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1.  Socioeconomic Position Is Positively Associated With Blood Pressure Dipping Among African-American Adults: The Jackson Heart Study 
American journal of hypertension  2011;24(9):1015-1021.
BACKGROUND
Blunted nocturnal blood pressure (NBP) dipping is a significant predictor of cardiovascular events. Lower socioeconomic position (SEP) may be an important predictor of NBP dipping, especially in African Americans (AA). However, the determinants of NBP dipping are not fully understood.
METHODS
The cross-sectional associations of individual and neighborhood SEP with NBP dipping, assessed by 24-h ambulatory BP monitoring, were examined among 837 AA adults (Mean age: 59.2 ± 10.7 years; 69.2% women), after adjustment for age, sex, hypertension status, body mass index (BMI), health behaviors, office, and 24-h systolic BP (SBP).
RESULTS
The mean hourly SBP was consistently lower among participants in the highest category of individual income compared to those in the lowest category, and these differences were most pronounced during sleeping hours. The odds of NBP dipping (defined as >10% decline in the mean asleep SBP compared to the mean awake SBP) increased by 31% (95% confidence interval: 13–53%) and 18% (95% confidence interval: 0–39%) for each s.d. increase in income and years of education, respectively, after multivariable adjustment.
CONCLUSIONS
NBP dipping is patterned by income and education in AA adults even after accounting for known risk factors. These results suggest that low SEP is a risk factor for insufficient NBP dipping in AA.
doi:10.1038/ajh.2011.98
PMCID: PMC4206938  PMID: 21654853
ambulatory blood pressure monitoring; blood pressure; hypertension; Jackson Heart Study; nocturnal dipping; socioeconomic position; systole
2.  The associations of fast food restaurant availability with dietary intake and weight among African Americans in the Jackson Heart Study, 2000–2004 
American Journal of Public Health  2011;101(Suppl 1):S301-S309.
Objectives
The purpose of this study was to examine the associations of fast food restaurant (FFR) availability with dietary intake and weight among African Americans in the Southeastern United States.
Methods
Cross-sectional associations of 0.5, 1, 2, and 5 mile FFR availability with energy, fat, carbohydrates, fiber, and fruit and vegetable intakes, and body mass index (BMI) and waist circumference were investigated in 4,740 African American Jackson Heart Study participants (55.2±12.6 years, 63.3% women).
Results
No consistent associations between FFR availability and BMI or waist circumference were observed. Greater FFR availability was associated with higher energy intake among persons <55 years after adjustment for individual socioeconomic status mean difference in energy intake per standard deviation increase in 5-mile FFR 138 KCal (Confidence interval (CI): 70.53, 204.75) and 58 Kcal (CI: 8.55, 105.97) in men and women, respectively. Similar associations were also observed for the 2-mile windows in men. FFR availability was positively associated with total fiber intake among men and women <55 years.
Conclusions
FFR availability may contribute to greater energy intake in younger African Americans.
doi:10.2105/AJPH.2010.300006
PMCID: PMC3222494  PMID: 21551382
3.  Socioeconomic status, John Henrysim and blood pressure among African-Americans in the Jackson Heart Study 
John Henryism connotes a strong behavioral predisposition to engage in effortful, active coping with difficult social and economic stressors. This behavioral predisposition is measured by the 12 item John Henryism Scale for Active Coping (JHAC). The John Henry hypothesis predicts that the well-known inverse socioeconomic status (SES)-blood pressure association will be stronger among persons who score high rather than low on the JHAC. We tested this hypothesis in a large African American cohort using baseline data from the Jackson Heart Study. Unlike previous studies, we used multiple indicators of SES: income, education, occupation, childhood SES and cumulative SES. Because the hypothesis is most relevant for adults still in the labor force, we excluded retired participants, yielding a sample size of 3,978. Gender-specific Poisson regression models for hypertension adjusting for age, John Henryism, SES, and a John Henryism-SES interaction term, were fit to examine associations. Separate models were fit for each SES indicator. We found some evidence that John Henryism modified the association between income and hypertension in men: low income was associated with higher prevalence of hypertension in men who scored high on John Henryism (prevalence ratio (PR) for low vs. high income tertile 1.12), but with lower hypertension prevalence among men who scored low on John Henryism (PR 0.85, one sided P value for multiplicative interaction <0.05). For women, the association of low income with higher hypertension prevalence was stronger at lower than higher levels of John Henryism (PR 1.27 and 1.06 at low and high levels of John Henryism respectively, P value<0.05). There was no evidence that John Henryism modified the associations of hypertension with other SES indicators in men or women. The modest support of the John Henryism Hypothesis in men only, adds to the literature on this subject, but underscores questions regarding the gender, spatial, socioeconomic and historical contexts in which the hypothesis is valid.
doi:10.1016/j.socscimed.2013.06.016
PMCID: PMC4149751  PMID: 23906131
United States; John Henryism; socioeconomic status; hypertension; African American
4.  Treatment of hypertension among African Americans: the Jackson Heart Study 
Hypertension treatment regimens used by African American adults of the Jackson Heart Study were evaluated at the first two clinical examinations (2415 persons at Exam I, 2000–2004; 2577 at Exam II, 2005–08). Blood pressure (BP) was below 140/90 mm Hg for 66% and 70% at Exam I and Exam II, respectively; JNC7 BP treatment targets were met for 56% and 61% at Exam I and Exam II, respectively. Persons with diabetes or CKD were less likely to have BP at target, as were men compared to women. Thiazide diuretics were the most commonly used anti-hypertensive medication, and persons taking a thiazide were more likely to have their BP controlled than persons not taking them; thiazides were used significantly less among men than women. Although calcium channel blockers are often considered to be effective monotherapy for African Americans, persons using calcium channel blocker monotherapy were significantly less like to be at target BP than persons using thiazide monotherapy.
doi:10.1111/jch.12088
PMCID: PMC3683967  PMID: 23730984
Anti-hypertensive Therapy; Hypertension in African Americans; Treatment and Diagnosis/Guidelines; Community-Based Studies; Epidemiology
5.  The Contribution of Stress to the Social Patterning of Clinical and Subclinical CVD Risk Factors in African Americans: The Jackson Heart Study 
Social science & medicine (1982)  2012;75(9):1697-1707.
