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In most doctors’ offices these days, you’ll find a pattern: Everybody’s Googling, all the time. Physicians search for clues to a diagnosis, or for reminders on the best treatment plans. Patients scour WebMD, tapping in their symptoms and doomscrolling a long list of possible problems.  

But those constant searches leave something to be desired. Doctors don’t have the time to sift through pages of results, and patients don’t have the knowledge to digest medical research. Everybody has trouble finding the most reliable information.  

Optimists believe artificial intelligence could help solve those problems, but the bots might not be ready for prime time. In a recent paper, Dr. Gary Franklin, a University of Washington research professor of environmental & occupational health sciences and of neurology in the UW School of Medicine, described a troubling experience with Google’s Gemini chatbot. When Franklin asked Gemini for information on the outcomes of a specific procedure – a decompressive brachial plexus surgery – the bot gave a detailed answer that cited two medical studies, neither of which existed.  

Franklin wrote that it’s “buyer beware when it comes to using AI Chatbots for the purposes of extracting accurate scientific information or evidence-based guidance.” He recommended that AI experts develop specialized chatbots that pull information only from verified sources.  

One expert working toward a solution is Lucy Lu Wang, a UW assistant professor in the Information School who focuses on making AI better at understanding and relaying scientific information. Wang has developed tools to extract important information from medical research papers, verify scientific claims, and make scientific images accessible to blind and low-vision readers. 

UW News sat down with Franklin and Wang to discuss how AI could enhance health care, what’s standing in the way, and whether there’s a downside to democratizing medical research.  

Each of you has studied the possibilities and perils of AI in health care, including the experiences of patients who ask chatbots for medical information. In a best-case scenario, how do you envision AI being used in health and medicine? 

Gary Franklin: Doctors use Google a lot, but they also rely on services like UpToDate, which provide really great summaries of medical information and research. Most doctors have zero time and just want to be able to read something very quickly that is well documented. So from a physician’s perspective trying to find truthful answers, trying to make my practice more efficient, trying to coordinate things better — if this technology could meaningfully contribute to any of those things, then it would be unbelievably great. 

I’m not sure how much doctors will use AI, but for many years, patients have been coming in with questions about what they found on the internet, like on WebMD. AI is just the next step of patients doing this, getting some guidance about what to do with the advice they’re getting. As an example, if a patient sees a surgeon who’s overly aggressive and says they need a big procedure, the patient could ask an AI tool what the broader literature might recommend. And I have concerns about that. 

Lucy Lu Wang: I’ll take this question from the clinician’s perspective, and then from the patient’s perspective.  

From the clinician’s perspective, I agree with what Gary said. Clinicians want to look up information very quickly because they’re so taxed and there’s limited time to treat patients. And you can imagine if the tools that we have, these chatbots, were actually very good at searching for information and very good at citing accurately, that they could become a better replacement for a type of tool like UpToDate, right? Because UpToDate is good, it’s human-curated, but it doesn’t always contain the most fine-grained information you might be looking for. 

These tools could also potentially help clinicians with patient communication, because there’s not always enough time to follow up or explain things in a way that patients can understand. It’s an add-on part of the job for clinicians, and that’s where I think language models and these tools, in an ideal world, could be really beneficial. 

Lastly, on the patient’s side, it would be really amazing to develop these tools that help with patient education and help increase the overall health literacy of the population, beyond what WebMD or Google does. These tools could engage patients with their own health and health care more than before.  

Zooming out from the individual to the systemic, do you see any ways AI could make health systems as a whole function more smoothly? 

GF: One thing I’m curious about is whether these tools can be used to help with coordination across the health care system and between physicians. It’s horrible. There was a book called “Crossing the Quality Chasm” that argued the main problem in American medicine is poor coordination across specialties, or between primary care and anybody else. It’s still horrible, because there’s no function in the medical field that actually does that. So that’s another question: Is there a role here for this kind of technology in coordinating health care? 

LLW: There’s been a lot of work on tools that can summarize a patient’s medical history in their clinical notes, and that could be one way to perform this kind of communication between specialties. There’s another component, too: If patients can directly interact with the system, we can construct a better timeline of the patient’s experiences and how that relates to their clinical medical care. 

We’ve done qualitative research with health care seekers that suggests there are lots of types of questions that people are less willing to ask their clinical provider, but much more willing to put into one of these models. So the models themselves are potentially addressing unmet needs that patients aren’t willing to directly share with their doctors. 

What’s standing in the way of these best-case scenarios?  

LLW: I think there are both technical challenges and socio-technical challenges. In terms of technical challenges, a lot of these models’ training doesn’t currently make them effective for tasks like scientific search and summarization.  

First, these current chatbots are mostly trained to be general-purpose tools, so they’re meant to be OK at everything, but not great at anything. And I think there will be more targeted development towards these more specific tasks, things like scientific search with citations that Gary mentioned before. The current training methods tend to produce models that are instruction-following, and have a very large positive response bias in their outputs. That can lead to things like generating answers with citations that support the answer, even if those citations don’t exist in the real world. These models are also trained to be overconfident in their responses. If the way the model communicates is positive and overconfident, then it’s going to lead to lots of problems in a domain like health care.  

And then, of course, there’s socio-technical problems, like, maybe these models should be developed with the specific goal of supporting scientific search. People are, in fact, working toward these things and have demonstrated good preliminary results. 

