Children's dietary guidelines need to change, experts say

Parents need better advice on how to encourage kids to eat veggies

IRONIC SINCE MILLENIALS AND GEN Z ARE VEGANS

FLINDERS UNIVERSITY

Research News

 

IMAGE: FLINDERS UNIVERSITY PROFESSOR REBECCA GOLLEY, DEPUTY DIRECTOR OF THE CARING FUTURES INSTITUTE view more 

CREDIT: FLINDERS UNIVERSITY

Dietary and infant feeding guidelines should be strengthened to include more practical advice on the best ways to support children to learn to like and eat vegetables, say nutrition and dietetics researchers from the Flinders University Caring Futures Institute.

With the Australian Health Survey showing only 6% of children aged 2-17 years are eating the recommended amount of veggies, experts say more tailored practical advice is needed on how to offer vegetables to young children through repeated exposure and daily variety in order to increase their intake.

A recent paper co-authored by researchers from Caring Futures Institute and CSIRO, Australia's national science agency, published in the American Journal of Clinical Nutrition, suggests that up to 10 or more exposures to a particular vegetable when the child is between the age of 6 months and five years can lead to greater chances of them liking vegetables and eating more of them.

While the strategy of repeatedly exposing young children to vegetables to assist flavour familiarity and ultimately intake is not new science, there is a gap between evidence and dietary advice.

"There is an opportunity to improve children's vegetable intake by including practical advice - the 'how to' in our recommendations to parents and caregivers," says Flinders Caring Futures Institute Deputy Director and co-lead author of the paper Professor Rebecca Golley.

Prof Golley says food preferences are established within a child's first five years of life. Therefore, it's crucial to establish healthy eating behaviours early to support growth, development, and dietary habits.

"We know that a lack of vegetable consumption across the lifespan has effects on health, including an increased risk of chronic diseases, obesity and being overweight," she says.

"That is why getting children to like a variety of vegetables such as green beans, peas, carrots and even Brussel sprouts from an early age is so important.

"Early eating behaviours are impressionable and babies and young children can be supported to try different foods and to learn to like them."

The paper, Supporting strategies for enhancing vegetable liking in the early years of life: an Umbrella review of systematic reviews' is an output of the five-year VegKIT project, funded by Hort Innovation and undertaken by a consortium led by CSIRO, including Flinders University and Nutrition Australia Victoria Division.

An umbrella review was undertaken on the diverse body of existing international research around sensory and behavioural strategies that support children to like certain foods including vegetables.

The project examined 11 systemic reviews to determine the effectiveness of strategies including repeated exposure and variety of vegetables, for which promising evidence was found.

Emerging evidence was found for other strategies such as offering vegetables as a first food (not fruit), using non-food rewards to encourage the eating of veggies and reading children vegetable-based story books.

The report also highlights that foundations for vegetable liking can even be laid before a child is born.

"It appears that the maternal diet also plays a part through exposure to vegetable flavours in-utero and increasing children's chances of liking and eating them later, and the same goes for the mothers' diet while breastfeeding," Professor Golley says.

However, she says these strategies must be backed by more research if they are to be underpinning advice for parents, health professionals and policymakers.

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Lucinda K Bell, Claire Gardner, Esther J Tian, Maeva O Cochet-Broch, Astrid A M Poelman, David N Cox, Sophie Nicklaus, Karen Matvienko-Sikar, Lynne A Daniels, Saravana Kumar, Rebecca K Golley, Supporting strategies for enhancing vegetable liking in the early years of life: an umbrella review of systematic reviews, The American Journal of Clinical Nutrition, 2021; DOI 10.1093/ajcn/nqaa384

Lifestyle intervention is beneficial for most people with type 2 diabetes, but not all

WAKE FOREST BAPTIST MEDICAL CENTER

Research News

WINSTON-SALEM, N.C. - March 11, 2021- For people who are overweight or obese and have type 2 diabetes, the first line of treatment is usually lifestyle intervention, including weight loss and increased physical activity. While this approach has cardiovascular benefit for many, it can be detrimental for people who have poor blood sugar control, according to a study conducted by researchers at Wake Forest School of Medicine.

In the study, published in the current issue of the journal Diabetes Care, the researchers re-evaluated the National Institutes of Health Action for Health in Diabetes (Look AHEAD) study that found intensive lifestyle intervention (ILI) neither helped nor hurt people with diabetes.

"Contrary to the initial findings of Look AHEAD, our work found that lifestyle interventions reduced potential cardiovascular harm and optimized benefits for 85% of those in the trial," said the study's lead investigator, Michael P. Bancks, Ph.D., assistant professor of public health sciences at Wake Forest School of Medicine, part of Wake Forest Baptist Health.