It is often hypothesized that psychosocial stress may contribute to associations of socioeconomic position (SEP) with risk factors for cardiovascular disease (CVD). However, few studies have investigated this hypothesis among African Americans, who may be more frequently exposed to stressors due to social and economic circumstances. Cross-sectional data from the Jackson Heart Study (JHS), a large population-based cohort of African Americans, were used to examine the contributions of stressors to the association of SEP with selected cardiovascular (CVD) risk factors and subclinical atherosclerotic disease. Among women, higher income was associated with lower prevalence of hypertension, obesity, diabetes and carotid plaque and lower levels of stress. Higher stress levels were also weakly, albeit positively, associated with hypertension, diabetes, and obesity, but not with plaque. Adjustment for the stress measures reduced the associations of income with hypertension, diabetes and obesity by a small amount that was comparable to, or larger, than the reduction observed after adjustment for behavioral risk factors. In men, high income was associated with lower prevalence of diabetes and stressors were not consistently associated with any of the outcomes examined. Overall, modest mediation effects of stressors were observed for diabetes (15.9%), hypertension (9.7%), and obesity (5.1%) among women but only results for diabetes were statistically significant. No mediation effects of stressors were observed in men. Our results suggest that stressors may partially contribute to associations of SEP with diabetes and possibly hypertension and obesity in African American women. Further research with appropriate study designs and data is needed to understand the dynamic and interacting effects of stressors and behaviors on CVD outcomes as well as sex differences in these effects.
doi:10.1016/j.socscimed.2012.06.003
PMCID: PMC3580180  PMID: 22841454
U.S.A.; Stress; social patterning; cardiovascular disease; risk factors; mediation analysis; African Americans
6.  Sleep-Disordered Breathing Symptoms among African-Americans in the Jackson Heart Study 
Sleep medicine  2012;13(8):1039-1049.
Background
Sleep-disordered breathing (SDB) is an increasingly recognized risk factor for cardiovascular disease (CVD). Limited data are available from large African American cohorts.
Methods
We examined the prevalence, burden, and correlates of sleep symptoms suggestive of SDB and risk for obstructive sleep apnea (OSA) in the Jackson Heart Study (JHS), an all-African-American cohort of 5,301 adults. Data on selected daytime and nighttime sleep symptoms were collected using a modified Berlin questionnaire during the baseline examination. Risk of OSA was calculated according to published prediction model. Age and multivariable-adjusted logistic regression models were used to examine the associations between potential risk factors and measures of sleep.
Results
Sleep symptoms, burden, and risk of OSA were high among men and women in the JHS and increased with age and obesity. Being married was positively associated with sleep symptoms among women. In men, poor to fair perceived health and increased levels of stress were associated with higher odds of sleep burden, whereas prevalent hypertension and CVD were associated with higher odds of OSA risk. Similar associations were observed among women with slight variations. Sleep duration <7 hours was associated with increased odds of sleep symptoms among women and increased sleep burden among men. Moderate to severe restless sleep was consistently and positively associated with odds of adverse sleep symptoms, sleep burden, and high risk OSA.
Conclusions
Sleep symptoms in JHS had a strong positive association with features of visceral obesity, stress, and poor perceived health. With increasing obesity among younger African Americans, these findings are likely to have broad public health implications.
doi:10.1016/j.sleep.2012.06.005
PMCID: PMC3427405  PMID: 22841028
African-American; epidemiology; Jackson Heart study; health status; obesity; sleep; sleep apnea syndromes; sleep disordered breathing
7.  Cumulative biological risk is socially patterned by education and income among African Americans in the Jackson Heart Study 
American Journal of Public Health  2012;102(7):1362-1369.
Objectives
The purpose of this study was to examine the social patterning of cumulative dysregulation of multiple systems, or allostatic load (AL), among African Americans adults.
Methods
We examined the cross-sectional associations of socioeconomic status (SES) with summary indices of allostatic load and neuroendocrine, metabolic, autonomic, and immune function components in 4,048 Jackson Heart Study participants.
Results
Lower education and income were associated with higher AL scores in African American women and men. Patterns were most consistent for the metabolic and immune dimensions, less consistent for the autonomic dimension and absent for the neuroendocrine dimension among African American women. Associations of SES with the global AL score and the metabolic and immune domains persisted after adjustment for behavioral factors and were stronger for income than education. There was some evidence that the neuroendocrine dimension was inversely associated with SES after behavioral adjustment in men, but the immune and autonomic components did not show clear dose response trends and no associations were observed for the metabolic component.
Discussion
Findings support the hypothesis that AL is socially patterned by SES in African American women, but less consistently in African American men.
doi:10.2105/AJPH.2011.300444
PMCID: PMC3371088  PMID: 22594727
8.  Subjective social status and psychosocial and metabolic risk factors for cardiovascular disease among African Americans in the Jackson Heart Study 
Social science & medicine (1982)  2012;74(8):1146-1154.