GF: So are the folks in your field pretty confident that that can be overcome in a fairly short time? 

LLW: I think the citation problem has already been overcome in research demonstration cases. If we, for example, hook up an LLM to PubMed search and allow it only to cite conclusions based on articles that are indexed in PubMed, then actually the models are very faithful to citations that are retrieved from that search engine. But if you use Gemini and ChatGPT, those are not always hooked up to those research databases.  

GF: The problem is that a person trying to search using those tools doesn’t know that. 

LLW: Right, that’s a problem. People tend to trust these things because, as an example, we now have AI-generated answers at the top of Google search, and people have historically trusted Google search to only index documents that people have written, maybe putting the ones that are more trustworthy at the top. But that AI-generated response can be full of misinformation. What’s happening is that some people are losing trust in traditional search as a consequence. It’s going to be hard to build back that trust, even if we improve the technology. 

We’re really at the beginning of this technology. It took a long time for us to develop meaningful resources on the internet — things like Wikipedia or PubMed. Right now, these chatbots are general-purpose tools, but there are already starting to be mixtures of models underneath. And in the future, they’re going to get better at routing people’s queries to the correct expert models, whether that’s to the model hooked up to PubMed or to trusted documents published by various associates related to health care. And I think that’s likely where we’re headed in the next couple of years.  

Trust and reliability issues aside, are there any potential downsides to deploying these tools widely? I can see a potential problem with people using chatbots to self-diagnose when it might be preferable to see a provider. 

LLW: You think of a resource like WebMD: Was that a net positive or net negative? Before its existence, patients really did have a hard time finding any information at all. And of course, there’s limited face time with clinicians where people actually get to ask those questions. So for every patient who wrongly self-diagnoses on WebMD, there are probably also hundreds of patients who found a quick answer to a question. I think that with these models, it’s going to be similar. They’re going to help address some of the gaps in clinical care where we don’t currently have enough resources.  

For more information or to reach the researchers, email Alden Woods at acwoods@uw.edu. 

When University of Washington President Ana Mari Cauce launched the Population Health Initiative in 2016, she spoke in soaring, ambitious terms. “We have an unprecedented opportunity to help people live longer, healthier, more productive lives – here and around the world,” she said. UW researchers have leapt at that opportunity, forging connections across the university, working side by side with community partners and breaking down traditional barriers to improving public health.  

In just eight years, the Initiative has funded 227 innovative, interdisciplinary projects. Many are focused right here in Western Washington, where projects have helped improve transportation accessibility in South Seattle, identified soil contaminants in community gardens in the Duwamish Valley, and improved how community leaders along the Okanogan River communicate the public health risks of wildfire smoke. Other projects have reached across the globe, targeting health disparities in Somalia, Peru, Brazil and more.  

“In this relatively short period of time, we’ve demonstrated the power that accrues when faculty and staff across the various areas of our campuses are working together and also exposing students to the cutting-edge work of tackling grand challenges,” Cauce said in her most recent campus address. 

And they’re just getting started. Many PHI-funded projects are still in their earliest stages, leveraging initial funding to show proof-of-concept for their ideas and setting the stage for future work. Fourteen projects so far have received much larger grants to empower researchers and community partners to expand successful projects and scale up for greater impact. 

With the Initiative now a third of the way into its 25-year vision, UW News checked in with three projects that recently received funding to scale their efforts. 

Spotting potential memory health issues in rural Washington

Diagnosing memory health issues in the best of circumstances is extraordinarily difficult. Patients typically make multiple visits to their doctor and take a rash of tests, many of which can produce flawed results — people who take the same test more than once, for example, will often score higher, potentially masking memory loss.  

It’s even harder in rural America, which has a severe shortage of neurologists. Patients seeking memory care might have to make a long, expensive trip to a major city, which leads many people to wait until a problem becomes apparent. By then, it’s often too late — modern treatments can slow the progress of memory loss, but there’s no way to regain what’s been lost. 

“So, how do you catch it early?” said Andrea Stocco, a UW associate professor of psychology. “We give people an app to have them check for themselves.”  

Stocco and Dr. Thomas Grabowski, director of the UW Alzheimer’s Disease Research Center, together with Hedderik van Rijn of the University of Groningen in the Netherlands, led the development of an online program that can measure a person’s memory and predict their risk of memory disorders. Like a flash-card app that helps students cram for a test, the program shows pictures and asks the user to recall what they saw a few minutes earlier. The app records how quickly and accurately the user responds to each question and makes the next one a little easier or more difficult.  

Researchers have long understood that a person’s ability to recall a specific memory tends to fade over time. This is called the “forgetting curve.” In previous work, Stocco and van Rijn found that they could measure individual differences in the slopes of such curves.  The app works by comparing a person’s responses to an internal model of forgetting and adjusting the slope of the model until it matches the responses. The resulting slope can be used to estimate the likelihood that their memory is fading faster than normal.  

By taking the test regularly, a person can track their memory’s decline over time. But preliminary tests, Stocco said, have shown that even a single use can spot a potential problem. 

“Just by looking at a single lesson, based on the result, there’s almost a perfect correspondence between the speed of forgetting and your probability of being diagnosed by a doctor,” Stocco said. “It can be as accurate as the best clinical tests but, instead of taking two or three hours, this can be done in eight minutes, and you don’t need a doctor.” 

