Browsing by Author "Virani, Salim S."

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    Association Between Social Vulnerability Index and Cardiovascular Disease: A Behavioral Risk Factor Surveillance System Study
    (American Heart Association, 2022) Jain, Vardhmaan; Al Rifai, Mahmoud; Khan, Safi U.; Kalra, Ankur; Rodriguez, Fatima; Samad, Zainab; Pokharel, Yashashwi; Misra, Arunima; Sperling, Laurence S.; Rana, Jamal S.; Ullah, Waqas; Medhekar, Ankit; Virani, Salim S.; Medicine, School of Medicine
    Background: Social and environmental factors play an important role in the rising health care burden of cardiovascular disease. The Centers for Disease Control and Prevention developed the Social Vulnerability Index (SVI) from US census data as a tool for public health officials to identify communities in need of support in the setting of a hazardous event. SVI (ranging from a least vulnerable score of 0 to a most vulnerable score of 1) ranks communities on 15 social factors including unemployment, minoritized groups status, and disability, and groups them under 4 broad themes: socioeconomic status, housing and transportation, minoritized groups, and household composition. We sought to assess the association of SVI with self‐reported prevalent cardiovascular comorbidities and atherosclerotic cardiovascular disease (ASCVD). Methods and Results: We performed a retrospective cohort analysis of adults (≥18 years) in the Behavioral Risk Factor Surveillance System 2016 to 2019. Data regarding self‐reported prevalent cardiovascular comorbidities (including diabetes, hypertension, hyperlipidemia, smoking, substance use), and ASCVD was captured using participants' response to a structured telephonic interview. We divided states on the basis of the tertile of SVI (first—participant lives in the least vulnerable group of states, 0–0.32; to third—participant lives in the most vulnerable group of states, 0.54–1.0). Multivariable logistic regression models adjusting for age, race and ethnicity, sex, employment, income, health care coverage, and association with federal poverty line were constructed to assess the association of SVI with cardiovascular comorbidities. Our study sample consisted of 1 745 999 participants ≥18 years of age. States in the highest (third) tertile of social vulnerability had predominantly Black and Hispanic adults, lower levels of education, lower income, higher rates of unemployment, and higher rates of prevalent comorbidities including hypertension, diabetes, chronic kidney disease, hyperlipidemia, substance use, and ASCVD. In multivariable logistic regression models, individuals living in states in the third tertile of SVI had higher odds of having hypertension (odds ratio (OR), 1.14 [95% CI, 1.11–1.17]), diabetes (OR, 1.12 [95% CI, 1.09–1.15]), hyperlipidemia (OR, 1.09 [95% CI, 1.06–1.12]), chronic kidney disease (OR, 1.17 [95% CI, 1.12–1.23]), smoking (OR, 1.05 [95% CI, 1.03–1.07]), and ASCVD (OR, 1.15 [95% CI, 1.12–1.19]), compared with those living in the first tertile of SVI. Conclusions: SVI varies across the US states and is associated with prevalent cardiovascular comorbidities and ASCVD, independent of age, race and ethnicity, sex, employment, income, and health care coverage. SVI may be a useful assessment tool for health policy makers and health systems researchers examining multilevel influences on cardiovascular‐related health behaviors and identifying communities for targeted interventions pertaining to social determinants of health.