Subjective social status has been shown to be inversely associated with multiple cardiovascular risk factors, independent of objective social status. However, few studies have examined this association among African Americans and the results have been mixed. Additionally, the influence of discrimination on this relationship has not been explored. Using baseline data (2000–2004) from the Jackson Heart Study, an African American cohort from the U.S. South (N = 5301), we quantified the association of subjective social status with selected cardiovascular risk factors: depressive symptoms, perceived stress, waist circumference, insulin resistance and prevalence of diabetes. We contrasted the strength of the associations of these outcomes with subjective versus objective social status and examined whether perceived discrimination confounded or modified these associations. Subjective social status was measured using two 10-rung "ladders," using the U.S. and the community as referent groups. Objective social status was measured using annual family income and years of schooling completed. Gender-specific multivariable linear and logistic regression models were fit to examine associations. Subjective and objective measures were weakly positively correlated. Independent of objective measures, subjective social status was significantly inversely associated with depressive symptoms (men and women) and insulin resistance (women). The associations of subjective social status with the outcomes were modest and generally similar to the objective measures. We did not find evidence that perceived racial discrimination strongly confounded or modified the association of subjective social status with the outcomes. Subjective social status was related to depressive symptoms but not consistently to stress or metabolic risk factors in African Americans.
doi:10.1016/j.socscimed.2011.12.042
PMCID: PMC3654526  PMID: 22381684
USA; African American; subjective social status; cardiovascular; risk factors
9.  The Socioeconomic Gradient of Diabetes Prevalence, Awareness, Treatment and Control Among African Americans in the Jackson Heart Study 
Annals of epidemiology  2011;21(12):892-898.
PURPOSE
Little research has focused on the social patterning of diabetes among African Americans. We examined the relationship between socioeconomic status (SES) and the prevalence, awareness, treatment and control of diabetes among African Americans.
METHODS
Education, income and occupation were examined among 4,303 participants (women=2,726; men=1,577). Poisson regression estimated relative probabilities (RP) of diabetes outcomes by SES.
RESULTS
The prevalence of diabetes was 19.6% in women and 15.9% in men. Diabetes awareness, treatment and control were 90.0%, 86.8%, and 39.2% in women, respectively, and 88.2%, 84.4%, and 35.9% in men, respectively. In adjusted models, low-income men and women had greater probabilities of diabetes than high-income men and women (RP 1.94, 95%CI: 1.28–2.92; RP 1.35, 95%CI: 1.04–1.74, respectively). Lack of awareness was associated with low education and low occupation in women (RP 2.28, 95%CI 1.01–5.18, and RP 2.62, 95%CI 1.08–6.33, respectively) but not in men. Lack of treatment was associated with low education in women. Diabetes control was not patterned by SES.
CONCLUSIONS
Diabetes prevalence is patterned by SES, and awareness and treatment are patterned by SES in women but not men. Efforts to prevent diabetes in African Americans need to address the factors that place those of low SES at higher risk.
doi:10.1016/j.annepidem.2011.05.006
PMCID: PMC3192269  PMID: 21737303
diabetes prevalence; socioeconomic status; Jackson Heart Study; African Americans; disparities
10.  Genome-wide association study for serum urate concentrations and gout among African Americans identifies genomic risk loci and a novel URAT1 loss-of-function allele 
Human Molecular Genetics  2011;20(20):4056-4068.
Serum urate concentrations are highly heritable and elevated serum urate is a key risk factor for gout. Genome-wide association studies (GWAS) of serum urate in African American (AA) populations are lacking. We conducted a meta-analysis of GWAS of serum urate levels and gout among 5820 AA and a large candidate gene study among 6890 AA and 21 708 participants of European ancestry (EA) within the Candidate Gene Association Resource Consortium. Findings were tested for replication among 1996 independent AA individuals, and evaluated for their association among 28 283 EA participants of the CHARGE Consortium. Functional studies were conducted using 14C-urate transport assays in mammalian Chinese hamster ovary cells. In the discovery GWAS of serum urate, three loci achieved genome-wide significance (P< 5.0 × 10−8): a novel locus near SGK1/SLC2A12 on chromosome 6 (rs9321453, P= 1.0 × 10−9), and two loci previously identified in EA participants, SLC2A9 (P= 3.8 × 10−32) and SLC22A12 (P= 2.1 × 10−10). A novel rare non-synonymous variant of large effect size in SLC22A12, rs12800450 (minor allele frequency 0.01, G65W), was identified and replicated (beta −1.19 mg/dl, P= 2.7 × 10−16). 14C-urate transport assays showed reduced urate transport for the G65W URAT1 mutant. Finally, in analyses of 11 loci previously associated with serum urate in EA individuals, 10 of 11 lead single-nucleotide polymorphisms showed direction-consistent association with urate among AA. In summary, we identified and replicated one novel locus in association with serum urate levels and experimentally characterize the novel G65W variant in URAT1 as a functional allele. Our data support the importance of multi-ethnic GWAS in the identification of novel risk loci as well as functional variants.
doi:10.1093/hmg/ddr307
PMCID: PMC3177647  PMID: 21768215
11.  Age is positively associated with HDL-cholesterol among African Americans in cross-sectional analysis: the Jackson Heart Study 
Journal of clinical lipidology  2011;5(3):173-178.
Background
African Americans have historically had high HDL-C compared to other races and ethnicities.
Objective
We sought to characterize whether there is a cross-sectional association between age and HDL-C in a contemporary community-based study of African Americans.
