking history, and past year substance use disorder, were used to estimate adjusted prevalence ratios (PRs). Among the 13,583 respondents, 17.0% reported a history of arrest, among whom 45.2% also reported a hypertension diagnosis and 24.4% reported a heart condition. Among those without a history of arrest, 46.7% reported a hypertension diagnosis and 25.2% reported a heart condition diagnosis. The adjusted models did not show evidence that history of arrest is associated with self-reported hypertension (adjusted PR 1.0; 95% confidence interval [CI] 0.93, 1.07, P = 0.937) or self-reported heart condition (1.0; 95% CI 0.91, 1.11, P = 0.915). We did not find evidence that history of arrest, a lower-level criminal legal system exposure, is associated with self-reported hypertension or heart conditions.

Cardiovascular Risk Factors among Individuals Incarcerated in an Arizona County Jail.

We aimed to estimate the prevalence of cardiovascular risk factors, including hypertension, diabetes, high cholesterol, cigarette smoking, alcohol consumption, and obesity among a sample of individuals incarcerated in an Arizona county jail and compare prevalence estimates to a matched non-institutionalized population. From 2017–2018, individuals housed at a county jail completed a cross-sectional health survey. We estimated the prevalence of hypertension, diabetes, cholesterol, overweight/obesity, cigarette smoking, binge drinking, and self-reported health among individuals incarcerated. We compared prevalence estimates of cardiovascular risk factors to a matched sample of 2017–2018 NHANES participants. Overall, 35.9%, 7.7%, and 17.8% of individuals incarcerated in jail self-reported hypertension, diabetes, and high cholesterol, respectively. Of individuals incarcerated, 59.6% were overweight or obese and 36.8% self-reported fair or poor general health. Over half of individuals incarcerated reported ever smoking cigarettes (72.3%) and binge drinking (60.7%). Compared to a matched sample of NHANES participants, individuals incarcerated in jail had a statistically higher prevalence of cigarette smoking and binge drinking. Screening of cardiovascular risk factors and providing preventive measures and interventions, such as healthy eating, physical activity, or pharmacological adherence interventions, while individuals are incarcerated may contribute to the prevention and management of cardiovascular risk factors and, eventually, cardiovascular disease.

Accuracy of Self-Reported Arterial Hypertension in Brazil: Systematic Review and Meta-Analysis

Background Self-reported hypertension is a useful method to estimate prevalence in the population. However, it is necessary to evaluate its accuracy, in relation to the gold-standard diagnostic methods of the disease. Objectives To estimate combined measures of sensitivity and specificity for self-reported hypertension, using Brazilian validation studies that included gold standard methods. Methods A systematic review and a meta-analysis were developed. Two independent examiners evaluated 1389 and read 113 potentially eligible articles. Since self-reported morbidity is influenced by the [...]

HIV and cardiovascular disease in sub-Saharan Africa: Demographic and Health Survey data for 4 countries

BackgroundInvestigate the relationship between two common cardiovascular diseases and HIV in adults living in sub-Saharan Africa using population data provided through the Demographic and Health Survey.MethodsData for four sub-Saharan countries were used. All adults asked questions regarding diagnosis of HIV, diabetes, and hypertension were included in the sample totaling 5356 in Lesotho, 3294 in Namibia, 9917 in Senegal, and 1051 in South Africa. Logistic models were run for each country separately, with self-reported diabetes as the first outcome and self-reported hypertension as the second outcome and HIV status as the primary independent variable. Models were adjusted for age, gender, rural/urban residence and BMI. Complex survey design allowed weighting to the population.ResultsPrevalence of self-reported diabetes ranged from 3.8% in Namibia to 0.5% in Senegal. Prevalence of self-reported hypertension ranged from 22.9% in Namibia to 0.6% in Senegal. In unadjusted models, individuals with HIV in Lesotho were 2 times more likely to have self-reported diabetes (OR = 2.01, 95% CI 1.08–3.73), however the relationship lost significance after adjustment. Individuals with HIV were less likely to have self-reported diabetes after adjustment in Namibia (OR = 0.29, 95% CI 0.12–0.72) and less likely to have self-reported hypertension after adjustment in Lesotho (OR = 0.63, 95% CI 0.47–0.83). Relationships were not significant for Senegal or South Africa.DiscussionHIV did not serve as a risk factor for self-reported cardiovascular disease in sub-Saharan Africa during the years included in this study. However, given the growing prevalence of diabetes and hypertension in the region, and the high prevalence of undiagnosed cardiovascular disease, it will be important to continue to track and monitor cardiovascular disease at the population level and in individuals with and without HIV.ConclusionsThe odds of self-reported diabetes in individuals with HIV was high in Lesotho and low in Namibia, while the odds of self-reported hypertension in individuals with HIV was low across all 4 countries included in this study. Programs are needed to target individuals that need to manage multiple diseases at once and should consider increasing access to cardiovascular disease management programs for older adults, individuals with high BMI, women, and those living in urban settings.