A Tier 3 grant from the Population Health Initiative and a collaboration with the Central Washington Area Health Education Center will allow the researchers to share the app with up to 500 people in rural Chelan and Douglas counties. Participants can take the test on their own time, and the results will be shared with researchers. If a potential problem emerges, the researchers plan to invite participants to Seattle for an in-person evaluation.  

“It’s a solution that seems to solve these problems of early access and diagnostic bottlenecks,” Stocco said. “If this works, there’s no problem giving it to everybody in the state. We’re really interested in expanding and adding people from underrepresented populations and underrepresented areas, and the grant will allow us to do that.” 

Nancy Spurgeon of the Central Washington Area Health Education Center is also a collaborator on the project to test the prototype app, which is not yet available to the public. 

Revamping the Point-In-Time Count to better understand King County’s unhoused population 

For years, volunteers fanned across King County on a cold night each January, flashlights and clipboards in hand, searching for people sleeping outside. They’d also gather the shelter head counts for that night. Officially called the Point-In-Time Count, this effort attempted to tally the number of people who lacked stable housing. This endeavor was replicated in cities across the country, and the results were combined to create a national count that influences how the federal government allocates funding. 

There’s just one problem – the count is notoriously inaccurate. Volunteers can’t possibly find everybody. It captures only a single moment in time, and collects only limited data on people’s circumstances or personal needs. A person sleeping in their car might need different services than a person who sleeps in a tent, and the count didn’t fully capture that distinction. 

So, a team of UW researchers designed a better way to count. Their method, detailed in a paper published Sept. 4 in in the American Journal of Epidemiology, taps into people’s social networks to generate a more representative sample, which the researchers then ran through a series of calculations to estimate the total unhoused population.   

Called “respondent-driven sampling,” the method stations volunteers in common “hubs,” like libraries or community centers, and offers cash gift cards for in-person interviews and peer referrals. Volunteers collect detailed information on people’s circumstances and needs, giving each person three tickets to share with their unhoused peers. When those peers come in for an interview and show the ticket, the person who referred them receives another small reward. The new person gets a gift card and another three tickets. 

“This method gives people a more active voice in being counted. It’s a more humane way to count people, and it’s also voluntary,” said Zack Almquist, a UW associate professor of sociology and co-lead on the project. “The regular PIT (Point-In-Time) count just counted people. Now we can collect all sorts of information from people on their circumstances and their needs. Should policymakers want to, they could leverage that data to change service offerings.” 

The researchers received a Tier 2 grant to develop the system. They launched it in partnership with King County in 2022 and 2024, and were recently awarded a Tier 3 grant to test out the feasibility of running it quarterly.  

“Running the count quarterly allows us to estimate how many people move in and out of homelessness and whether there are seasonal changes, which are rarely measured,” Almquist said. “Also, people’s needs change depending on the time of year, and this method will help us better understand those rhythms.”  

Other cities and counties have expressed interest, the researchers said. The team has also begun to expand the effort, aiming to improve data across the broad spectrum of housing and homelessness services.  

“A very important byproduct of this work across schools and departments at UW is that we can create an ecosystem of people and projects,” said Amy Hagopian, a UW professor emeritus of health systems and population health and co-lead on the project. “We’ve spun off projects on sleep assessments, relationships with organizations that collect data on homelessness, and we’re mapping the sweeps of encampments in relationship to where people choose to be located. We have a whole network of homelessness-related research now. 

“These PHI grants gave us the fuel to ignite these projects.” 

Other collaborators are Paul Hebert of the UW Department of Health Systems and Population Health and of the VA Health Services Research and Development; Tyler McCormick of the UW Departments of Sociology and Statistics; Junhe Yang of the Center for Studies in Demography & Ecology and the eScience Institute; and Owen Kajfasz, Janelle Rothfolk and Cathea Carey of the King County Regional Homelessness Authority. 

Engaging community to mitigate flood risk in the Duwamish Valley 

More than a century ago, Seattle leaders set out to control and redirect the Duwamish River. They dredged the riverbed and dug out its twists and turns. Wetlands were filled in, the valley was paved over and a system of hydrology was severed. What had been a wild, winding river valley with regular flooding became an angular straightaway built for industry. But when UW postdoctoral scholar Maja Jeranko looks out at the Duwamish, she sees the river fighting back.  

“The water was always there,” Jeranko said, “and now it’s fighting to come back up.”  

The river returned with devastating effect in December 2022, when a king tide and heavy rainfall flooded the South Park neighborhood, submerging homes and shuttering local businesses. The underserved neighborhood faces a significant risk of future floods. 

To mitigate that risk, the City of Seattle has updated the neighborhood’s stormwater drainage system and launched a new flood-warning system. But the Duwamish River Community Coalition, a nonprofit focused on river pollution and environmental health, saw an opportunity for something greater. The DRCC asked a team of UW researchers to help develop flood adaptation plans that are community-based, culturally responsive and that enrich the local environment.  

“In the community, people don’t think there’s been enough engagement. There’s all this talk about flood mitigation, but all they see are sandbags,” Jeranko said. “So DRCC was like, ‘Look, we really need the people who live in the flood zone to understand the solutions.’ Because we have this long-lasting relationship with them, they see us as someone who’s able to provide a list of solutions, not favor one over the others, and do it in an informative way.” 