Methods
Cross-sectional data was modeled by logistic regression for predictors of HDL-C among African-Americans, ages 35–74, participating in the baseline examination of a community-based study of cardiovascular disease in Jackson, MS, during 2000–2004. After excluding persons taking lipid-lowering medications, hormone replacement therapy, oral contraceptives, or thyroid replacement, the analytical data set comprised 2420 persons (1370 women, 1050 men).
Results
HDL-C had a significant positive association with age after controlling for serum triglycerides, sex, waist circumference, percent dietary calories from carbohydrates, alcohol use, and leisure physical activity. Sex was a significant effect modifier of this relationship, whereby the increase in HDL-C with age was steeper for women than for men.
Conclusions
Cross-sectional analysis found a positive association of HDL-C with age while controlling for triglycerides. Careful evaluation of longitudinal data will be needed to confirm whether this is a true effect of aging, or a cohort or survivor effect.
doi:10.1016/j.jacl.2011.02.002
PMCID: PMC3100667  PMID: 21600522
high density lipoprotein cholesterol; triglycerides; aging; epidemiology; African Americans; cohort studies
12.  Geographic Representation of the Jackson Heart Study Cohort to the African-American Population in Jackson, Mississippi 
American Journal of Epidemiology  2010;173(1):110-117.
Recent advances in geographic information systems software and multilevel methodology provide opportunities for more extensive characterization of “at-risk” populations in epidemiologic studies. The authors used age-restricted, geocoded data from the all-African-American Jackson Heart Study (JHS), 2000–2004, to demonstrate a novel use of the Lorenz curve and Gini coefficient to determine the representativeness of the JHS cohort to the African-American population in a geographic setting. The authors also used a spatial binomial model to assess the geographic variability in participant recruitment across the Jackson, Mississippi, Metropolitan Statistical Area. The overall Gini coefficient, an equality measure that ranges from 0 (perfect equality) to 1 (perfect inequality), was 0.37 (95% confidence interval (CI): 0.30, 0.45), indicating moderate representation. The population of sampled women (Gini coefficient = 0.34, 95% CI: 0.30, 0.39) tended to be more representative of the underlying population than did the population of sampled men (Gini coefficient = 0.49, 95% CI: 0.35, 0.61). Representative recruitment of JHS participants was observed in predominantly African-American and mixed-race census tracts and in the center of the study area, the area nearest the examination clinic. This is of critical importance as the authors continue to explore novel approaches to investigate the geographic variation in disease etiology.
doi:10.1093/aje/kwq317
PMCID: PMC3025639  PMID: 21076050
African Americans; Bayesian model; binomial model; epidemiologic methods; Gini coefficient; Lorenz curve; representation; topography, medical
13.  The Triglyceride/High-Density Lipoprotein Cholesterol Ratio Fails to Predict Insulin Resistance in African-American Women: An Analysis of Jackson Heart Study 
Abstract
Background
Compared to whites, insulin-resistant African Americans have worse outcomes. Screening programs that could identify insulin resistance early enough for intervention to affect outcome often rely on triglyceride (TG) and high-density lipoprotein cholesterol (HDL-C) levels. Racial differences in TG and HDL-C may compromise the efficacy of these programs in African Americans. A recommendation currently exists to use the TG/HDL-C ratio ≥2.0 to predict insulin resistance in African Americans. The validity of this recommendation needs examination. Therefore, our aim was to determine the ability of TG/HDL-C ratio to predict insulin resistance in African Americans.
Methods
In 1,903 African Americans [895 men, 1,008 women, age 55 ± 12 years, mean ± standard deviation (SD), range 35–80 years, body mass index (BMI) 31.0 ± 6.4 kg/m2, range 18.5–55 kg/m2] participating in the Jackson Heart Study, a population-based study of African Americans, Jackson, Mississippi tricounty region, insulin resistance was defined by the upper quartile (≥4.43) of homeostasis model assessment of insulin resistance (HOMA-IR). An area under the receiver operating characteristic curve (AUC-ROC) of >0.70 was required for prediction of insulin resistance by TG/HDL-C. The optimal test cutoff was determined by the Youden index.
Results
HOMA-IR was similar in men and women (3.40 ± 2.03 vs. 3.80 ± 2.46, P = 0.60). Women had lower TG (94 ± 49 vs. 109 ± 65 mg/dL P < 0.001) and TG/HDL-C (1.9 ± 1.4 vs. 2.7 ± 2.1, P < 0.001). For men, AUC-ROC for prediction of insulin resistance by TG/HDL-C was: 0.77 ± 0.01, mean ± standard error (SE), with an optimal cutoff of ≥2.5. For women, the AUC-ROC was 0.66 ± 0.01, rendering an optimal cutoff indefinable. When women were divided in two groups according to age, 35–50 years and 51–80 years, the results did not change.
Conclusions
In African-American men, the recommended TG/HDL-C threshold of 2.0 should be adjusted upward to 2.5. In African-American women, TG/HDL-C cannot identify insulin resistance. The Jackson Heart Study can help determine the efficacy of screening programs in African-Americans.
doi:10.1089/met.2010.0028
PMCID: PMC3125564  PMID: 20715971
14.  Association of Socioeconomic Status and CKD among African Americans: The Jackson Heart Study 
Background
Socioeconomic status (SES) is recognized as a key social environmental factor because it has implications for access to resources that help individuals care for themselves and others. Few studies have examined the association of SES with CKD in high-risk populations.
Study Design
Single-site longitudinal population-based cohort
Setting and Participants
The data for this study were drawn from the baseline examination of the Jackson Heart Study. The analytic cohort consisted of 3,430 African American men and women living in the tri-county area of the Jackson, Mississippi metropolitan areas with complete data to determine CKD status.