Self-Measured Blood Pressure Monitoring Among Adults With Self-Reported Hypertension in 20 US States and the District of Columbia, 2019.

Hypertension is a major risk factor for cardiovascular disease. Achieving hypertension control requires multiple supportive inventions, including self-measured blood pressure (SMBP) monitoring. The objective of this study is to report the use of SMBP among US adults. Behavioral Risk Factor Surveillance System data were used for this study. The 2019 survey included, for the first time, an optional SMBP module. Twenty states and the District of Columbia (N = 159,536) opted to include the module, which assessed whether participants were advised by a healthcare professional to use SMBP, and if they used SMBP monitoring. Among those using SMBP, additional questions assessed the location of SMBP monitoring and whether SMBP readings were shared with a healthcare professional. Among adults in the study population, 33.9% (95% confidence interval 33.4%-34.5%) reported having hypertension (N = 66,869). Among them, nearly 70% were recommended to use SMBP by their healthcare professional and approximately 61% reported SMBP use regardless of recommendation. The most common location of SMBP was the home (85.6%). Overall, >80% shared their SMBP reading with their healthcare professional, 74% and 7% were shared in person and via the internet or email, respectively. There were differences in healthcare professional recommendations, use of SMBP, and SMBP information sharing across demographic characteristics and state of residency. SMBP recommendation was common practice among healthcare professionals, as reported by US adults with hypertension. Data from this study can be used to guide interventions to promote hypertension self-management and control.

Stroke and cardiovascular risk factors among working-aged Finnish migraineurs

BackgroundThe aim of our study was to evaluate the risk for comorbid cardio- and cerebrovascular diseases in the working-aged migraine population of Finland.MethodsA total of 1505 cases who reported diagnosed migraine and 3010 controls from a cohort of 11,596 cases in the Finnish Health and Social Support Study were included. The study material was linked with two registers. ICD diagnoses I63 for ischemic stroke (IS), I21 − I22 for acute myocardial infarction (AMI), and G43 for transient ischemic attack (TIA) among study participants were drawn from the national Finnish Care Register for Health Care at the follow-up in 2012. Reimbursed triptan prescriptions were drawn from the national Social Security Institution (SII) data. The self-reported vascular risk factors were hypertension, high cholesterol values, any diabetes, myocardial infarction, stroke, and TIA. Odds Ratios (OR) with 95% confidence (95% CI) intervals were assessed for diagnosed stroke, myocardial infarction, and TIA.ResultsMigraineurs were mostly female (82%) and ≥ 54 years old (62%). Triptans were reimbursed among 34.7% of migraineurs. A self-reported hypertension (21%), high serum cholesterol (38%), and any diabetes (7%) were more common among migraineurs vs controls (p < 0.05). There was no risk for AMI. The risk for TIA (OR 3.20, 95% CI 1.45–7.05) and IS (2.57, 95% CI 1.28–5.17) among migraineurs vs controls remained high after adjustment for self-reported hypertension, obesity, and smoking. The risk was higher among women in two groups ≥54 years (3.25, 95% CI 1.35–7.84 and 5.0, 95% CI 1.94–12.89, respectively). The average age for IS in migraine was 57.5 years and for TIA 58.2 years among women, and 52.8 years and 50.3 years among men, respectively.ConclusionCardiovascular risk should be screened in the aging migraine population, and hormonal and other migraine-related risk factors should be considered, especially among women. Efficacious attack treatment with triptans should be offered to migraine patients who do not show contraindications.