Boosted by a Tier 3 grant from the PHI, Jeranko and a team representing five UW departments, the Burke Museum and the DRCC are engaging with the community. This fall, the team will present the neighborhood with an expansive list of flood mitigation options and encourage city leaders to consider people’s preferences. Early work shows the community would favor nature-based solutions, Jeranko said. Floodable parks, for example, would provide ecological, recreational and public health benefits to the entire community, while storing flood water during storms.  

“It has been wonderful to collaborate with the UW team on this to make sure we are centering community voices in every single step of the planning for climate resilience,” said Paulina López, executive director of the DRCC. “Community leadership and representation is indispensable to bring climate justice to the Duwamish Valley.” 

Jeranko hopes their community-based model will be replicated by communities across the country facing similar risks from climate change and sea level rise. 

“Even though UW and a lot of other universities really support and invest in community-engaged work, a lot of times it’s fundamentally hard to make that research happen,” Jeranko said. “But the Population Health Initiative grant was about supporting all those things.” 

Other collaborators on the project are Nicole Errett, BJ Cummings, Katelin Teigen and Juliette Randazza of the Department of Environmental & Occupational Health Sciences; Celina Balderas Guzman of the Department of Landscape Architecture; Bethany Gordon of the Department of Civil & Environmental Engineering, Sameer Shah of the School of Environmental and Forest Sciences; Amir Sheikh of the Quaternary Research Center and the Burke Museum; and López and Robin Schwartz of the DRCC. 

For more information on any of the projects mentioned, or to learn more about the UW Population Health Initiative, visit the Initiative’s website or contact Alden Woods at acwoods@uw.edu.  

Twelve years after Washington and Colorado became the first states to legalize recreational marijuana, it’s safe to say that weed is here to stay. Nearly 30% of Washington adults report using cannabis in the last month, and a majority of Americans believe marijuana products are safe.  

When it comes to the safety of long-term marijuana use among the general population, the jury’s still out. But there are some groups for whom cannabis poses a serious health risk. Among the most vulnerable are young adults with psychosis, who tend to use cannabis at extremely high rates, and whose symptoms can be exacerbated by long-term marijuana use. A team of University of Washington researchers is focused on this particular group. 

To effectively treat these patients’ symptoms and improve long-term outcomes, it’s critical for providers to help young adults stop using marijuana as quickly as possible after their first psychotic episode. But that’s proven tricky. Current best practices aren’t always effective for young adults with psychosis, who tend to use cannabis for different reasons than their peers and who may feel different effects. 

That leaves mental health care providers with a difficult problem: How can they best discern why their patients use cannabis, and what’s the best way to help them stop?  

UW researchers Denise Walker and Ryan Petros, from the School of Social Work, and Maria Monroe-DeVita, an associate professor in department of psychiatry and behavioral sciences in the UW School of Medicine, studied motivations among this group and then developed a novel treatment method. A pilot study of 12 people showed the method to be effective, though final results have yet to be published. UW News sat down with the research team to discuss their intervention and why it’s so important to help young people in this group cut down their use. 

Cannabis use is increasing across the board, but the numbers are staggeringly high among young adults with psychosis – you cite statistics estimating that 60-80% have used cannabis at some point in their lifetime. What makes a person experiencing psychosis so much more likely to use cannabis?  

Denise Walker: Many people were probably using cannabis before the onset of their psychosis symptoms, because there is strong research evidence that cannabis increases the risk for developing psychosis-related disorders. For those who do develop a psychosis-related disorder like schizophrenia, continued cannabis use impedes the recovery process and makes outcomes worse. There is still a lot more to learn about the cause and effect of these relationships, but cannabis does seem to have a unique relationship with psychosis. 

Ryan Petros: In addition, there is some evidence to suggest that people with schizophrenia are more prone to feeling bored than people without schizophrenia. In general, a lot of people use cannabis because they like it, and they find the associated high to be fun. It may be that people with schizophrenia-spectrum disorders are more likely to use cannabis to have fun and feel good because they are more likely to feel bored and less likely to feel pleasure in everyday activities. But the fact of the matter is, we don’t really know. Another reason that people use cannabis, in general, is because it facilitates social interactions or provides a shared activity in social settings. Because people with schizophrenia-spectrum disorders have smaller social networks and fewer social engagements, it may be that they use cannabis to facilitate improved social interaction, but here again, we need more research to know with more certainty. 

At the heart of all this research is the different health risks of cannabis use for people with and without psychosis or other mental health challenges. What are those differences, and why is cannabis use among young adults with psychosis particularly concerning? 

RP: For people with a psychosis, cannabis use is associated with higher rates of dropping from treatment and decreased adherence to medication. It leads to increased symptoms of psychosis and higher rates of psychiatric rehospitalization. In the long –term, cannabis use increases the risk of poor psychosocial outcomes and diminished overall functioning. 

DW: Essentially, continued cannabis use makes it much harder for young adults with psychosis to take advantage of treatment, make strides in their recovery and, ultimately, get on with having the life they want. 

RP: Another major reason for concern is that not only is cannabis use on the rise, people also have progressively adopted more tolerant attitudes toward cannabis. Cannabis has recently overtaken alcohol as the drug most often used on a daily basis in the United States. While some people can use cannabis without a problem, it’s recommended that some others abstain from using at all.  Over time, however, people have come to believe that cannabis use has health benefits, and they are less likely to perceive risks of use. This may result in a particularly challenging set of circumstances for helping someone with psychosis to learn about the real risks that cannabis use has for their health and wellness and to make the choice to reduce or abstain from use. 