Predictor
High SES (defined as having a family income at least 3.5 times the poverty level or having at least one undergraduate degree)
Outcomes and Measurements
CKD (defined as the presence of albuminuria or reduced estimated glomerular filtration rate (eGFR) <60 ml/min/1.73m2). Associations were explored through bivariable analyses and multivariable logistic regression analyses adjusting for CKD and cardiovascular disease risk factors as well as demographic factors.
Results
The prevalence of CKD in the Jackson Heart Study was 20% (865/3430 participants). The proportion of the Jackson Heart Study cohort with albuminuria and decreased eGFR was 12.5% (429/3430 participants) and 10.1% (347/3430 participants) respectively. High SES was inversely associated with CKD. The odds of having CKD were 41% lower for affluent participants than their less affluent counterparts. There were no statistically significant interactions between sex and education or income although subgroup analysis showed that high income was associated with CKD among male (OR 0.47, CI 0.23–0.97) but not female (OR 0.64, CI 0.40–1.03) participants.
Limitations
Models were estimated using cross-sectional data.
Conclusion
CKD is associated with SES. Additional research is needed to elucidate the impact of wealth and social contexts in which individuals are embedded, and the mediating effects of sociocultural factors.
doi:10.1053/j.ajkd.2010.01.016
PMCID: PMC2876216  PMID: 20381223
15.  Association of genetic variation with systolic and diastolic blood pressure among African Americans: the Candidate Gene Association Resource study 
Fox, Ervin R. | Young, J. Hunter | Li, Yali | Dreisbach, Albert W. | Keating, Brendan J. | Musani, Solomon K. | Liu, Kiang | Morrison, Alanna C. | Ganesh, Santhi | Kutlar, Abdullah | Ramachandran, Vasan S. | Polak, Josef F. | Fabsitz, Richard R. | Dries, Daniel L. | Farlow, Deborah N. | Redline, Susan | Adeyemo, Adebowale | Hirschorn, Joel N. | Sun, Yan V. | Wyatt, Sharon B. | Penman, Alan D. | Palmas, Walter | Rotter, Jerome I. | Townsend, Raymond R. | Doumatey, Ayo P. | Tayo, Bamidele O. | Mosley, Thomas H. | Lyon, Helen N. | Kang, Sun J. | Rotimi, Charles N. | Cooper, Richard S. | Franceschini, Nora | Curb, J. David | Martin, Lisa W. | Eaton, Charles B. | Kardia, Sharon L.R. | Taylor, Herman A. | Caulfield, Mark J. | Ehret, Georg B. | Johnson, Toby | Chakravarti, Aravinda | Zhu, Xiaofeng | Levy, Daniel | Munroe, Patricia B. | Rice, Kenneth M. | Bochud, Murielle | Johnson, Andrew D. | Chasman, Daniel I. | Smith, Albert V. | Tobin, Martin D. | Verwoert, Germaine C. | Hwang, Shih-Jen | Pihur, Vasyl | Vollenweider, Peter | O'Reilly, Paul F. | Amin, Najaf | Bragg-Gresham, Jennifer L. | Teumer, Alexander | Glazer, Nicole L. | Launer, Lenore | Zhao, Jing Hua | Aulchenko, Yurii | Heath, Simon | Sõber, Siim | Parsa, Afshin | Luan, Jian'an | Arora, Pankaj | Dehghan, Abbas | Zhang, Feng | Lucas, Gavin | Hicks, Andrew A. | Jackson, Anne U. | Peden, John F. | Tanaka, Toshiko | Wild, Sarah H. | Rudan, Igor | Igl, Wilmar | Milaneschi, Yuri | Parker, Alex N. | Fava, Cristiano | Chambers, John C. | Kumari, Meena | JinGo, Min | van der Harst, Pim | Kao, Wen Hong Linda | Sjögren, Marketa | Vinay, D.G. | Alexander, Myriam | Tabara, Yasuharu | Shaw-Hawkins, Sue | Whincup, Peter H. | Liu, Yongmei | Shi, Gang | Kuusisto, Johanna | Seielstad, Mark | Sim, Xueling | Nguyen, Khanh-Dung Hoang | Lehtimäki, Terho | Matullo, Giuseppe | Wu, Ying | Gaunt, Tom R. | Charlotte Onland-Moret, N. | Cooper, Matthew N. | Platou, Carl G.P. | Org, Elin | Hardy, Rebecca | Dahgam, Santosh | Palmen, Jutta | Vitart, Veronique | Braund, Peter S. | Kuznetsova, Tatiana | Uiterwaal, Cuno S.P.M. | Campbell, Harry | Ludwig, Barbara | Tomaszewski, Maciej | Tzoulaki, Ioanna | Palmer, Nicholette D. | Aspelund, Thor | Garcia, Melissa | Chang, Yen-Pei C. | O'Connell, Jeffrey R. | Steinle, Nanette I. | Grobbee, Diederick E. | Arking, Dan E. | Hernandez, Dena | Najjar, Samer | McArdle, Wendy L. | Hadley, David | Brown, Morris J. | Connell, John M. | Hingorani, Aroon D. | Day, Ian N.M. | Lawlor, Debbie A. | Beilby, John P. | Lawrence, Robert W. | Clarke, Robert | Collins, Rory | Hopewell, Jemma C. | Ongen, Halit | Bis, Joshua C. | Kähönen, Mika | Viikari, Jorma | Adair, Linda S. | Lee, Nanette