52-LB: Weight Management Practices among U.S. Safety-Net Health Center Patients with Diabetes or Other Metabolic Disorders

Introduction: First-line intervention for the metabolic disorders or type 2 Diabetes is lifestyle change, including weight management, diet, and increased physical activity. This study evaluated the associations between health professional (HP) weight discussions and weight management practices among high risk safety-net patients. Methods: Cross-sectional data on adults (aged≥18 years) with self-reported diabetes, hypertension or hyperlipidemia from the 2014 National Health Center Patient Survey (HCPS) was analyzed. The HCPS is a nationally representative survey of patients receiving care at safety-net health centers. Outcome (binary) was whether patients tried to lose weight in prior 12 months. Independent variables were HP discussing the weight problem, talking about weight loss options (i.e., exercise), suggesting a nutritionist visit, or offering weight loss medication. Logistic regression models with complex sampling design was used to test the association between HP weight discussions and the outcome, adjusted for psycho-sociodemographic covariates. Results: Of 3671 patients, 55.5% (n=2039) tried to lose weight in prior 12 months. Women (62.4%) and Hispanic race/ethnicity (62.8%) were associated with a higher prevalence of attempting to lose weight in prior 12 months. In the fully adjusted model, having received HP’s weight discussion (AOR=5.54, 95%CI: 3.59-8.56), suggest exercise (AOR=3.61, 95% CI: 2.37-5.49), and recommend a nutritionist visit (AOR=2.59, 95% CI: 1.67-4.01) were associated for increased likelihood of attempting weight loss. Conclusions: HP advice to lose weight may increase patients’ motivation to lose weight and weight loss behavior. Better training for HPs in delivering high-value care such as brief weight counselling could lead to improved chronic disease health outcomes for safety-net patient populations. Disclosure J. J. Wang: None. Z. Shi: None. A. Yan: None.

Sex Differences in the Mediating Effects of Modifiable Risk Factors in Associations Between Socioeconomic Position and Cardiovascular Disease Morbidity and Mortality

Abstract Objectives Socioeconomic inequities in cardiovascular diseases (CVDs) are greater in females than males. However, the mechanisms underpinning the excess CVD risk conferred by low socioeconomic position (SEP) in females remain unclear. This study aimed to quantify the mediating effects of modifiable risk factors to associations between SEP and CVD morbidity and mortality. Methods We combined eight cycles of the nationally-representative cross-sectional Canadian Community Health Survey (2000–2011) to identify a cohort of adults (≥35 years) without CVD at the time of survey administration (n = 289,800). Survey data were linked to administrative health (Hospital Discharge Abstract Database) and mortality (Canadian Mortality Database) records for 2000–2012. SEP was captured by a latent variable consisting of self-reported educational level and household income. Self-reported modifiable risk factors, including smoking, physical inactivity, obesity, diabetes, and hypertension were considered as potential mediators. The outcome was CVD morbidity and mortality as reported in administrative health and mortality databases. Generalized structural equation modeling was used to estimate the mediating effects of modifiable risk factors in associations between SEP and CVD morbidity and mortality in males and females. Results The total effects of SEP on CVD morbidity and mortality were higher in females than in males. The modifiable risk factors mediated the higher proportion of the total effects in females than in males (87.80% vs 687.8%). Smoking was the most important mediator of associations between SEP and CVD morbidity and mortality for both males and females. The pathways linking SEP with obesity, diabetes and hypertension and subsequent CVD morbidity and mortality were significant in females but not among males. Conclusions These findings revealed evidence of some sex-specific patterns in the mediating effects of modifiable risk factors on associations between SEP and CVD morbidity and mortality. The findings suggest that different strategies may be required to reduce inequities in CVD in males and females. Funding Sources This study was funded by a Libin Cardiovascular Research Institute of Alberta Innovation Seed Grant and the Petro-Canada Young Innovator Award in Community Health.

