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New York City, NY, United States

Albrecht S.S.,University of Michigan | McVeigh K.H.,Bureau of Epidemiology Services
Preventing Chronic Disease | Year: 2012

Introduction: In New York City, the age-adjusted prevalence of nonspecific psychological distress (NPD) among Hispanics is twice that of non-Hispanic whites; nationally, there is little Hispanic-white disparity. We aimed to explain the pattern of disparity in New York City. Methods: Data came from the 2006 National Health Interview Survey and 2006 Community Health Survey in New York City. Respondents with scores higher than 12 on the K6, a brief scale used to screen for mental health disorders, were defined as having NPD. Multivariate analyses controlled for Hispanic ancestry, socioeconomic status (education, employment, and income), nativity, language of interview, and health characteristics. Results: In New York City, the disparity between Hispanics and whites was fully explained after accounting for the disproportionate concentration of low socioeconomic status among Hispanics (odds ratio for NPD, 0.81; 95% confidence interval, 0.60-1.11). These factors also partially accounted for differences between Hispanics in New York City and the United States, but the prevalence of NPD overall in New York City remained elevated relative to the United States. Conclusion: Elevated NPD prevalence among New York City Hispanics was primarily attributable to large disparities in socioeconomic status; differences between New York City and the United States remained but were not specific to Hispanics. Interventions in New York City aimed at addressing racial/ethnic disparities in health may overlap with those addressing socioeconomic inequalities. Further study into the higher overall prevalence of NPD in New York City will be necessary to inform the design and targeting of interventions.


Lim S.,Gotham Center | Lim S.,City University of New York | Harris T.G.,Bureau of Epidemiology Services | Nash D.,City University of New York | And 2 more authors.
American Journal of Epidemiology | Year: 2015

We studied a cohort of 15,620 adults who had experienced at least 1 jail incarceration and 1 homeless shelter stay in 2001-2003 in New York City to identify trajectories of these events and tested whether a particular trajectory was associated with all-cause, drug-related, or human immunodeficiency virus (HIV)-related mortality risk in 2004- 2005. Using matched data on jail time, homeless shelter stays, and vital statistics, we performed sequence analysis and assessed mortality risk using standardized mortality ratios (SMRs) and marginal structural modeling.We identified 6 trajectories. Sixty percent of the cohort members had a temporary pattern, which was characterized by sporadic experiences of brief incarceration and homelessness, whereas the rest had the other 5 patterns, which reflected experiences of increasing, decreasing, or persistent jail or shelter stays. Mortality risk among individuals with a temporary pattern was significantly higher than those of adults who had not been incarcerated or stayed in a homeless shelter during the study period (all-cause SMR: 1.35, 95% confidence interval (CI): 1.14, 1.59; drugrelated SMR: 4.60, 95% CI: 3.17, 6.46; HIV-related SMR: 1.54, 95% CI: 1.03, 2.21); all-cause and HIV-related SMRs in other patterns were not statistically significantly different. When we compared all 6 trajectories, the temporary pattern was more strongly associated with higher mortality risk than was the continuously homelessness pattern. Institutional interventions to reduce recurrent cycles of incarceration and homelessness are needed to augment behavioral interventions to reduce mortality risk. © The Author 2015.


Waddell E.N.,Bureau of Epidemiology Services
Preventing chronic disease | Year: 2010

INTRODUCTION: Low-density lipoprotein (LDL) cholesterol is a major contributor to coronary heart disease and the primary target of cholesterol-lowering therapy. Substantial disparities in cholesterol control exist nationally, but it is unclear how these patterns vary locally. METHODS: We estimated the prevalence, awareness, treatment, and control of high LDL cholesterol using data from a unique local survey of New York City's diverse population. The New York City Health and Nutrition Examination Survey 2004 was administered to a probability sample of New York City adults. The National Health and Nutrition Examination Survey 2003-2004 was used for comparison. High LDL cholesterol and coronary heart disease risk were defined using National Cholesterol Education Program Adult Treatment Panel III (ATP III) guidelines. RESULTS: Mean LDL cholesterol levels in New York City and nationally were similar. In New York City, 28% of adults had high LDL cholesterol, 71% of whom were aware of their condition. Most aware adults reported modifying their diet or activity level (88%), 64% took medication, and 44% had their condition under control. More aware adults in the low ATP III risk group than those in higher risk groups had controlled LDL cholesterol (71% vs 33%-42%); more whites than blacks and Hispanics had controlled LDL cholesterol (53% vs 31% and 32%, respectively). CONCLUSION: High prevalence of high LDL cholesterol and inadequate treatment and control contribute to preventable illness and death, especially among those at highest risk. Population approaches - such as making the food environment more heart-healthy - and aggressive clinical management of cholesterol levels are needed.