R. | Chen, Ming-Huei | Olden, Matthias | Pattaro, Cristian | Hoffman Bolton, Judith A. | Köttgen, Anna | Bergmann, Sven | Mooser, Vincent | Chaturvedi, Nish | Frayling, Timothy M. | Islam, Muhammad | Jafar, Tazeen H. | Erdmann, Jeanette | Kulkarni, Smita R. | Bornstein, Stefan R. | Grässler, Jürgen | Groop, Leif | Voight, Benjamin F. | Kettunen, Johannes | Howard, Philip | Taylor, Andrew | Guarrera, Simonetta | Ricceri, Fulvio | Emilsson, Valur | Plump, Andrew | Barroso, Inês | Khaw, Kay-Tee | Weder, Alan B. | Hunt, Steven C. | Bergman, Richard N. | Collins, Francis S. | Bonnycastle, Lori L. | Scott, Laura J. | Stringham, Heather M. | Peltonen, Leena | Perola, Markus | Vartiainen, Erkki | Brand, Stefan-Martin | Staessen, Jan A. | Wang, Thomas J. | Burton, Paul R. | SolerArtigas, Maria | Dong, Yanbin | Snieder, Harold | Wang, Xiaoling | Zhu, Haidong | Lohman, Kurt K. | Rudock, Megan E. | Heckbert, Susan R. | Smith, Nicholas L. | Wiggins, Kerri L. | Shriner, Daniel | Veldre, Gudrun | Viigimaa, Margus | Kinra, Sanjay | Prabhakaran, Dorairajan | Tripathy, Vikal | Langefeld, Carl D. | Rosengren, Annika | Thelle, Dag S. | MariaCorsi, Anna | Singleton, Andrew | Forrester, Terrence | Hilton, Gina | McKenzie, Colin A. | Salako, Tunde | Iwai, Naoharu | Kita, Yoshikuni | Ogihara, Toshio | Ohkubo, Takayoshi | Okamura, Tomonori | Ueshima, Hirotsugu | Umemura, Satoshi | Eyheramendy, Susana | Meitinger, Thomas | Wichmann, H.-Erich | Cho, Yoon Shin | Kim, Hyung-Lae | Lee, Jong-Young | Scott, James | Sehmi, Joban S. | Zhang, Weihua | Hedblad, Bo | Nilsson, Peter | Smith, George Davey | Wong, Andrew | Narisu, Narisu | Stančáková, Alena | Raffel, Leslie J. | Yao, Jie | Kathiresan, Sekar | O'Donnell, Chris | Schwartz, Steven M. | Arfan Ikram, M. | Longstreth, Will T. | Seshadri, Sudha | Shrine, Nick R.G. | Wain, Louise V. | Morken, Mario A. | Swift, Amy J. | Laitinen, Jaana | Prokopenko, Inga | Zitting, Paavo | Cooper, Jackie A. | Humphries, Steve E. | Danesh, John | Rasheed, Asif | Goel, Anuj | Hamsten, Anders | Watkins, Hugh | Bakker, Stephan J.L. | van Gilst, Wiek H. | Janipalli, Charles S. | Radha Mani, K. | Yajnik, Chittaranjan S. | Hofman, Albert | Mattace-Raso, Francesco U.S. | Oostra, Ben A. | Demirkan, Ayse | Isaacs, Aaron | Rivadeneira, Fernando | Lakatta, Edward G. | Orru, Marco | Scuteri, Angelo | Ala-Korpela, Mika | Kangas, Antti J. | Lyytikäinen, Leo-Pekka | Soininen, Pasi | Tukiainen, Taru | Würz, Peter | Twee-Hee Ong, Rick | Dörr, Marcus | Kroemer, Heyo K. | Völker, Uwe | Völzke, Henry | Galan, Pilar | Hercberg, Serge | Lathrop, Mark | Zelenika, Diana | Deloukas, Panos | Mangino, Massimo | Spector, Tim D. | Zhai, Guangju | Meschia, James F. | Nalls, Michael A. | Sharma, Pankaj | Terzic, Janos | Kranthi Kumar, M.J. | Denniff, Matthew | Zukowska-Szczechowska, Ewa | Wagenknecht, Lynne E. | Fowkes, Gerald R. | Charchar, Fadi J. | Schwarz, Peter E.H. | Hayward, Caroline | Guo, Xiuqing | Bots, Michiel L. | Brand, Eva | Samani, Nilesh J. | Polasek, Ozren | Talmud, Philippa J. | Nyberg, Fredrik | Kuh, Diana | Laan, Maris | Hveem, Kristian | Palmer, Lyle J. | van der Schouw, Yvonne T. | Casas, Juan P. | Mohlke, Karen L. | Vineis, Paolo | Raitakari, Olli | Wong, Tien Y. | Shyong Tai, E. | Laakso, Markku | Rao, Dabeeru C. | Harris, Tamara B. | Morris, Richard W. | Dominiczak, Anna F. | Kivimaki, Mika | Marmot, Michael G. | Miki, Tetsuro | Saleheen, Danish | Chandak, Giriraj R. | Coresh, Josef | Navis, Gerjan | Salomaa, Veikko | Han, Bok-Ghee | Kooner, Jaspal S. | Melander, Olle | Ridker, Paul M. | Bandinelli, Stefania | Gyllensten, Ulf B. | Wright, Alan F. | Wilson, James F. | Ferrucci, Luigi | Farrall, Martin | Tuomilehto, Jaakko | Pramstaller, Peter P. | Elosua, Roberto | Soranzo, Nicole | Sijbrands, Eric J.G. | Altshuler, David | Loos, Ruth J.F. | Shuldiner, Alan R. | Gieger, Christian | Meneton, Pierre | Uitterlinden, Andre G. | Wareham, Nicholas J. | Gudnason, Vilmundur | Rettig, Rainer | Uda, Manuela | Strachan, David P. | Witteman, Jacqueline C.M. | Hartikainen, Anna-Liisa | Beckmann, Jacques S. | Boerwinkle, Eric | Boehnke, Michael | Larson, Martin G. | Järvelin, Marjo-Riitta | Psaty, Bruce M. | Abecasis, Gonçalo R. | Elliott, Paul | van Duijn , Cornelia M. | Newton-Cheh, Christopher
Human Molecular Genetics  2011;20(11):2273-2284.