"However, for those who had poor blood sugar control, lifestyle intervention increased the risk of major cardiovascular events. Based on our findings, doctors may want to consider alternative options, such as glucose-lowering drugs, before trying lifestyle modification for those people."

Look AHEAD randomized 5145 participants with type 2 diabetes (T2D) who were overweight or obese to 10 years of ILI or a control group that received diabetes support and education. ILI focused on weight loss through decreased caloric intake and increased physical activity.

In the Wake Forest School of Medicine study, the researchers divided the study participants into four subgroups: diabetes onset at older age, poor glycemic control, severe obesity and younger age at onset. These subgroups were determined based on diabetes diagnosis, body mass index, waist circumference, measure of blood sugar value (glycemic control) and the age of diabetes onset.

Bancks and his team examined each group's response to the intensive lifestyle intervention and its association with major cardiovascular events. In the subgroup with poor glycemic control, the intervention was associated with 85% higher risk of having a cardiovascular event as compared to the control group. Among the three other diabetes subgroups analyzed, ILI was not associated with an increased risk of fatal and non-fatal cardiovascular events.

"Although the interest in diabetes subgroups is growing, our study is one of the first to apply it to lifestyle intervention," Bancks said. "So for clinicians, determining which subgroup their patient most closely resembles should help them determine the best treatment option and reduce any potential harm for that individual."

These results provide support for further investigation into whether these findings apply to other diabetes complications, including cognitive issues, and to assess what interventions would be beneficial for those individuals, Bancks said.

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Support for the study was provided by the National Institute of Diabetes and Digestive and Kidney Diseases.

Unhealthy weight gains, increased drinking reported by Americans coping with pandemic stress

Stress in America™ poll reveals secondary pandemic health crisis; parents, essential workers, communities of color more likely to report mental, physical health consequences

AMERICAN PSYCHOLOGICAL ASSOCIATION

Research News

 

IMAGE: PARENTS' MENTAL, PHYSICAL HEALTH IMPACTED SINCE START OF PANDEMIC view more 

CREDIT: AMERICAN PSYCHOLOGICAL ASSOCIATION

WASHINGTON -- As growing vaccine demand signals a potential turning point in the global COVID-19 pandemic, the nation's health crisis is far from over. One year after the World Health Organization declared COVID-19 a global pandemic, many adults report undesired changes to their weight, increased drinking and other negative behavior changes that may be related to an inability to cope with prolonged stress, according to the American Psychological Association's latest Stress in America™ poll.

APA's survey of U.S. adults, conducted in late February 2021 by The Harris Poll, shows that a majority of adults (61%) experienced undesired weight changes - weight gain or loss -- since the pandemic started, with 42% reporting they gained more weight than they intended. Of those, they gained an average of 29 pounds (the median amount gained was 15 pounds) and 10% said they gained more than 50 pounds, the poll found. Such changes come with significant health risks, including higher vulnerability to serious illness from the coronavirus. For the 18% of Americans who said they lost more weight than they wanted to, the average amount of weight lost was 26 pounds (the median amount lost was 12 pounds). Adults also reported unwanted changes in sleep and increased alcohol consumption. Two in 3 (67%) said they have been sleeping more or less than desired since the pandemic started. Nearly 1 in 4 adults (23%) reported drinking more alcohol to cope with their stress.

"We've been concerned throughout this pandemic about the level of prolonged stress, exacerbated by the grief, trauma and isolation that Americans are experiencing. This survey reveals a secondary crisis that is likely to have persistent, serious mental and physical health consequences for years to come," said Arthur C. Evans Jr., PhD, APA's chief executive officer. "Health and policy leaders must come together quickly to provide additional behavioral health supports as part of any national recovery plan."

CAPTION

1 in 4 Essential Workers Diagnosed With Mental Health Disorder Since Start of Pandemic

CREDIT

American Psychological Association

The pandemic has taken a particularly heavy toll on parents of children under 18. While slightly more than 3 in 10 adults (31%) reported their mental health has worsened compared with before the pandemic, nearly half of mothers who still have children home for remote learning (47%) reported their mental health has worsened; 30% of fathers who still have children home said the same. Parents were more likely than those without children to have received treatment from a mental health professional (32% vs. 12%) and to have been diagnosed with a mental health disorder since the coronavirus pandemic began (24% vs. 9%). More than half of fathers (55%) reported gaining more weight than they wanted to, and nearly half (48%) said they have been drinking more alcohol to cope with stress.

The majority of essential workers (54%), such as health care workers and people who work in law enforcement, said they have relied on a lot of unhealthy habits to get them through the pandemic. Nearly 3 in 10 (29%) said their mental health has worsened, while 3 in 4 (75%) said they could have used more emotional support than they received since the pandemic began. Essential workers were more than twice as likely as adults who are not essential workers to have received treatment from a mental health professional (34% vs. 12%) and to have been diagnosed with a mental health disorder since the coronavirus pandemic started (25% vs. 9%).

