Ethnic and Racial Variation in Intracerebral Hemorrhage Risk Factors and Risk Factor Burden.
Ethnic and Racial Variation in Intracerebral Hemorrhage Risk Factors and Risk Factor Burden.
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DOI：
10.1001/jamanetworkopen.2021.21921
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发表时间：
2021-08-02
影响因子：
13.8
通讯作者：
Woo D
中科院分区：
文献类型：
--
作者：
Kittner SJ;Sekar P;Comeau ME;Anderson CD;Parikh GY;Tavarez T;Flaherty ML;Testai FD;Frankel MR;James ML;Sung G;Elkind MSV;Worrall BB;Kidwell CS;Gonzales NR;Koch S;Hall CE;Birnbaum L;Mayson D;Coull B;Malkoff MD;Sheth KN;McCauley JL;Osborne J;Morgan M;Gilkerson LA;Behymer TP;Demel SL;Moomaw CJ;Rosand J;Langefeld CD;Woo D
脑叶和非脑叶脑出血(ICH)的危险因素在黑人、西班牙裔和白人人群中的患病率和负担是否有所不同？在这项对3000例黑人、西班牙裔和白人脑出血患者进行的病例对照研究中，载脂蛋白E基因ɛ2和ɛ4等位基因与白人脑叶脑出血相关，而与黑人和西班牙裔脑出血无关；高血压是所有组中脑叶和非叶脑出血的危险因素；黑人和西班牙裔脑出血患者的平均年龄比白人患者年轻10岁以上。黑人和西班牙裔患者在高血压治疗或未治疗以及缺乏医疗保险方面的归因风险百分比高于白人患者。这些发现表明，潜在的可改变的风险因素和健康的社会决定因素是黑人和西班牙裔人口经历的不成比例的非物质文化遗产负担的重要因素。这项病例对照研究按脑出血部位和种族/民族分层，考察了脑出血已有的和新的危险因素的患病率、赔率和人群归因风险。与白人相比，黑人和西班牙裔个体患脑出血(ICH)的风险更高，但尚未在这些不成比例受影响的人群中进行大规模的脑出血研究。根据脑出血的地点和种族/民族分组，检查脑出血已有的和新的危险因素的患病率、几率和人群归因风险(PAR)百分比。脑出血的种族/种族差异研究是对3000名经历过自发性脑出血的黑人、西班牙裔和白人个体(每组1000例)进行的脑出血病例对照研究。招聘工作于2009年9月至2016年7月期间在美国42家医院的19个地点进行。对照参与者通过随机数字拨号识别，并按年龄(±5岁)、性别、种族/民族和地理地区与病例参与者匹配。数据分析从2019年1月至2020年5月进行。病例和对照受试者接受了标准化访谈、体重指数的体格测量和载脂蛋白E基因ɛ2和ɛ4等位基因的基因分型，计算所有脑出血人群中每个危险因素的患病率、多变量调整优势比(OR)和PAR百分比，并按种族/民族和大叶或非大叶位置进行分层。有1000名黑人患者(中位数[四分位数范围]年龄，57[50-65]岁，425名[42.5%]女性)，1000名西班牙裔患者(中位数[IQR]年龄58[49-69]岁；373名[37.3%]女性)，1000名白人患者(中位数[IQR]年龄71[59-80]岁；437名[43.7%]女性)。黑人和西班牙裔患者的平均年龄(SD)显著低于白人患者(例如，大叶型ICH：黑人，62.2[15.2]岁；西班牙裔，62.5[15.7]岁；白人，71.0[13.3]岁)。在黑人和西班牙裔患者中，超过一半的脑出血与治疗或未治疗的高血压有关(治疗后的高血压，黑人患者的PAR：53.6%；95%的CI，46.4%-59.8%；西班牙裔患者：46.5%；95%的CI，40.6%-51.8%；未治疗的高血压，黑人患者：45.5%；95%的CI，39.%-51.1%；西班牙裔患者：42.7%；95%的CI，37.6%-47.3%)。在黑人和西班牙裔患者中，缺乏医疗保险也与脑出血的PAR比例不成比例地相关(黑人患者：21.7%；95%CI，17.5%-25.7%；西班牙裔患者：30.2%；95%CI，26.1%-34.1%；白人患者：5.8%；95%CI，3.3%-8.2%)。高睡眠呼吸暂停风险评分与脑叶(OR，1.68；95%CI，1.36-2.06)和非脑叶(OR，1.62；95%CI，1.37-1.91)脑出血有关，而高胆固醇只与非脑叶脑出血(OR，0.60；95%CI，0.52-0.70)负相关；两者均与种族和民族无关。与白人载脂蛋白E和脑出血的ɛ2和ɛ4等位基因的相关性(例如，载脂蛋白Eɛ2等位基因的存在：OR为1.84；95%可信区间为1.3 4-2.5 2)相反，在黑人和西班牙裔个体中，载脂蛋白E等位基因与脑叶脑出血无关。这项研究发现睡眠呼吸暂停是脑出血的一个新的危险因素。结果表明，高血压治疗不充分和缺乏医疗保险是黑人和西班牙裔人口脑出血负担不成比例和发病较早的重要原因。这些研究结果强调了解决可改变的风险因素和健康的社会决定因素以减少健康差距的重要性。
Does the prevalence and burden of risk factors for lobar and nonlobar intracerebral hemorrhage (ICH) differ among Black, Hispanic, and White populations? In this case-control study of 3000 cases of ICH among Black, Hispanic, and White patients, the ɛ2 and ɛ4 alleles of APOE, the gene encoding apolipoprotein E, were associated with lobar ICH in White but not Black and Hispanic patients; hypertension was a risk factor for both lobar and nonlobar ICH in all groups; and the mean age for ICH among Black and Hispanic patients was more than 10 years younger than that of their White counterparts. Black and Hispanic patients had a higher attributable risk percentage for treated or untreated hypertension and lack of health insurance than White patients. These findings suggest that potentially modifiable risk factors and social determinants of health are important contributors to the disproportionate ICH burden experienced by Black and Hispanic populations. This case-control study examines the prevalence, odds, and population attributable risk for established and novel risk factors for intracerebral hemorrhage, stratified by intracerebral hemorrhage location and racial/ethnic group. Black and Hispanic individuals have an increased risk of intracerebral hemorrhage (ICH) compared with their White counterparts, but no large studies of ICH have been conducted in these disproportionately affected populations. To examine the