National Association of Chronic Disease Directors

Abstract Background: Modernization of public health data systems is a national priority. Improved chronic disease surveillance can provide more timely, accurate, and local measures to inform public health policy and intervention. Although electronic health record (EHR) data have great potential for surveillance, population coverage is non-random, which may result in biased estimates. Statistical approaches are needed to adjust estimates to represent the underlying population and validate the results against independent estimates. Methods: MENDS, the Multi-State-EHR-Based Network for Disease Surveillance, uses EHR data to calculate chronic disease and risk factor prevalence metrics. In this study, we applied post-stratification weighting to MENDS data from nearly 800,000 adults from Louisiana to estimate the prevalence of hypertension and hypertension control at the state and parish (county-equivalent) levels during February 2023. We then compared weighted MENDS hypertension prevalence estimates with measures derived from traditional public health surveillance. Results: Weighted MENDS hypertension prevalence estimates were approximately 10% lower than crude MENDS estimates, and approximately 13% higher than hypertension awareness estimates from the 2021 Behavioral Risk Factor Surveillance System, with similar geographic and demographic patterns. Weighted MENDS hypertension prevalence estimates indicated that 43.0% of Louisiana adult residents had hypertension (versus 47.7% crude prevalence). Prevalence was higher than the overall state estimate among men (47.3% weighted; 55.9% crude), Black patients (50.2% weighted; 55.7% crude), those receiving Medicare (70.6% weighted; 76.2% crude), and individuals living in rural areas (46.1% weighted; 49.8% crude). Hypertension prevalence increased with age and with more clinical visits during the previous 2 years. Hypertension prevalence was highest in the southeastern parishes near New Orleans and Baton Rouge. Demographic and geographic patterns in prevalence of hypertension control were like hypertension prevalence. Conclusions: Post-stratification weighting of MENDS data brought EHR-based data estimates closer to survey-based estimates of hypertension and can improve representativeness of chronic disease indicators. These estimates can provide public health organizations with timely, accurate, and local information. Further, EHR-based systems can produce unique measures, such as the prevalence of hypertension control, which can provide a more nuanced understanding of community needs and help public health agencies evaluate the effectiveness of community interventions.

Abstract BackgroundAsian American subgroups are underrepresented in Alzheimers Disease and Related Dementias (ADRD) research in the U.S. and globally.MethodOur approach was threefold: First, we identified data collection and reporting gaps for ADRD among Asian Americans in the U.S from multiple nationally representative surveys, e.g. Health and Retirement Survey, Medical Expenditure Panel Survey, and the Census. Second, we examined multi‐morbidity (e.g. diabetes, hypertension, cardiovascular disease and stroke) burden among a specific group of Asian Americans, South Asian Indians. Third, we provide knowledge gaps and recommendations for inclusion of Asian Americans to center racial equity in ADRD science.ResultDespite being a highly heterogeneous group and diverse in terms of culture, diet, language, Asian Americans are lumped together in national surveys. The three national surveys we examined in the U.S. have not collected disaggregated data on Asian Americans, a group that is growing in the U.S. Moreover, there is a lack of disease registers for different groups of Asian Americans which makes it difficult to assess and quantify the prevalence and burden of ADRD in this group. Due to a lack of systematic data collection efforts, the extent of dementia burden and classification of dementia cannot be accurately examined in the sub‐groups of Asian Americans. The data gaps in the collection and reporting of data on sub‐groups of Asian Americans prevent from designing culturally and linguistically sensitive interventions which are highly needed for sub‐groups of Asian Americans. South Asian Indians, a sub‐group of Asian Americans, considered to be of higher socioeconomic background in the U.S. were seldom omitted from the minority classification despite having a higher burden of multiple chronic conditions such as diabetes, hypertension, cardiovascular disease, and stroke, i.e. multi‐morbidity combinations which can greatly contribute to increased ADRD risk in this sub‐group.ConclusionThere is a critical need for the collection and reporting of disaggregated ADRD data on Asian Americans for centering racial equity in ADRD science in the U.S. Such efforts will aid in the understanding of mechanistic pathways for vascular cognitive impairment via inclusion of unique Asian populations that have been underrepresented in ADRD research both in the U.S. and globally.

Health equity is a public health priority, yet little is known about commitment to health equity in health departments, especially among practitioners whose work addresses chronic disease prevention. Their work places them at the forefront of battling the top contributors to disparities in morbidity and mortality. A random sample of 537 chronic disease practitioners working in state health departments was surveyed on health equity commitments, partnerships, and needed skills. A small percentage of respondents (2percent) worked primarily on health equity, and a larger group (9percent) included health equity as one of their multiple work areas. People who rated their work unit's commitment to health equity as high were more likely to engage with sectors outside of health and rate their leaders as high quality, and less likely to identify skills gaps in their work unit. Opportunities exist to more fully address health equity in state public health practice through organizational, institutional, and governmental policies, including those regarding resource allocation and staff training.

Fibromyalgia is frequently associated with impairments in activities of daily living and work disability. Limited data have investigated the impact of fibromyalgia on relationships with family and friends. This exploratory study was designed to survey a large community sample of adults with fibromyalgia about the impact on the spouse/partner, children and close friends. A 40-question, multiple-choice survey was made available online for a two-month period, with potential participants recruited through fibromyalgia and migraine community websites. Items included questions about demographics, fibromyalgia symptoms, comorbid mood disturbance and relationship impact, including the Relationship Assessment Scale. The survey was completed by 6,126 adults who had been diagnosed with fibromyalgia. Using updated diagnostic criteria from the American College of Rheumatology, 91% satisfied the criteria for fibromyalgia (Fibromyalgia Severity score ≥13 and pain ≥3 months). Half of participants endorsed that fibromyalgia had mildly to moderately damaged relationship(s) with their spouse(s)/partner(s) or contributed to a break-up with a spouse or partner. Half of participants scored as not being satisfied with their current spouse/partner relationship, with satisfaction negatively affected by the presence of mood disturbance symptoms and higher fibromyalgia severity. Relationships with children and close friends were also negatively impacted for a substantial minority of participants. In addition to physical impairments that are well documented among individuals with fibromyalgia, fibromyalgia can result in a substantial negative impact on important relationships with family and close friends.

National health communication campaign developers have ignored rural audiences in campaign development and testing, despite the health disparities that exist for this group. Researchers in a rural Midwestern state tested the appropriateness of CDC's national colorectal cancer screening campaign, Screen for Life. Based on focus groups and a quasiexperimental design evaluation, researchers determined that the national campaign did not adequately address the needs of the rural audience. A new print and radio campaign was developed based on previous findings, grounded in social marketing and the health belief model. New tailored campaign materials were refined in focus groups. Final versions were tested in two quasiexperimental designs. Results support the campaign's reach and efficacy. Those in the intervention county were significantly more likely than the unexposed to (a) report recent exposure to ads, (b) plan to seek out information regarding screening, and (c) plan to get screened in the near future.