Further, people of color reported unintended physical changes during the pandemic. Hispanic adults were most likely to report undesired changes to sleep (78% Hispanic vs. 76% Black, 63% white and 61% Asian), physical activity levels (87% Hispanic vs. 84% Black, 81% Asian and 79% white) and weight (71% Hispanic vs. 64% Black, 58% white and 54% Asian) since the pandemic began. Black Americans were most likely to report feelings of concern about the future. More than half said they do not feel comfortable going back to living life like they used to before the pandemic (54% Black vs. 48% Hispanic, 45% Asian and 44% white) and that they feel uneasy about adjusting to in-person interaction once the pandemic ends (57% Black vs. 51% Asian, 50% Hispanic and 47% white).

"It's clear that the pandemic is continuing to have a disproportionate effect on certain groups," said APA President Jennifer Kelly, PhD. "We must do more to support communities of color, essential workers and parents as they continue to cope with the demands of the pandemic and start to show the physical consequences of prolonged stress."

Overall, Americans are hesitant about the future, regardless of vaccination status. Nearly half of adults (49%) said they feel uneasy about adjusting to in-person interaction once the pandemic ends. Adults who received a COVID-19 vaccine were just as likely as those who had not received a vaccine to say this (48% vs. 49%, respectively).

The full report and more graphics are available at http://www.stressinamerica.org.

CAPTION

Slightly More than 6 in 10 U.S. Adults Report Undesired Weight Change Since Start of Pandemic

CREDIT

American Psychological Association

Methodology

This Stress in America™ survey was conducted online within the United States by The Harris Poll on behalf of the American Psychological Association between Feb. 19 and 24, 2021, among 3,013 adults age 18+ who reside in the U.S. Interviews were conducted in English and Spanish. Data were weighted to reflect their proportions in the population based on the 2020 Current Population Survey (CPS) by the U.S. Census Bureau. Weighting variables included age by gender, race/ethnicity, education, region, household income and time spent online. Hispanic adults were also weighted for acculturation, taking into account respondents' household language as well as their ability to read and speak in English and Spanish. Country of origin (U.S./non-U.S.) was also included for Hispanic and Asian subgroups. Weighting variables for Gen Z adults (ages 18 to 24) included education, age by gender, race/ethnicity, region, household income, and size of household, based on the 2019 CPS. Propensity score weighting was used to adjust for respondents' propensity to be online.

Parents are defined as U.S. adults ages 18+ who have at least one person under the age of 18 living in their household at least 50% of the time for whom they are the parent or guardian.

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The American Psychological Association, in Washington, D.C., is the largest scientific and professional organization representing psychology in the United States. APA's membership includes nearly 220,000 researchers, educators, clinicians, consultants and students. Through its divisions in 54 subfields of psychology and affiliations with 60 state, territorial and Canadian provincial associations, APA works to advance the creation, communication and application of psychological knowledge to benefit society and improve people's lives.

More heart infections and strokes in the US linked to national opioid epidemic

American Stroke Association International Stroke Conference -- presentation P658

AMERICAN HEART ASSOCIATION

Research News

 

DALLAS, March 11, 2021 — The ongoing U.S. opioid epidemic may have led to an increase in the number of strokes due to more bacterial infections of the heart, or infective endocarditis, according to preliminary research to be presented at the American Stroke Association’s International Stroke Conference 2021. The virtual meeting is March 17-19, 2021 and is a world premier meeting for researchers and clinicians dedicated to the science of stroke and brain health.

According to the most recent comprehensive data (January 2020) from the Centers for Disease Control and Prevention (CDC), stroke is the fifth leading cause of death in the United States and a major contributor to long-term disability. Typically each year in the United States, up to 47,000 people are treated in the hospital for endocarditis, which increases stroke risk. This serious, sometimes deadly infection occurs when bacteria in the bloodstream reach the heart lining, valves or blood vessels. While endocarditis is uncommon, people with certain heart conditions are at greater risk.

Another risk factor for endocarditis is intravenous (IV) drug use. During IV drug use, bacteria from the injection needle enter the blood stream. In light of the ongoing, two decades-long national opioid epidemic, researchers wanted to understand the risk of stroke among patients with endocarditis from IV drug use compared to patients with endocarditis due to other causes. They also measured the frequency of endocarditis related to IV drug use.

This study included 351 patients treated for endocarditis at Ohio State University’s Wexner Medical Center between January 1, 2014 and July 1, 2018. Nearly half of the patients had a history of IV drug use.