MO535PREVALENCE OF CHRONIC KIDNEY DISEASE AND ASSOCIATED RISK FACTORS ON THE ISLAND OF MONTSERRAT

Abstract Background and Aims Chronic Kidney Disease (CKD) is a global health problem with disproportionate burden in low- and middle-income countries in Latin America and the Caribbean. Despite these disparities, little is known of the prevalence and risk factors of CKD in the Caribbean. We sought to determine prevalence of CKD among patients attending ambulatory centres in Montserrat, an island that to date, has no facilities for renal replacement therapy. Method A cross-sectional observational study of Participants were individuals aged ≥18 years was performed. Random cluster sampling of at least 500 participants who attended clinic from January 1 to July 1, 2020 across all primary health care facilities on island was performed. Patients without lab values for creatinine were excluded. The main outcome measures was estimated CKD prevalence (as defined based on KDIGO 2012 guidelines of eGFR &amp;lt; 60mL/min/1.73m2 using creatinine based CKD-EPI for blacks; and estimated prevalence of CKD risk factors (Self-reported diabetes or hypertension and obesity, BMI&amp;gt; 30kg/m2). Multivariate Logistic regression was used to determine independent predictors of CKD. Results Three hundred and fifty-five participants (n = 355) were selected for participation. Participants’ mean age was 63 ± 17 years, with 60% (n=213) being female. 38% (n=135) had self-reported diabetes and 58% (n=201) had hypertension; and 44% were obese. Mean± SD estimated GFR was 81 ± 30 ml/min/1.73 m2 . One quarter of the participants (25%) had an eGFR &amp;lt;60 ml/min/1.73 m2, indicating CKD. Age [95% CI, OR 1.03 (1.01–1.07)], Self-reported hypertension [95% CI, OR 2.09, (1.13–3.90)] and female gender [95% CI ,OR 0.20 (0.10, 0.39)] were independent predictors of reduced eGFR. Conclusion CKD and its risk factors were prevalent among adults in Montserrat. Consideration must be made for infrastructural and/or policy changes to be mandated, to slow the progression of CKD. Primary prevention initiatives can be implemented to reduce the associated morbidity, mortality and cost associated with CKD. There is room for further longitudinal studies to identify etiology, as well as factors affecting CKD progression. This study will also propel creation of the Montserrat arm of the Caribbean Renal Registry, to allow for future follow up of long-term effects, as well as ascertain risk factors for CKD progression.

Abstract P073: Cardiometabolic Conditions And Their Risk Factors Among Adults In Puerto Rico Before And After Hurricane María, 2015-2019

Adults living in Puerto Rico (PR) have high prevalence of multiple cardiometabolic conditions and their risk factors. It remains unknown if the destructive events of Hurricane María in 2017 influenced disease burden. We aimed to contrast estimated prevalence of chronic diseases and lifestyle and psychosocial risk factors among adults living in PR before and after the Hurricane. Data from adults aged 30-75y was obtained from PRADLAD, a pilot cross-sectional study of 380 adults conducted in 2015, and from PROSPECT, a longitudinal study that started in 2019 and had 534 participants recruited by March 2020. A subset of 87 PRADLAD participants returned to PROSPECT. Data collection protocols were similar between studies and included validated questions on sociodemographic factors, lifestyle behaviors, psychosocial factors, self-reported medically-diagnosed diseases, and measured anthropometrics. We estimated crude and age-standardized characteristics contrasting the two study populations at different time points (PRADLAD 2015 vs. PROSPECT 2019). Analysis was also conducted solely for the 87 returning participants. Sociodemographic characteristics were similar between studies. Contrasting all participants from both studies showed significantly (p&lt;0.05) higher crude abdominal obesity (73.2 vs. 61.3%), sedentarism (44.4 vs. 35.8%), binge drinking (17.9 vs. 12.1%), and social support (26.9 vs. 24.7 mean score) in 2019 vs. 2015, but lower depressive symptoms (31.7 vs. 52.6%) and perceived stress (19.3 vs. 21.7 mean score). In 2019 (vs. 2015), there was significantly higher crude self-reported hypertension (47.3 vs. 39.2%), arthritis (32.3 vs. 25.6%), high cholesterol (36.4 vs. 23.8%), pre-diabetes (20.3 vs. 15.2%), high triglycerides (23.1 vs. 14.7%), eye disease (17.6 vs. 12.7%), fatty liver disease (12.8 vs. 7.5%), and osteoporosis (13.9 vs. 5.2%). Trends remained, albeit slightly attenuated, after age-standardization. Similar differences in depressive symptoms, perceived stress, social support, high cholesterol, and fatty liver disease were noted for the 87 returning participants, who also reported higher gastrointestinal disease (30.6 vs. 15.1%) and heart disease or stroke (9.5 vs. 2.3%) in 2019 vs. 2015. In conclusion, adults in PR have higher prevalence of unhealthy behaviors and chronic diseases, including multiple cardiometabolic conditions, after Hurricane María, suggesting that natural disasters may amplify cardiovascular-related disparities. Despite this, depressive symptoms and stress were lower and social support was higher post-Hurricane. Larger longitudinal studies and trend data should confirm these observations. Leveraging positive psychosocial factors may bolster population-wide behavioral and clinical preventive measures to improve cardiometabolic health and close inequities among adults in PR, who often face natural disasters.