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    Impact of Social Vulnerability on Comorbid Cancer and Cardiovascular Disease Mortality in the United States
    (Elsevier, 2022-09-20) Ganatra, Sarju; Dani, Sourbha S.; Kumar, Ashish; Khan, Safi U.; Wadhera, Rishi; Neilan, Tomas G.; Thavendiranathan, Paaladinesh; Barac, Ana; Hermann, Joerg; Leja, Monika; Deswal, Anita; Fradley, Michael; Liu, Jennifer E.; Sadler, Diego; Asnani, Aarti; Baldassarre, Lauren A.; Gupta, Dipti; Yang, Eric; Guha, Avirup; Brown, Sherry-Ann; Stevens, Jennifer; Hayek, Salim S.; Porter, Charles; Kalra, Ankur; Baron, Suzanne J.; Ky, Bonnie; Virani, Salim S.; Kazi, Dhruv; Nasir, Khurram; Nohria, Anju; Medicine, School of Medicine
    Background: Racial and social disparities exist in outcomes related to cancer and cardiovascular disease (CVD). Objectives: The aim of this cross-sectional study was to study the impact of social vulnerability on mortality attributed to comorbid cancer and CVD. Methods: The Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database (2015-2019) was used to obtain county-level mortality data attributed to cancer, CVD, and comorbid cancer and CVD. County-level social vulnerability index (SVI) data (2014-2018) were obtained from the CDC's Agency for Toxic Substances and Disease Registry. SVI percentiles were generated for each county and aggregated to form SVI quartiles. Age-adjusted mortality rates (AAMRs) were estimated and compared across SVI quartiles to assess the impact of social vulnerability on mortality related to cancer, CVD, and comorbid cancer and CVD. Results: The AAMR for comorbid cancer and CVD was 47.75 (95% CI: 47.66-47.85) per 100,000 person-years, with higher mortality in counties with greater social vulnerability. AAMRs for cancer and CVD were also significantly greater in counties with the highest SVIs. However, the proportional increase in mortality between the highest and lowest SVI counties was greater for comorbid cancer and CVD than for either cancer or CVD alone. Adults <45 years of age, women, Asian and Pacific Islanders, and Hispanics had the highest relative increase in comorbid cancer and CVD mortality between the fourth and first SVI quartiles, without significant urban-rural differences. Conclusions: Comorbid cancer and CVD mortality increased in counties with higher social vulnerability. Improved education, resource allocation, and targeted public health interventions are needed to address inequities in cardio-oncology.
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    Variation in statin prescription among veterans with HIV and known atherosclerotic cardiovascular disease
    (Elsevier, 2022) Erqou, Sebhat; Papaila, Alexa; Halladay, Christopher; Ge, Augustus; Liu, Michael A.; Jiang, Lan; Lally, Michelle; Menon, Anupama; Shah, Nishant R.; Miech, Edward; Virani, Salim S.; Zullo, Andrew R.; Shireman, Theresa I.; Longenecker, Christopher T.; Ross, David; Sullivan, Jennifer L.; Wu, Wen-Chih; Rudolph, James L.; Emergency Medicine, School of Medicine
    Background: People with HIV have increased atherosclerotic cardiovascular disease (ASCVD) risk, worse outcomes following incident ASCVD, and experience gaps in cardiovascular care, highlighting the need to improve delivery of preventive therapies in this population. Objective: Assess patient-level correlates and inter-facility variations in statin prescription among Veterans with HIV and known ASCVD. Methods: We studied Veterans with HIV and existing ASCVD, ie, coronary artery disease (CAD), ischemic cerebrovascular disease (ICVD), and peripheral arterial disease (PAD), who received care across 130 VA medical centers for the years 2018-2019. We assessed correlates of statin prescription using two-level hierarchical multivariable logistic regression. Median odds ratios (MORs) were used to quantify inter-facility variation in statin prescription. Results: Nine thousand six hundred eight Veterans with HIV and known ASCVD (mean age 64.3 ± 8.9 years, 97% male, 48% Black) were included. Only 68% of the participants were prescribed any-statin. Substantially higher statin prescription was observed for those with diabetes (adjusted odds ratio [OR] = 2.3, 95% confidence interval [CI], 2.0-2.6), history of coronary revascularization (OR = 4.0, CI, 3.2-5.0), and receiving antiretroviral therapy (OR = 3.0, CI, 2.7-3.4). Blacks (OR = 0.7, CI, 0.6-0.9), those with non-coronary ASCVD, ie, ICVD and/or PAD only, (OR 0.53, 95% CI: 0.48-0.57), and those with history of illicit substance use (OR=0.7, CI, 0.6-0.9) were less likely to be prescribed statins. There was significant variation in statin prescription across VA facilities (10th, 90th centile: 55%, 78%), with an estimated 20% higher likelihood of difference in statin prescription practice for two clinically similar individuals treated at two comparable facilities (adjusted MOR = 1.21, CI, 1.18-1.24), and a greater variation observed for Blacks or those with non-coronary ASCVD or history of illicit drug use. Conclusion: In an analysis of large-scale VA data, we found suboptimal statin prescription and significant interfacility variation in statin prescription among Veterans with HIV and known ASCVD, particularly among Blacks and those with a history of non-coronary ASCVD.