The researchers found:

• Over the four-year study, the occurrence of endocarditis from IV drug use increased by 630%.
• Patients with endocarditis due to IV drug use were much more likely (26%) than those with endocarditis from other causes (14%) to have a stroke.
• Patients with endocarditis from IV drug use were more likely than other patients to be homeless, unemployed and uninsured.

“Patients who are known IV drug users who have endocarditis should be more carefully screened for symptoms of cardiovascular disease,” said the study’s corresponding author Shahid M. Nimjee, M.D., Ph.D., associate professor of neurosurgery and surgical director of the Comprehensive Stroke Center at Ohio State University Wexner Medical Center in Columbus, Ohio.

“The wider societal impact of the opioid epidemic is not well understood,” Nimjee said. “Our research suggests that the impact of the opioid epidemic is far-reaching and contributes to increased costs in the criminal justice, health care systems and the workplace. The increased costs can be particularly substantial for stroke care.”

Medical costs were more than two times higher among patients with endocarditis from IV drug use than among those with endocarditis from other causes. This translated into a difference of more than $100,000 in health care costs during admission per patient, Nimjee noted.

The study did not control for other factors that could have affected stroke risk, and it included patients from only one hospital, therefore, the findings may not apply to other groups of patients.

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Co-authors are Nguyen Hoang, M.D.; Varun Shah, B.S.; Bipul Gnywali, B.S.; Jessica Granger, B.A.; Victoria Schuneman, M.D.; David Dornbos III, M.D.; H. Francis Farhadi, M.D., Ph.D.; Patrick P. Youssef, M.D.; and Ciaran J. Powers, M.D., Ph.D. The study authors report no funding or disclosures.

Additional Resources:

• Multimedia is available on the right column of release link https://newsroom.heart.org/news/more-heart-infections-and-strokes-in-the-u-s-linked-to-national-opioid-epidemic?preview=037cb78b2fe2ff2bdc9daf23f83a50b1
• AHA resources on infective endocarditis
• Alarming number of heart infections tied to opioid epidemic
• Opioid epidemic fueling a rise in infection-related stroke
• Opioid use may increase risk of dangerous heart rhythm disorder
• AHA Opioid Education for Healthcare Providers
• For more news at ASA International Stroke Conference 2021, follow us on Twitter @HeartNews #ISC21.

Statements and conclusions of studies that are presented at the American Heart Association’s scientific meetings are solely those of the study authors and do not necessarily reflect the Association’s policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. The Association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and biotech companies, device manufacturers and health insurance providers are available here, and the Association’s overall financial information is available here.

The American Stroke Association’s International Stroke Conference (ISC) is the world’s premier meeting dedicated to the science and treatment of cerebrovascular disease. ISC 2021 will be held virtually, March 17-19, 2021. This 3-day conference will feature more than 1,200 compelling presentations in 21 categories that emphasize basic, clinical and translational sciences as they evolve toward a better understanding of stroke pathophysiology with the goal of developing more effective therapies. Engage in the International Stroke Conference on social media via #ISC21.

About the American Stroke Association

The American Stroke Association is devoted to saving people from stroke — the No. 2 cause of death in the world and a leading cause of serious disability. We team with millions of volunteers to fund innovative research, fight for stronger public health policies and provide lifesaving tools and information to prevent and treat stroke. The Dallas-based association officially launched in 1998 as a division of the American Heart Association. To learn more or to get involved, call 1-888-4STROKE or visit stroke.org. Follow us on Facebook, Twitter. 

Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by 

Life-saving role of mobile stroke units at risk due to reimbursement limitations

American Stroke Association International Stroke Conference -- presentation MP19

AMERICAN HEART ASSOCIATION

Research News

 

DALLAS, March 11, 2021 -- Ambulances with specialized staff and equipment to provide rapid stroke treatment report financial difficulties due to limited reimbursement from health care insurers, according to preliminary research to be presented at the American Stroke Association's International Stroke Conference 2021. The virtual meeting is March 17-19, 2021 and is a world premier meeting for researchers and clinicians dedicated to the science of stroke and brain health.

According to the most recent comprehensive data from the Centers for Disease Control and Prevention (CDC), stroke is the fifth leading cause of death in the United States and a major contributor to long-term disability. Stroke occurs when a blood vessel to or in the brain either becomes blocked or bursts, preventing blood and oxygen from reaching all of the brain. Treatment to quickly restore blood flow to the brain is essential to improve outcomes and survival.

Mobile stroke units are ambulances with specialized staff and equipment to quickly diagnose and treat stroke on the way to the hospital. When every minute is critical, the mobile stroke unit staff can administer medications to restore blood flow, control bleeding or lower high blood pressure before reaching the emergency department. However, mobile stroke units are not widely available, in part because there are no established means for the government or insurance companies to reimburse the costs of care provided by mobile stroke units, especially when specialized tests (CT scans, etc.) and medications are administered outside of a hospital.