Population-based body\u2013brain mapping links brain morphology with anthropometrics and body composition

Understanding complex body–brain processes and the interplay between adipose tissue and brain health is important for understanding comorbidity between psychiatric and cardiometabolic disorders. We investigated associations between brain structure and anthropometric and body composition measures using brain magnetic resonance imaging (MRI; n = 24,728) and body MRI (n = 4973) of generally healthy participants in the UK Biobank. We derived regional and global measures of brain morphometry using FreeSurfer and tested their association with (i) anthropometric measures, and (ii) adipose and muscle tissue measured from body MRI. We identified several significant associations with small effect sizes. Anthropometric measures showed negative, nonlinear, associations with cerebellar/cortical gray matter, and brain stem structures, and positive associations with ventricular volumes. Subcortical structures exhibited mixed effect directionality, with strongest positive association for accumbens. Adipose tissue measures, including liver fat and muscle fat infiltration, were negatively associated with cortical/cerebellum structures, while total thigh muscle volume was positively associated with brain stem and accumbens. Regional investigations of cortical area, thickness, and volume indicated widespread and largely negative associations with anthropometric and adipose tissue measures, with an opposite pattern for thigh muscle volume. Self-reported diabetes, hypertension, or hypercholesterolemia were associated with brain structure. The findings provide new insight into physiological body–brain associations suggestive of shared mechanisms between cardiometabolic risk factors and brain health. Whereas the causality needs to be determined, the observed patterns of body–brain relationships provide a foundation for understanding the underlying mechanisms linking psychiatric disorders with obesity and cardiovascular disease, with potential for the development of new prevention strategies.

Health outcomes following retirement: a comparative study of health and non-health pensioners in Ghana

Occupation is a major determinant of health outcomes. Healthcare workers are assumed to know how to prevent diseases and live a healthy life. The aim of this study is to determine the association between working in healthcare as a pre-retirement occupation and health outcomes after retirement. This cross-sectional study was conducted among 4813 members of the National Pensioners Association in Ghana. Thirteen study centres were used in the study. A total of 403 study participants (8.4%) were healthcare workers. After retirement, healthcare workers died earlier compared to non-healthcare workers. Life-table analysis of data demonstrated that 51.9% (95% CI = 47.1–56.9) of health workers died within 5 years after retirement, compared to 35.9% (95% CI = 34.5–37.4) of non-healthcare workers within same time period. Healthcare workers had a significantly higher prevalence of obesity (34.0, 95% CI = 29.5–38.8), self-reported hypertension (54.8%, 95% CI = 49.9–59.7) and high serum total cholesterol (46.4%, 95% CI = 48.7–58.5) compared to non-health workers. Logistic regression of factors on health outcomes after retirement among healthcare workers revealed that healthcare workers were nearly twice as likely to have arthritis (AOR = 1.6, 95% CI = 1.2–2.1), hearing loss (AOR = 2.0, 95% CI = 1.2–3.1), ischaemic heart disease (AOR = 2.0, 95% CI = 1.2–3.3), and cerebrovascular accident (AOR = 2.1, 95% CI = 1.1–4.0) compared to non-healthcare workers. Retired healthcare workers die earlier after retirement and have a higher prevalence of non-communicable disease and its risk factors compared to non-healthcare workers. It is imperative to put in place measures to ensure individual health workers and occupational health teams develop innovative ways to care for themselves.

The association between non-communicable disease and hearing aid adoption in older adults with hearing loss