The prevalence of hypertension in African Americans (AAs) is higher than in other US groups; yet, few have performed genome-wide association studies (GWASs) in AA. Among people of European descent, GWASs have identified genetic variants at 13 loci that are associated with blood pressure. It is unknown if these variants confer susceptibility in people of African ancestry. Here, we examined genome-wide and candidate gene associations with systolic blood pressure (SBP) and diastolic blood pressure (DBP) using the Candidate Gene Association Resource (CARe) consortium consisting of 8591 AAs. Genotypes included genome-wide single-nucleotide polymorphism (SNP) data utilizing the Affymetrix 6.0 array with imputation to 2.5 million HapMap SNPs and candidate gene SNP data utilizing a 50K cardiovascular gene-centric array (ITMAT-Broad-CARe [IBC] array). For Affymetrix data, the strongest signal for DBP was rs10474346 (P= 3.6 × 10−8) located near GPR98 and ARRDC3. For SBP, the strongest signal was rs2258119 in C21orf91 (P= 4.7 × 10−8). The top IBC association for SBP was rs2012318 (P= 6.4 × 10−6) near SLC25A42 and for DBP was rs2523586 (P= 1.3 × 10−6) near HLA-B. None of the top variants replicated in additional AA (n = 11 882) or European-American (n = 69 899) cohorts. We replicated previously reported European-American blood pressure SNPs in our AA samples (SH2B3, P= 0.009; TBX3-TBX5, P= 0.03; and CSK-ULK3, P= 0.0004). These genetic loci represent the best evidence of genetic influences on SBP and DBP in AAs to date. More broadly, this work supports that notion that blood pressure among AAs is a trait with genetic underpinnings but also with significant complexity.
doi:10.1093/hmg/ddr092
PMCID: PMC3090190  PMID: 21378095
16.  Psychometric Testing of the Daily Spiritual Experiences Scale Among African Americans in the Jackson Heart Study 
Journal of religion and health  2009;50(3):675-685.
This study provided the first examination of the psychometric properties of the 6-item Daily Spiritual Experiences Scale (DSES) in a large African American sample, the Jackson Heart Study (JHS). The JHS included measures of spiritual (DSES) and religious practices. Internal reliability, dimensionality, fit indices, and correlation were assessed. DSES scores reflected frequent daily spiritual experiences (12.84 ± 4.72) and reliability scores were high (α = 0.85; 95% CI 0.84–0.86). The DSES loaded on a single factor, with significant goodness-of-fit scores (RMSEA = 0.094, P < 0.01). Moderate significant correlations were noted among DSES items. Our findings confirm that the 6-item DSES had excellent psychometric properties in this sample.
doi:10.1007/s10943-009-9278-2
PMCID: PMC2888881  PMID: 19693673
Daily Spiritual Experiences Scale; Spirituality; Psychometrics; African American; Jackson Heart Study
17.  Methods for Retrospective Geocoding in Population Studies: The Jackson Heart Study 
The increasing use of geographic information systems (GIS) in epidemiological population studies requires careful attention to the methods employed in accomplishing geocoding and creating a GIS. Studies have provided limited details, hampering the ability to assess validity of spatial data. The purpose of this paper is to describe the multiphase geocoding methods used to retrospectively create a GIS in the Jackson Heart Study (JHS). We used baseline data from 5,302 participants enrolled in the JHS between 2000 and 2004 in a multiphase process to accomplish geocoding 2 years after participant enrollment. After initial deletion of ungeocodable addresses (n = 52), 96% were geocoded using ArcGIS. An interactive method using data abstraction from participant records, use of additional maps and street reference files, and verification of existence of address, yielded successful geocoding of all but 13 addresses. Overall, nearly 99% (n = 5,237) of the JHS cohort was geocoded retrospectively using the multiple strategies for improving and locating geocodable addresses. Geocoding validation procedures revealed highly accurate and reliable geographic data. Using the methods and protocol developed provided a reliable spatial database that can be used for further investigation of spatial epidemiology. Baseline results were used to describe participants by select geographic indicators, including residence in urban or rural areas, as well as to validate the effectiveness of the study’s sampling plan. Further, our results indicate that retrospectively developing a reliable GIS for a large, epidemiological study is feasible. This paper describes some of the challenges in retrospectively creating a GIS and provides practical tips that enhanced the success.
doi:10.1007/s11524-009-9403-2
PMCID: PMC2821611  PMID: 20187277
African Americans; Jackson Heart Study; Cohort studies; Geocoding; Geographic information systems; Spatial distribution
18.  Employment Status, Coronary Heart Disease, and Stroke among Women 
Annals of epidemiology  2009;19(9):630-636.
Purpose
To investigate the association of employment status with CHD and ischemic stroke among middle-aged women.
Methods
Proportional hazards regression was used to assess the association of employment status, incident CHD, and incident ischemic stroke among 7,058 women, aged 45-64 years at baseline (1987-89), from the Atherosclerosis Risk in Communities Study.