"If mobile stroke units cannot be reimbursed for the important care they provide, this vital service will be lost unless private donors are willing to continually step up to support these programs," said study lead author Kenneth Reichenbach, M.S.N., F.N.P.-C., A.G.A.C.N.P.-B.C., B.S.R.T.-(R), PHRN, program director of the Mobile Stroke Unit at Lehigh Valley Health Network in Allentown, Pennsylvania. "We need overwhelming, united support for this to change within federal entities including the Centers for Medicare and Medicaid Services to explore appropriate pathways for Medicare reimbursement for the full range of advanced mobile stroke unit services."

Through a blinded survey, researchers collected information in June 2019 (to reflect the previous 12 months of their operation) from all 20 U.S. mobile stroke unit programs. Of the 19 units that responded, 18 reported negative financial status while one, classified as an outpatient clinic and not an ambulance, reported a positive financial status. All mobile stroke programs depend at least partly on funding from personal gifts, grants or institutional support because of billing restrictions from health care insurers.

In other findings, the programs reported administering critical clot-busting medications to stroke patients an average of 72 times per year (median of 30) over the 12 months surveyed for all mobile stroke unit programs combined. Each program is open and available nearly every day of the month, with 600 responses per year, on average, for all programs combined. All mobile stroke units can perform CT scans (computed tomography) to image the brain, and 21% have an additional certification as certified CT mobile laboratories. Each mobile stroke unit has an average of four staff members on board at a time, which may include a CT technologist, paramedic/emergency medical technician, stroke nurse and a stroke expert. Individuals working as stroke experts vary by program: 37% have medical doctors and 16% have an advanced practice health care professional. In 47% of the programs, telemedicine is used instead of an on-board expert to connect remotely to a stroke expert.

"Mobile stroke units diagnose and treat patients with acute stroke safely and considerably faster than patients arriving to an emergency department by regular ambulance or private auto," Reichenbach said. "Saving brain tissue could translate into better functional outcome and quality of life for many more stroke patients."

The American Heart Association's 2019 Recommendations for the Establishment of Stroke Systems of Care suggests reimbursement is an issue that warrants further investigation before there is widespread use of mobile stroke units.

To recognize stroke symptoms requiring immediate treatment, the American Stroke Association recommends everyone remember the acronym F.A.S.T. for face drooping, arm weakness, speech difficulty, time to call 9-1-1. Fortunately, most strokes are preventable through healthy lifestyle choices: not smoking; eating healthy foods; being physically active; maintaining a healthy body weight; and controlling high blood sugar, cholesterol and blood pressure.

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Co-authors are Claranne Mathiesen, R.N., M.S.N., C.N.R.N.; Leslie Thomas, A.A.; Margaret Hilger, B.A.; James C. Grotta, M.D.; and Anne W. Alexandrov, Ph.D., R.N. Author disclosures are listed in the abstract.

The Prehospital Stroke Treatment Organization (PRESTO) funded the study.

Additional Resources:

• Multimedia is available on the right column of release link https://newsroom.heart.org/news/life-saving-role-of-mobile-stroke-units-at-risk-due-to-reimbursement-limitations?preview=6780a90dd239eacf4f829aa1a437b0c9
• Don't Die of Doubt
• What is Brain Health?
• Fast treatment via mobile stroke unit reduced survivor disability
• Mobile stroke units could expedite treatment and improve patient outcomes in urban areas
• American Stroke Association policy statement on stroke systems of care
• For more news at ASA International Stroke Conference 2021, follow us on Twitter @HeartNews #ISC21.

Statements and conclusions of studies that are presented at the American Heart Association's scientific meetings are solely those of the study authors and do not necessarily reflect the Association's policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. The Association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and biotech companies, device manufacturers and health insurance providers are available here, and the Association's overall financial information is available here.

The American Stroke Association's International Stroke Conference (ISC) is the world's premier meeting dedicated to the science and treatment of cerebrovascular disease. ISC 2021 will be held virtually, March 17-19, 2021. This 3-day conference features more than 1,200 compelling presentations in 21 categories that emphasize basic, clinical and translational sciences as they evolve toward a better understanding of stroke pathophysiology with the goal of developing more effective therapies. Engage in the International Stroke Conference on social media via #ISC21.

About the American Stroke Association

The American Stroke Association is devoted to saving people from stroke -- the No. 2 cause of death in the world and a leading cause of serious disability. We team with millions of volunteers to fund innovative research, fight for stronger public health policies and provide lifesaving tools and information to prevent and treat stroke. The Dallas-based association officially launched in 1998 as a division of the American Heart Association. To learn more or to get involved, call 1-888-4STROKE or visit stroke.org. Follow us on Facebook, Twitter.