Yi S.,Bureau of Chronic Disease Prevention and Tobacco Control | Elfassy T.,Bureau of Chronic Disease Prevention and Tobacco Control | Gupta L.,Bureau of Epidemiology Services | Myers C.,Bureau of Epidemiology Services | And 2 more authors.
American Journal of Hypertension | Year: 2014

BackgroundCharacterization of health conditions in recent immigrant subgroups, including foreign-born whites and Asians, is limited but important for identifying emerging health disparities. Hypertension, a major modifiable risk factor for cardiovascular disease, has been shown to be associated with acculturation, but the acculturative experience varies for different racial/ethnic groups. Assessing the impact of race/ethnicity on the relationship between acculturation-related factors and hypertension is therefore of interest.METHODSData from the 2005-2008 waves (n = 36,550) of the NYC Community Health Survey were combined to estimate self-reported hypertension prevalence by nativity, language spoken at home, and time spent in the United States. Multivariable analyses were used to assess (i) the independent associations of acculturation-related factors and hypertension and (ii) potential effect modification by race/ethnicity. Sensitivity analysis recalibrating self-reported hypertension using measured blood pressures from a prior NYC population-based survey was performed. Prevalence was also explored by country of origin.RESULTS Being foreign vs. US born was associated with higher self-reported hypertension in whites only. Speaking Russian vs. English at home was associated with a 2-fold adjusted odds of self-reported hypertension. Living in the United States for ≥10 years vs. less time was associated with higher self-reported hypertension prevalence in blacks and Hispanics. Hypertension prevalence in Hispanics was slightly lower when using a recalibrated definition, but other RESULTS did not change substantively.CONCLUSIONSRace/ethnicity modifies the relationship between acculturation-related factors and hypertension. Consideration of disease prevalence in origin countries is critical to understanding health patterns in immigrant populations. Validation of self-reported hypertension in Hispanic populations is indicated. © 2013 © Published by Oxford University Press on behalf of American Journal of Hypertension Ltd 2013. This work is written by (a) US Government employees(s) and is in the public domain in the US.


Richards C.A.,Columbia University | Kerker B.D.,Bureau of Epidemiology Services | Thorpe L.,York College - The City University of New York | Olson C.,Bureau of Epidemiology Services | And 2 more authors.
American Journal of Gastroenterology | Year: 2011

Objectives: In 2003, in response to low colonoscopy screening rates and significant sociodemographic disparities in colonoscopy screening in New York City (NYC), the NYC Department of Health and Mental Hygiene, together with the Citywide Colon Cancer Control Coalition, launched a multifaceted campaign to increase screening. We evaluated colonoscopy trends among adult New Yorkers aged 50 years and older between 2003 and 2007, the first five years of this campaign. Methods: Data were analyzed from the NYC Community Health Survey, an annual, population-based surveillance of New Yorkers. Annual prevalence estimates of adults who reported a timely colonoscopy, one within the past 10 years, were calculated. Multivariate models were used to analyze changes over time in associations between colonoscopy screening and sociodemographic characteristics. Results: Overall, from 2003 to 2007 the proportion of New Yorkers aged 50 years and older who reported timely colonoscopy screening increased from 41.7% to 61.7%. Racial/ethnic and sex disparities observed in 2003 were eliminated by 2007: prevalence of timely colonoscopy was similar among non-Hispanic whites, non-Hispanic blacks, Hispanics, men, and women. However, Asians, the uninsured, and those with lower education and income continued to lag in receipt of timely colonoscopies. Conclusions: The increased screening colonoscopy rate and reduction of racial/ethnic disparities observed in NYC suggest that multifaceted, coordinated urban campaigns can improve low utilization of clinical preventive health services and reduce public-health disparities. © 2011 by the American College of Gastroenterology.

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