Results
After adjusting for age and race-field center, women employed outside the home had a decreased risk of CHD (hazard ratio (HR) =0.70, 95% confidence interval (95% CI) =0.56, 0.86) and ischemic stroke (HR=0.62, 95% CI=0.47, 0.84) compared to homemakers. Differences in cardiovascular disease risk factors partially accounted for the association of employment status and CHD (HR=0.79, 95% CI=0.63, 0.99) and stroke (HR=0.79, 95% CI=0.58, 1.08). Also, modest differences were noted when the results were stratified by education, with employed women having a lower risk of CHD (HR=0.65, 95% CI=0.45, 0.93) than homemakers among those with less than a high school education.
Conclusions
Women employed outside of the home had a lower risk of CHD and stroke compared to homemakers and for CHD, this association was stronger among women with less than a high school education. These findings suggest additional research into the varied occupational experiences of women, socioeconomic status, and health is warranted.
doi:10.1016/j.annepidem.2009.04.008
PMCID: PMC2725197  PMID: 19596203
women; employment; coronary disease; stroke; socioeconomic status
19.  Social Environmental Stressors, Psychological Factors, and Kidney Disease 
Kidney disease is one of the most striking examples of health disparities in American public health. Disparities in the prevalence and progression of kidney disease are generally thought to be a function of group differences in the prevalence of kidney disease risk factors such as diabetes, hypertension, and obesity. However, the presence of these comorbidities does not completely explain the elevated rate of progression from chronic kidney disease (CKD) to end-stage renal disease among high-risk populations such as African Americans. We believe that the social environment is an important element in the pathway from CKD risk factors to CKD and end-stage renal disease. This review of the literature draws heavily from social science and social epidemiology to present a conceptual frame specifying how social, economic, and psychosocial factors interact to affect the risks for and the progression of kidney disease.
doi:10.231/JIM.0b013e31819dbb91
PMCID: PMC2824501  PMID: 19240646
psychosocial factors; socioeconomic factors; environmental factors; end-stage renal disease; chronic kidney disease
20.  Prevalence and Awareness of CKD Among African Americans: The Jackson Heart Study 
Background
Chronic kidney disease (CKD) leads to End Stage Renal Disease (ESRD) and is a growing epidemic throughout the world. In the United States, African Americans have an incidence of ESRD four times that of Whites.
Study Design
Cross Sectional to examine the prevalence and awareness of CKD in African Americans
Setting & Participants
Observational Cohort in the Jackson Heart Study (JHS)
Predictor
CKD was defined as estimated glomerular filtration rate < 60 ml/min/1.73 m2, presence of albuminuria, or being on dialysis
Outcomes and Measurements
Data from the Jackson Heart Study (JHS) were analyzed. Medical history including disease awareness and drug therapy, anthropometric measurements, serum, and urine samples were obtained from JHS participants at the baseline visit. Associations between CKD prevalence and awareness and selected demographic, socioeconomic, healthcare access, and disease status parameters were assessed utilizing logistic regression models.
Results
The prevalence of CKD in the JHS was 20%; CKD awareness was only 15.8%. Older participants had higher prevalence but were also more aware of CKD. Hypertension, diabetes, cardiovascular disease (CVD), hypercholesterolemia, hypertriglyceridemia, increasing age and waist circumference as well as being single or less physically active were associated with CKD. Only advancing of CKD stage was associated with awareness.
Limitations
Cross-sectional assessment, single urine measurement
Conclusions
The JHS has a high prevalence and low awareness of CKD, especially those with less severe disease status. This emphasizes the need for earlier diagnosis and increased education of health care providers and the general population.
doi:10.1053/j.ajkd.2008.08.035
PMCID: PMC2668959  PMID: 19166799
renal insufficiency; proteinuria; African American; chronic disease; epidemiology; population
21.  DEVELOPMENT AND PSYCHOMETRIC TESTING OF A MULTIDIMENSIONAL INSTRUMENT OF PERCEIVED DISCRIMINATION AMONG AFRICAN AMERICANS IN THE JACKSON HEART STUDY 
Ethnicity & disease  2009;19(1):56-64.
Objective
Assessing the discrimination-health disparities hypothesis requires psychometrically sound, multidimensional measures of discrimination. Among the available discrimination measures, few are multidimensional and none have adequate psychometric testing in a large, African American sample. We report the development and psychometric testing of the multidimensional Jackson Heart Study Discrimination (JHSDIS) Instrument.
Methods
A multidimensional measure assessing the occurrence, frequency, attribution, and coping responses to perceived everyday and lifetime discrimination; lifetime burden of discrimination; and effect of skin color was developed and tested in the 5302-member cohort of the Jackson Heart Study. Internal consistency was calculated by using Cronbach α. coefficient. Confirmatory factor analysis established the dimensions, and intercorrelation coefficients assessed the discriminant validity of the instrument.
Setting
Tri-county area of the Jackson, MS metropolitan statistical area.
Results
The JHSDIS was psychometrically sound (overall α=.78, .84 and .77, respectively, for the everyday and lifetime subscales). Confirmatory factor analysis yielded 11 factors, which confirmed the a priori dimensions represented.
Conclusions
The JHSDIS combined three scales into a single multidimensional instrument with good psychometric properties in a large sample of African Americans. This analysis lays the foundation for using this instrument in research that will examine the association between perceived discrimination and CVD among African Americans.
PMCID: PMC2724869  PMID: 19341164
Discrimination; Racism; Jackson Heart Study; African American; Cardiovascular Disease

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