African American women experience higher risk of pregnancy-related stroke, death

American Stroke Association International Stroke Conference - Presentation P869

AMERICAN HEART ASSOCIATION

Research News

 

DALLAS, March 11, 2021 -- African American women have a significantly increased risk of stroke and death during pregnancy and childbirth or in the period right after birth, compared to the risk of stroke among white women, according to preliminary research to be presented at the American Stroke Association's International Stroke Conference 2021. The virtual meeting is March 17-19, 2021 and is a world premier meeting for researchers and clinicians dedicated to the science of stroke and brain health.

"Each year, thousands of American women have a stroke or die from a stroke during pregnancy. The risk of stroke is also high following childbirth," said lead study author Mohamed M. Gad, M.D., a resident physician in the department of internal medicine at the Cleveland Clinic in Cleveland, Ohio. "Even so, we lack data on the racial disparities in cardiovascular disease and stroke outcomes for women during and post-pregnancy in the U.S."

Using the Nationwide Inpatient Sample, a hospital database across the U.S., researchers analyzed data on nearly 40 million pregnant and post-partum women hospitalized during pregnancy regardless of cause between 2002 and 2017. Nearly 22% of the women included were African American.

Researchers evaluated stroke outcomes among the pregnant women and found:

• While pregnancy-related stroke was very rare, occurring in just 0.03% of the overall study population, 41% of the women who experienced a stroke during pregnancy were African American.
• The highest number of in-hospital deaths for women with pregnancy-associated stroke occurred among African American women, 7.8% versus 5% for white women.
• Compared with white women, African American women with pregnancy-associated stroke faced nearly two times the risk of dying from stroke, and the increased risk of death was consistent across age groups. There was little change in these results after accounting for multiple risk factors.
• When comparing pregnancy-associated stroke outcomes by income levels, African American women in the lowest income group were 1.91 times more likely to die than white women in the same income group. In the highest income group, African American women were 2.38 times more likely to die compared to their white counterparts.

"We found that serious disparities exist despite adjusting for socioeconomic variables. This means that there is no single socioeconomic factor such as income or access to health care that puts a woman more at-risk. Those factors can contribute, yet they do not explain the whole story," Gad said. "We need to understand and address other potential causes of pregnancy-associated stroke and death. If addressed, we can lower the overall burden of disease in the U.S."

Gad said the study provides evidence that can help improve understanding and guide interventions that could help minimize these racial gaps.

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Study co-authors are Jasmin Abdeldayem, M.D.; Omar M. Abdelfattah, M.D.; Anas M. Saad, M.D.; Ahmed M. Mahmoud, M.D.; and Islam Y. Elgendy, M.D. The authors' disclosures are listed in the abstract. The study authors report no funding.

Additional Resources:

Multimedia is available on the right column of release link https://newsroom.heart.org/news/african-american-women-experience-higher-risk-of-pregnancy-related-stroke-death?preview=dba8212524afb87cd55a3b044b20c844

U.S.-born Black women at higher risk of preeclampsia than Black immigrants
Pregnancy-related stroke more common among Black women
Why are Black women at such high risk of dying from pregnancy complications?
How to have a heart-healthy pregnancy before you even conceive

For more news at ASA International Stroke Conference 2021, follow us on Twitter @HeartNews #ISC21.

Statements and conclusions of studies that are presented at the American Heart Association's scientific meetings are solely those of the study authors and do not necessarily reflect the Association's policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. The Association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and biotech companies, device manufacturers and health insurance providers are available here, and the Association's overall financial information is available here.

The American Stroke Association's International Stroke Conference (ISC) is the world's premier meeting dedicated to the science and treatment of cerebrovascular disease. ISC 2021 will be held virtually, March 17-19, 2021. The 3-day conference will feature more than 1,200 compelling presentations in 21 categories that emphasize basic, clinical and translational sciences as they evolve toward a better understanding of stroke pathophysiology with the goal of developing more effective therapies. Engage in the International Stroke Conference on social media via #ISC21.

About the American Stroke Association

The American Stroke Association is devoted to saving people from stroke -- the No. 2 cause of death in the world and a leading cause of serious disability. We team with millions of volunteers to fund innovative research, fight for stronger public health policies and provide lifesaving tools and information to prevent and treat stroke. The Dallas-based association officially launched in 1998 as a division of the American Heart Association. To learn more or to get involved, call 1-888-4STROKE or visit stroke.org. Follow us on Facebook, Twitter.