prevalence, odds, and population attributable risk (PAR) percentage for established and novel risk factors for ICH, stratified by ICH location and racial/ethnic group. The Ethnic/Racial Variations of Intracerebral Hemorrhage Study was a case-control study of ICH among 3000 Black, Hispanic, and White individuals who experienced spontaneous ICH (1000 cases in each group). Recruitment was conducted between September 2009 and July 2016 at 19 US sites comprising 42 hospitals. Control participants were identified through random digit dialing and were matched to case participants by age (±5 years), sex, race/ethnicity, and geographic area. Data analyses were conducted from January 2019 to May 2020. Case and control participants underwent a standardized interview, physical measurement for body mass index, and genotyping for the ɛ2 and ɛ4 alleles of APOE, the gene encoding apolipoprotein E. Prevalence, multivariable adjusted odds ratio (OR), and PAR percentage were calculated for each risk factor in the entire ICH population and stratified by racial/ethnic group and by lobar or nonlobar location. There were 1000 Black patients (median [interquartile range (IQR)] age, 57 [50-65] years, 425 [42.5%] women), 1000 Hispanic patients (median [IQR] age, 58 [49-69] years; 373 [37.3%] women), and 1000 White patients (median [IQR] age, 71 [59-80] years; 437 [43.7%] women). The mean (SD) age of patients with ICH was significantly lower among Black and Hispanic patients compared with White patients (eg, lobar ICH: Black, 62.2 [15.2] years; Hispanic, 62.5 [15.7] years; White, 71.0 [13.3] years). More than half of all ICH in Black and Hispanic patients was associated with treated or untreated hypertension (PAR for treated hypertension, Black patients: 53.6%; 95% CI, 46.4%-59.8%; Hispanic patients: 46.5%; 95% CI, 40.6%-51.8%; untreated hypertension, Black patients: 45.5%; 95% CI, 39.%-51.1%; Hispanic patients: 42.7%; 95% CI, 37.6%-47.3%). Lack of health insurance also had a disproportionate association with the PAR percentage for ICH in Black and Hispanic patients (Black patients: 21.7%; 95% CI, 17.5%-25.7%; Hispanic patients: 30.2%; 95% CI, 26.1%-34.1%; White patients: 5.8%; 95% CI, 3.3%-8.2%). A high sleep apnea risk score was associated with both lobar (OR, 1.68; 95% CI, 1.36-2.06) and nonlobar (OR, 1.62; 95% CI, 1.37-1.91) ICH, and high cholesterol was inversely associated only with nonlobar ICH (OR, 0.60; 95% CI, 0.52-0.70); both had no interactions with race and ethnicity. In contrast to the association between the ɛ2 and ɛ4 alleles of APOE and ICH in White individuals (eg, presence of APOE ɛ2 allele: OR, 1.84; 95% CI, 1.34-2.52), APOE alleles were not associated with lobar ICH among Black or Hispanic individuals. This study found sleep apnea as a novel risk factor for ICH. The results suggest a strong contribution from inadequately treated hypertension and lack of health insurance to the disproportionate burden and earlier onset of ICH in Black and Hispanic populations. These findings emphasize the importance of addressing modifiable risk factors and the social determinants of health to reduce health disparities.
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影响因子：
15.9
作者：
SOMERS, VK;DYKEN, ME;ABBOUD, FM
通讯作者：
ABBOUD, FM
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作者：
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通讯作者：
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作者：
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通讯作者：
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作者：
Rajabli, Farid;Feliciano, Briseida E.;Pericak-Vance, Margaret A.
通讯作者：
Pericak-Vance, Margaret A.
DOI：
10.1161/circoutcomes.116.003166
发表时间：
2017-01-01
影响因子：
6.9
作者：
Gu, Anna;Yue, Yu;Argulian, Edgar
通讯作者：
Argulian, Edgar