Objective: To assess whether specific non-communicable diseases are associated with hearing aid adoption in older adults with hearing loss. Design: A cross-sectional, observational study. Study sample: Data was obtained from one of the largest pharmacy-led health and beauty retailers in the United Kingdom. In total, 17,172 older adults were included. Results: Greater odds of adopting hearing aids were associated with being older (Odds ratio [OR] = 1.03; 95% confidence interval [CI] = 1.02, 1.03), having fewer self-reported hearing difficulties (OR = 0.61; 95% CI = 0.58, 0.64), and greater audiometric hearing loss (OR = 1.68; 95% CI = 1.54, 1.83). The odds of adopting hearing aids were lower if individuals self-reported hypertension (OR = 0.87; 95% CI = 0.79, 0.97) and diabetes (OR = 0.83; 95% CI = 0.72, 0.95). Using a decision tree model, self-reported hearing difficulties, audiometric hearing loss, and age were the best combination of variables to differentiate between individuals that did and did not adopt hearing aids. Conclusions: This study demonstrates that hearing aid adoption is lower in older adults with cardiovascular disease risk factors. Thus, there is a need for healthcare professionals to identify older adults living with hearing loss and cardiovascular ill-health, ensuring that they receive appropriate patient-centred support to manage their health.

Combining self-reported and objectively measured survey data to improve hypertension prevalence estimates: Portuguese experience

BackgroundAccurate data on hypertension is essential to inform decision-making. Hypertension prevalence may be underestimated by population-based surveys due to misclassification of health status by participants. Therefore, adjustment for misclassification bias is required when relying on self-reports. This study aims to quantify misclassification bias in self-reported hypertension prevalence and prevalence ratios in the Portuguese component of the European Health Interview Survey (INS2014), and illustrate application of multiple imputation (MIME) for bias correction using measured high blood pressure data from the first Portuguese health examination survey (INSEF).MethodsWe assumed that objectively measured hypertension status was missing for INS2014 participants (n = 13,937) and imputed it using INSEF (n = 4910) as auxiliary data. Self-reported, objectively measured and MIME-corrected hypertension prevalence and prevalence ratios (PR) by sex, age group and education were estimated. Bias in self-reported and MIME-corrected estimates were computed using objectively measured INSEF data as a gold-standard.ResultsSelf-reported INS2014 data underestimated hypertension prevalence in all population subgroups, with misclassification bias ranging from 5.2 to 18.6 percentage points (pp). After MIME-correction, prevalence estimates increased and became closer to objectively measured ones, with bias reduction to 0 pp - 5.7 pp. Compared to objectively measured INSEF, self-reported INS2014 data considerably underestimated prevalence ratio by sex (PR = 0.8, 95CI = [0.7, 0.9] vs. PR = 1.2, 95CI = [1.1, 1.4]). MIME successfully corrected direction of association with sex in bivariate (PR = 1.1, 95CI = [1.0, 1.3]) and multivariate analyses (PR = 1.2, 95CI = [1.0, 1.3]). Misclassification bias in hypertension prevalence ratios by education and age group were less pronounced and did not require correction in multivariate analyses.ConclusionsOur results highlight the importance of misclassification bias analysis in self-reported hypertension. Multiple imputation is a feasible approach to adjust for misclassification bias in prevalence estimates and exposure-outcomes associations in survey data.

THE EFFECTS OF MIDDAY NAP DURATION ON THE RISK OF HYPERTENSION IN CHINESE RURAL POPULATION

Abstract Objective: Most previous epidemiological studies regarding sleep and risk of hypertension focused on the association between night sleep duration and hypertension. However, data on the effect of midday nap duration on hypertension are scarce, especially among rural population. The study was conducted to evaluate the associations of the midday nap duration with blood pressure and hypertension in Chinese rural population. Design and method: From August 2016 to July 2017, a total of 1755 eligible participants were consecutively enrolled in our study in Hunan province, China. Hypertension was defined as systolic blood pressure/diastolic blood pressure &gt; = 140/90mmHg or self-reported hypertension and current use of anti-hypertensive medicines. Participants were categorized into three groups according to midday nap duration, such as no napping (reference), short (&lt;1 h), and long (&gt; = 1 h). Multivariable regression models were applied to assess the potential association. Results: Of the 1755 included participants, 908 suffered from hypertension. Participants’ mean age was 55.86 years. 638 (36.35%) were men and 1117 (63.65%) were women. Compared to reference (no napping), fully adjusted odd ratios (ORs) and 95% confidence interval (CI) of hypertension were 0.72 (0.57–0.92) in participants with long midday napping duration (&gt; = 1 h). Linear regression analyses showed that long midday nap duration (b = -2.78, 95% CI: -4.89, -0.67, P = 0.010) were significantly negative association with systolic blood pressure. Conclusions: Our findings suggest that long midday nap duration might decrease the risk of hypertension and reduce the levels of systolic blood pressure among rural population. These findings warrant further prospective studies in a larger population.