Structural racism: Communities with higher redlining scores had higher rates of stroke

American Stroke Association International Stroke Conference -- presentation P873

AMERICAN HEART ASSOCIATION

Research News

 

DALLAS, March 11, 2021 -- Discriminatory housing policies that restricted the sale or purchase of homes by race in certain neighborhoods across the U.S., called 'redlining,' which were established nearly a century ago and outlawed by the Fair Housing Act of 1968, were associated with higher rates of stroke in the same neighborhoods in 2017, according to preliminary research to be presented at the American Stroke Association's International Stroke Conference 2021. The virtual meeting is March 17-19, 2021 and is a world premier meeting for researchers and clinicians dedicated to the science of stroke and brain health.

"Differences in stroke rates, whether we are studying ischemic or hemorrhagic stroke, are usually attributed to biological differences or differences in underlying conditions," said lead study author Jeffrey J. Wing, Ph.D., M.P.H., an assistant professor of epidemiology in the College of Public Health at The Ohio State University in Columbus, Ohio. "Yet, our findings suggest the difference we found in the Columbus area may actually be the result of structural racism."

Beginning in 1936, the Home Owners' Loan Corporation began restricting the sale of homes in certain neighborhoods across the country by redlining or marking neighborhoods by "risk for investment," which equated to race. As a result, residents who lived within these redlined areas were denied home loans, which lowered tax revenues in these communities, thereby reducing investment in schools and services, and creating numerous inequities for residents for multiple generations.

"Even though redlining was abolished in 1968, redlining is a form of structural racism that perpetuated segregation and racial inequities. Accumulating evidence shows this divisive and exclusionary housing practice continues to have long-term effects on the health of many people, even today - more than 80 years later," said study co-author Helen Meier, Ph.D., M.P.H., assistant research scientist at University of Michigan's Institute for Social Research. "Our study is one of the first to link historic redlining in a U.S. city to frequency of stroke."

Researchers examined the association between the discriminatory housing policies of redlining and stroke rates in Columbus, Ohio neighborhoods in 2017. They calculated historic redlining scores for neighborhoods within the boundaries of Columbus based on the degree of redlining. Thus, the greater the redlining, the higher the redlining score.

Researchers then matched the redlining scores with stroke rates measured in the same neighborhoods from the 500 Cities Project. The 500 Cities Project is from the U.S. Centers for Disease Control and Prevention and reports on 27 chronic disease measures for the 500 largest American cities in all 50 states, quantified by city and census tract-level data. They assessed the association between historic redlining scores and stroke rates across neighborhoods in Columbus in 2017.

Researchers found:

• Higher historic redlining scores were associated with greater rates of stroke, when comparing the highest to the lowest quartile of historic redlining scores. 
• Neighborhoods in the highest group of historic redlining scores had a 1.48% higher stroke rate, compared to those with the lowest redlining scores.

"As different cities across the country declare racism as a public health crisis, it's important to have more research that shows the link between racism and health disparities," Wing said. "Our research has the potential to help change how we treat and care for all individuals and promote equitable access to care that can lead to improved health outcomes."

"Health disparities in stroke are going to persist until we address the legacy of structural racism, of which historical redlining is one form," Meier said. "It's important to document the significant, negative impacts of structural racism on health."

Study limitations include people who had a history of stroke may not have always resided in the same census tract, leading to unmeasured variability in redlining exposure. In addition, this is an ecologic-designed study, where redlining exposure was combined with stroke rate to a neighborhood level, which limits the assessment of individual associations, Wing added.

The American Heart Association recently published a presidential advisory that names structural racism as a cause of poor health and premature death from heart disease and stroke. The advisory, titled "Call to Action: Structural Racism as a Fundamental Driver of Health Disparities," reviews the historical context, current state and potential solutions to address structural racism in the U.S. and outlines steps the Association is taking to address and mitigate the root causes of health care disparities.

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Co-authors of the study are Emily E. Lynch, M.P.H.; Sarah E. Laurent, Ph.D. candidate; Bruce C. Mitchell, Ph.D.; and Jason Richardson, M.A. The authors' disclosures are listed in the abstract.

Meier's work was funded in part by the Shaw Scientist Award from the Greater Milwaukee Foundation. Wing reports no study funding.

Additional Resources:

• Multimedia is available on the right column of release link https://newsroom.heart.org/news/structural-racism-communities-with-higher-redlining-scores-had-higher-rates-of-stroke?preview=cda802f68a8cb4086b88134ed14788de
• African American celebrities and influencers to amplify national conversation on health justice and equity
• Structural racism causes poor health, premature death from heart disease and stroke
• What does the life - and senseless deaths - of Black men and women mean for the health of Black Americans?
• Lifetime discrimination may increase risk of hypertension among African Americans
• For more news at ASA International Stroke Conference 2021, follow us on Twitter @HeartNews #ISC21.

Statements and conclusions of studies that are presented at the American Heart Association's scientific meetings are solely those of the study authors and do not necessarily reflect the Association's policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. The Association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and biotech companies, device manufacturers and health insurance providers are available here, and the Association's overall financial information is available here.