DW: I agree. Perceptions surrounding cannabis are often polarized – it is often viewed as either “good” or “bad,” when in reality, it’s somewhere in the middle. There can be benefits for some to use cannabis and real risks of harm for others. These mixed messages, or at least the lack of acknowledgement of harms, contribute to continued hardship for those experiencing psychosis and their families. 

What methods are currently recommended to help people reduce their cannabis use, and why might those not be as effective for young adults with psychosis?  

DW: The gold standard treatment includes a combination of motivational enhancement therapy (MET), cognitive behavioral therapy (CBT), and contingency management. Contingency management is often not available in the community, and studies show that MET plus CBT perform almost as well. Because it is normal for motivation to wax and wane for someone contemplating changing their cannabis use, MET addresses the issue of motivation early on. CBT teaches skills to avoid drug use, cope with social situations and negative moods, and solve problems without the use of cannabis. Family therapy is another option with strong support.  

The big problem is that we don’t know if these treatments are effective for young adults with psychosis.  MET is the most studied intervention in cannabis treatment, alone and in combination; however, it has not been tested with young adults with psychosis.  With a few optimizations, we believe that it could perform even better than with the general population, and we have begun to test it with young adults with psychosis. 

Your team has developed an intervention for young adults with psychosis that incorporates MET. Can you describe what that intervention looks like, and why it might be more effective for this population?  

DW: MET is a person-centered, nonjudgmental approach that facilitates an honest and candid discussion about cannabis use. The techniques are intended to draw out the individuals’ personal reasons for making a change and to grow their motivation to do so. Individualized feedback is created based on a client’s responses to an assessment of their cannabis use and related experiences and summarizes information about their cannabis use patterns, how their cannabis use compares with others, and their risk factors for developing a cannabis use disorder. It also provides an opportunity for clients to think about their personal goals and how their cannabis use promotes or detracts from their ability to attain those goals.  

When we asked young adults with psychosis what they wanted in a cannabis intervention, they were clear that they wanted an individualized and nonjudgmental approach. They also said they wanted accurate and science-based information about the relationship between cannabis and psychosis. MET ticks those boxes. With a few adaptations, it is an ideal format for providing objective information, while also inviting the young adult to talk it through and consider what the information means to them personally. 

Currently, providers are giving the message to patients that cannabis is harmful for those with psychosis, which is a great start.  But most providers don’t feel confident discussing why cannabis is harmful and what the research has found.  My sense is that patients often take that message and defend against it with their own personal experiences of what they like about cannabis. MET offers an invitation to receive and discuss objective evidence, consider their own experiences of how cannabis affects their symptoms and what they want for their future, and do so in a supportive environment that allows for looking at their use from a variety of perspectives.   

You ran a pilot program to understand how the new intervention works. What did you learn in that pilot study?  

DW: We adapted the MET intervention to include personalized feedback on the interaction between cannabis and psychosis and included some graphics and ideas about ways to reduce those risks in addition to abstinence. Twelve young adults experiencing psychosis who used cannabis regularly enrolled in the study and were offered the intervention. Most of the participants were not interested in changing their use of cannabis at the outset of the study, and by the end, several chose to reduce their cannabis use. 

Overall, the feedback was very positive. Participants overwhelmingly said they would recommend the intervention and would retain the psychosis specific pieces of the conversation. They appreciated the data that was included and the opportunity to discuss what it meant for them. They also said they enjoyed talking about how cannabis fits into their larger life and goals for the future. Overall, the feedback suggests this intervention has promise and should be studied in a larger trial. 

Maria Monroe-DeVita: My long-term goal would be to offer this new intervention either in addition to, or integrated within, the evidence-based package of services known to work best for individuals experiencing first episode psychosis. 

Denise Walker is a research professor in the UW School of Social Work, Ryan Petros is an associate professor in the UW School of Social Work, and Maria Monroe-DeVita is an associate professor of psychiatry and behavioral sciences in the UW School of Medicine.  

For more information or to reach the researchers, contact Alden Woods at acwoods@uw.edu. 

UPDATE (Aug. 2, 2024): A previous version of this story misstated Paul Kinahan’s name.

Fifteen faculty members at the University of Washington have been elected to the Washington State Academy of Sciences. They are among 36 scientists and educators from across the state announced Aug. 1 as new members. Selection recognizes the new members’ “outstanding record of scientific and technical achievement, and their willingness to work on behalf of the academy to bring the best available science to bear on issues within the state of Washington.”

Twelve UW faculty members were selected by current WSAS members. They are:

• Wendy Barrington, associate professor of epidemiology, of health systems and population health, and of child, family and population health nursing, who “possesses the rare combination of scientific rigor and courageous commitment to local community health. Identifying original ways to examine questions, and seeking out appropriate scientific methods to study those questions, allow her to translate research to collaborative community interventions with a direct impact on the health of communities.”
• Philip Bell, the Shauna C. Larson endowed chair in learning sciences, for “his work in the cultural basis of scientific research and learning, bringing rigor and light to multiculturalism in science and STEM education through STEM Teaching Tools and other programs.”
• Katherine Comtois, professor of psychiatry and behavioral sciences, “for her sustained commitment to community-engaged, science-driven practice and policy change related to the prevention of suicide and the promotion of mental health, with a focus on providing effective, sustainable and culturally appropriate care to people with serious mental illness.”
• Valerie Daggett, the David and Nancy Auth endowed professor in bioengineering, who has “charted new paths for 30-plus years. Her quest to deeply understand protein folding/unfolding and the link to amyloid diseases has propelled her to pioneer unique computational and experimental methods leading to the discovery and characterization of a new protein structure linked to toxicity early in amyloidogenesis.”
• Jeremy Hess, professor of environmental and occupational health sciences, of global health, and of emergency medicine, who is “a global and national leader at the intersection of climate change and health whose work has advanced our understanding of climate change health effects and has informed the design of preparedness and disaster response planning in Washington state, nationally and globally.”
• Paul Kinahan, professor of bioengineering and of radiology, who is “recognized for his contributions to the science and engineering of medical imaging systems and for leadership in national programs and professional and scientific societies advancing the capabilities of medical imaging.”
• Daniel Kirschen, the Donald W. and Ruth Mary Close professor of electrical and computer engineering and faculty member in the UW Clean Energy Institute, who is “recognized for his distinguished research contributions to the design and operation of economical, reliable and environmentally sustainable power systems, and the development of influential educational materials used to train the next generation of power engineers.”
• Juliana McElrath, senior vice president and director of the Vaccine and Infectious Disease Division at the Fred Hutchinson Cancer Center, the Joel D. Meyers endowed chair of clinical research and of vaccine and infectious disease at Fred Hutch, and UW professor of medicine, who is “is recognized for her seminal contributions to developing validated laboratory methods for interrogating cellular and humoral immune responses to HIV, TB and COVID-19 vaccines, which has led to the analysis of more than 100 vaccine and monoclonal antibody trials for nearly three decades, including evidence of T-cell immune responses as a correlate of vaccine protection.”
• Aseem Prakash, professor of political science and the Walker family professor for the arts and sciences, who is a specialist “in environmental politics, international political economy, and the politics of nonprofit organizations. He is widely recognized as a leader in the field of environmental politics, best known for his path-breaking research on the role firms and nongovernmental organizations can play in promoting more stringent regulatory standards.”
• Michael Spencer, the Ballmer endowed dean of social work, for investigations of “how inequality, in its many forms, affects health, illness and quality of life. He has developed unique conceptual frameworks to investigate how race, ethnicity and immigration are associated with health and social outcomes.”
• Stefan Stoll, professor of chemistry, who is elected “for distinguished scientific and community contributions to advancing the field of electron paramagnetic resonance spectroscopy, which have transformed how researchers worldwide analyze data.”
• Ruikang Wang, professor of bioengineering and of ophthalmology, whose “pioneering work in biomedical optics, including the invention of optical microangiography and development of novel imaging technologies, has transformed clinical practice, significantly improving patient outcomes. Through his numerous publications, patents and clinical translations, his research has helped shape the field of biomedical optics.”

Three new UW members of the academy were selected by virtue of their previous election to one of the National Academies. They are:

• Qiang Fu, professor of atmospheric and climate science, who had been elected to the National Academy of Sciences “for contributions to research and expertise in atmospheric radiation and cloud processes, remote sensing, cloud/aerosol/radiation/climate interactions, stratospheric circulation and stratosphere-troposphere exchanges and coupling, and climate change.”
• Ali Rowhani-Rahbar, the Bartley Dobb professor for the study and prevention of violence in the Department of Epidemiology and a UW professor of pediatrics, who had been elected to the National Academy of Medicine “for being a national public health leader whose innovative and multidisciplinary research to integrate data across the health care system and criminal legal system has deepened our understanding of the risk and consequences of firearm-related harm and informed policies and programs to reduce its burden, especially among underserved communities and populations.”
• Tumaini Rucker Coker, division chief of general pediatrics at Seattle Children’s Hospital and a UW professor of pediatrics, who had been elected to the National Academy of Medicine “for her leadership in advancing child health equity through scholarship in community-partnered design of innovative care models in pediatric primary care. Her work has transformed our understanding of how to deliver child preventive health care during the critical early childhood period to achieve equitable health outcomes and reduce disparities.”

In addition, Dr. Thomas Lynch, president and director of the Fred Hutchinson Cancer Center and of the Cancer Consortium — a partnership between the UW, Seattle Children’s Hospital and Fred Hutch — was elected to the academy for being “part of a research effort that found mutations in the cell-surface protein epidermal growth factor receptor (EGFR), which plays an important role in helping lung cancer cells survive. Today, drugs that target EGFR can dramatically change outcomes for lung cancer patients by slowing the progression of the cancer.”

Kristi Morgansen, the Boeing-Egtvedt endowed professor and chair in aeronautics and astronautics, will join the board effective Sept. 30. Morgansen was elected to WSAS in 2021 “for significant advances in nonlinear methods for integrated sensing and control in engineered, bioinspired and biological flight systems,” and “for leadership in cross-disciplinary aerospace workforce development.” She is currently director of the Washington NASA Space Grant Consortium, co-director of the UW Space Policy and Research Center and chair of the AIAA Aerospace Department Chairs Association. She is also a member of the WSAS education committee.

“I am excited to serve on the WSAS board and work with WSAS members to leverage and grow WSAS’s impact by identifying new opportunities for WSAS to collaborate and partner with the state in addressing the state’s needs,” said Morgansen.

The new members to the Washington State Academy of Sciences will be formally inducted in September.