Long-term stroke death rates are higher among Black Medicare patients

American Stroke Association International Stroke Conference -- presentation P655

AMERICAN HEART ASSOCIATION

Research News

 

DALLAS, March 11, 2021 — A long-term look at Medicare patients shows that Black patients who have an ischemic stroke (blocked blood flow to the brain) die at a higher rate than white patients, even after accounting for preexisting health conditions, according to preliminary research to be presented at the American Stroke Association’s International Stroke Conference 2021. The virtual meeting is March 17-19, 2021 and is a world premier meeting for researchers and clinicians dedicated to the science of stroke and brain health.

“So much of what we know is limited to the early or acute phase — the first two weeks after a stroke,” said lead study author Judith H. Lichtman, Ph.D., M.P.H., professor and chair of the department of epidemiology at the Yale School of Public Health in New Haven, Connecticut. “When you have a stroke, it’s not just about the acute event, it’s about the early recovery period to secondary prevention visits that affect your long-term chances of survival.”

Researchers analyzed data on 744,044 Medicare beneficiaries (ages 65 and older) who had been treated at U.S. hospitals for ischemic stroke between 2005 and 2007. Overall, 85.6% were white, 9.9% were Black and 4.5% were of other races or ethnic groups. Black patients had higher rates of kidney failure, dementia and diabetes. Atherosclerosis and chronic obstructive pulmonary disease (COPD) were more common in white patients.

Patients were followed over a 10-year period, and analysis of the data found:

• Overall, the death rate was about 75%. Black patients had the highest death rate at 76.4%, followed by whites at 75.4%; and the death rate for those of other races or other ethnic groups was 70.3%.
• Even after adjusting for differences in preexisting health problems, the risk of death within 10 years after stroke was about 4% higher for Black patients than white patients. However, the stroke death risk was about 8% lower for those of other races.
• Importantly, within the first year after hospital discharge for ischemic stroke, the death rate for Black patients started to climb slightly in comparison to whites and other races, and these differences continued over the decade.

“These are racial differences in long-term stroke survivorship, and these differences start within the first year after a stroke,” Lichtman said. “We need to take a closer look at the recovery period and think about how we can optimize secondary prevention and post-stroke care for everybody. Stroke care during the first year after a stroke plays an important role in the long run.”

Future research will need to investigate the reasons behind these differences in death rates among Black patients and white patients. “Currently, much of the focus is on the acute stroke event, itself, yet we need to find out more – are there racial differences using rehab services, are some people not seeing neurologists and getting follow up care?” Lichtman said. “Stroke is an acute event, but it’s just as important to focus on early follow-up care that will support patients for better long-term outcomes and survival.”

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Co-authors are Erica C. Leifheit, Ph.D.; Yun Wang, Ph.D.; Andrew Arakaki, M.P.H.; and Larry B. Goldstein, M.D. The authors’ disclosures are available in the abstract.

The study was funded by the American Heart Association and the National Institute on Aging of the National Institutes of Health.

Additional Resources:

• Multimedia is available on the right column of release link https://newsroom.heart.org/news/long-term-stroke-death-rates-are-higher-among-black-medicare-patients?preview=61bb19ecbb6986bc5d17491112fb0285
• What is Brain Health?
• Stroke risk factors
• More stroke awareness, better eating habits may help reduce stroke risk for young adult African Americans
• Risk of stroke may more than double for African Americans who smoke
• African Americans live shorter lives due to heart disease and stroke
• For more news at ASA International Stroke Conference 2021, follow us on Twitter @HeartNews #ISC21.

Statements and conclusions of studies that are presented at the American Heart Association’s scientific meetings are solely those of the study authors and do not necessarily reflect the Association’s policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. The Association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and biotech companies, device manufacturers and health insurance providers are available here, and the Association’s overall financial information is available here.

The American Stroke Association’s International Stroke Conference (ISC) is the world’s premier meeting dedicated to the science and treatment of cerebrovascular disease. ISC 2021 will be held virtually, March 17-19, 2021. The 3-day conference will feature more than 1,200 compelling presentations in 21 categories that emphasize basic, clinical and translational sciences as they evolve toward a better understanding of stroke pathophysiology with the goal of developing more effective therapies. Engage in the International Stroke Conference on social media via #ISC21.

About the American Stroke Association

The American Stroke Association is devoted to saving people from stroke — the No. 2 cause of death in the world and a leading cause of serious disability. We team with millions of volunteers to fund innovative research, fight for stronger public health policies and provide lifesaving tools and information to prevent and treat stroke. The Dallas-based association officially launched in 1998 as a division of the American Heart Association. To learn more or to get involved, call 1-888-4STROKE or visit stroke.org. Follow us on Facebook, Twitter.