You know that nail salon smell? That sharp hit of chemicals, the strangely sweet scent of polish, the faint tingle in your nose? That’s air pollution, and it’s been linked to a variety of health effects experienced by the workers who breathe it. Nail salon workers commonly experience irritated skin and eyes, headaches, loss of smell and respiratory problems.  

Officials in some cities and states, including Washington, have introduced new regulations designed to better protect nail salon workers — a population that is 81% women, 79% foreign-born and typically earns low wages. 

But the mysteries around what, exactly, causes those potent smells make protecting these workers more difficult. Cosmetics manufacturers are rarely required to disclose what specific chemicals they use to scent their products, which has hindered efforts to better understand the air that salon workers breathe.  

Diana Ceballos, a UW assistant professor of environmental and occupational health sciences, set out to solve the mystery. In a study published June 19 in Atmospheric Pollution Research, Ceballos and her co-authors analyzed the air in a group of nail salons around Boston — where Ceballos previously worked at Harvard University — and identified 18 distinct fragrance chemicals. It’s the most comprehensive study to date of the specific fragrance chemical mixtures found in nail salon air, and will allow researchers to further study the potential health risks.

UW News sat down with Ceballos to discuss the findings of the study, the mysteries around fragrance chemicals and how to better protect nail salon workers’ health.  

Nail salons are a bit of a research specialty of yours. You’ve published papers on trace elements in nail polish, workers’ exposure to “old” solvents and metals as well as “new” harmful chemicals, and the presence of plasticizers in popular nail products. How did you come to focus on nail salons and their workers?  

Diana Ceballos: I started working on nail salons soon after I read a New York Times exposé back in 2015. It won all sorts of awards. When that story came out, it created havoc. I was working at the Centers for Disease Control and Prevention at the time, and the New York Health Department asked for technical assistance because they were horrified by the conditions in nail salons. I was put on the team partly because I’m an industrial hygienist, but also because I speak Spanish, and there are a lot of Spanish-speaking workers in these salons.  

Then my life changed, and I went back to academia. I just knew there was more we could be doing. There was just so little research in this area, it was incredible. So, I decided I wanted to focus on nail salons. In the meantime, a lot of other people had the same idea, so lots of different groups around the country and internationally have started working on this.  

What are fragrance chemicals, and what do we know about them?  

DC: Fragrances are added to nail salon products to create a desired smell — lotion that you want to smell like lavender, for example — but many fragrances are used to mask undesired smells. A lot of nail products have very strong, not-so-good smells, so companies add fragrances to mask those smells. But then you have even more scented chemicals in the air! 

A good number of fragrances are known sensitizers. That doesn’t only cause irritation on the skin, but, for example, some fragrances could trigger an asthma attack if inhaled. Or, if they’re a sensitizer, they could even help cause asthma and other respiratory complications. It’s not just the skin, it’s the entire immune system. And that’s just the effects that we know of. 

There are also some positive effects from fragrances. It’s well-known that some fragrances can be relaxing or affect the ambiance of an environment. But that hasn’t been well-studied. Some of these chemicals are very little-known. They could be toxic, but we don’t know. They’re just used in small amounts to produce fragrance, and for the most part, chemical regulations have been focused on bigger culprits. It’s just in the last decade or so that officials have paid attention to chemicals that show up in smaller quantities, like fragrances. 

For a very long time, fragrances were trade secrets, and specific chemicals weren’t listed as ingredients. Labels just said ‘fragrance.’ In the last 10 years, chemical regulations in Europe and in some states have introduced more discrimination of toxic chemicals that could include fragrances, but there’s a lot of work still to disclose the ingredients. For example, in the new cosmetics bill in Washington, there’s more information required on ingredients lists. That was already the case in California, for example, but it’s just starting. We aren’t the first ones to ever measure them, but to our knowledge we’ve measured the biggest number of fragrances. Also, our analysis suggests that not only nail products are contributing to fragrances, but also other products in the salons such as personal care products and cleaning agents are potential emission sources. 

Many people can identify the strong scent of a nail salon, but I’m not sure we consider that we’re actually smelling air pollution. How does that pollution affect nail salon workers?  

DC: Indoor air quality is important for anyone. The quality of our health depends on the air that we breathe. Even for a customer, nail salons are very fragrant and have many odors. Some people are very sensitive to odors. Even just talking about the odor itself can trigger a lot of health effects. People can get headaches, dizziness, and get nauseated. So, there are people that don’t go to nail salons because they can’t be in there. And that’s a customer. Imagine the workers.  

There are people who have to do this work because they don’t have training in anything else, and in surveys of the health of people who work in nail salons, it’s fairly prevalent to have headaches, irritation, fussiness — all the typical symptoms of odors, let alone toxic chemicals. It can deteriorate your well-being and quality of life, especially as some of these workers are on 12-hour shifts, seven days a week. So, it’s significant, the amount of time they’re exposed to these fragrances along with many other toxic chemicals. 

You note throughout your research that the air pollution in nail salons is something that can affect the air we all breathe — even if we never visit a salon. How is that possible? 

DC: It’s very important to lower chemical concentrations indoors because they eventually go outside and contribute to overall air pollution. It’s hard to control that in small businesses, but one thing that was clear when Boston was building a ventilation policy was that it was important to make sure businesses filtered out chemicals before they went out the window. Now we know that fragrances make up a considerable part of overall chemicals in nail salons and they’re adding to the mix. And since you have fragrances in a bunch of products, it all adds up. We must consider the accumulated burden that fragrances can have in the indoor environment and put more purposeful thought into how we produce products that contain those things — not just during the life cycle of the products, but also how they interact with the environment.  

There are policies right now that are trying to work on fragrances, but we need to learn more. It’s going to be a while before we can control or guide manufacturers better. It’s very early, but I think there’s a lot we can learn about fragrances in the future. 

Other authors on the June 19 paper are Chunrong Jia and Xianqiang Fu of the University of Memphis and Thomas Webster of Boston University.  

For more information or to reach Ceballos, contact Alden Woods at acwoods@uw.edu. 

Puntos destacados de la investigación:

• En un análisis de más de 1,300 supervivientes de ataque o derrame cerebral, se observó que las mujeres eran menos propensas que los hombres a tomar, conforme a las indicaciones dadas, medicamentos para prevenir los ataques o derrames cerebrales recurrentes, como estatinas para reducir el colesterol y medicamentos para diluir la sangre y prevenir los coágulos.
• Las mujeres mexicoamericanas fueron tres veces más propensas a informar que no tomaban los medicamentos para reducir el colesterol de acuerdo con las indicaciones en comparación con los hombres mexicoamericanos que participaron en el estudio.
• Las mujeres de mayor edad o casadas también tenían más probabilidades de omitir dosis indicadas. Los investigadores sugieren analizar estos factores para mejorar la adherencia terapéutica y prevenir los ataques o derrames cerebrales recurrentes, particularmente entre mujeres mexicoamericanas.

Prohibida su divulgación hasta las 4 a. m. CT/5 a. m. ET del miércoles, 4 de diciembre de 2024

DALLAS, 4 de diciembre de 2024 — Las mujeres que han tenido un ataque o derrame cerebral pueden ser menos propensas que los hombres a tomar medicamentos para prevenir un segundo ataque o derrame cerebral, y las mujeres mexicoamericanas informan las mayores tasas de incumplimiento terapéutico, según lo señala una nueva investigación publicada hoy en la revista profesional de la American Heart Association, una publicación con revisión por pares abierta de la American Heart Association (Asociación Americana del Corazón).

“Nuestras conclusiones señalan desigualdades preocupantes entre lo que informan los hombres y las mujeres acerca de la toma habitual de medicamentos para prevenir el ataque o derrame cerebral conforme a las indicaciones dadas, especialmente entre personas mexicoamericanas”, señaló la autora sénior del estudio, Lynda Lisabeth, Ph.D., M.P.H., FAHA, profesora de Neurología y Epidemiología en la University of Michigan de Ann Arbor. “Los médicos clínicos podrían considerar la posibilidad de analizar estos factores y discutir la importancia de no omitir dosis al indicar estos medicamentos a pacientes para ayudar a reducir su riesgo de sufrir otro ataque o derrame cerebral”.

El estudio incluyó a más de 1,300 personas adultas, de 45 años o más, que tuvieron un primer ataque o derrame cerebral isquémico (causado por un coágulo de sangre o por la acumulación de placa que bloquea el flujo sanguíneo al cerebro) entre 2008 y 2019.

Los investigadores analizaron si, 90 días después del ataque o derrame cerebral, los participantes informaban que tomaban sus medicamentos para prevenir un ataque o derrame cerebral secundario. Se consideraron cuatro tipos de medicamentos comunes para prevenir el ataque o derrame cerebral: antihipertensivos para reducir la presión arterial; estatinas para reducir el colesterol; y antiplaquetarios y anticoagulantes, dos medicamentos que reducen la formación de coágulos de sangre.

A través del análisis, se observó que, 90 días después del ataque o derrame cerebral:

• El 11.5% de los participantes informó que no tomaba sus medicamentos para prevenir el ataque o derrame cerebral de acuerdo con las indicaciones dadas.
• En la comparación entre hombres y mujeres, estas fueron más propensas a informar la omisión de dosis de medicamentos para reducir el colesterol y antiplaquetarios, pero no de medicamentos para reducir la presión arterial.
• En comparación con los hombres mexicoamericanos, las mujeres mexicoamericanas fueron tres veces más propensas a informar que no tomaban los medicamentos para reducir el colesterol de acuerdo con las indicaciones.
• Las mujeres casadas o de mayor edad también fueron más propensas que los hombres a informar que habían omitido dosis de los medicamentos recetados para prevenir el ataque o derrame cerebral.

“Nos sorprendió la magnitud de las diferencias en los comportamientos relativos a la toma de medicamentos entre hombres y mujeres, especialmente entre mujeres de origen mexicoamericano”, manifestó la coautora del estudio Chen Chen, estudiante del doctorado en Epidemiología de la University of Michigan. “Nuestro análisis revela factores potenciales que pueden estar exacerbando estas desigualdades. Por ejemplo, las mujeres en general y las mujeres mexicoamericanas en particular tienen más probabilidades de estar a cargo del cuidado de otros familiares. Como resultado, es posible que tengan menos oportunidades de priorizar y gestionar su propia salud, lo cual puede contribuir a una mayor probabilidad de falta de adherencia terapéutica”.

Los investigadores dijeron que era posible que los efectos adversos específicos de las estatinas, como el dolor y la debilidad muscular, explicaran por qué más personas informaban no tomar los medicamentos para reducir el colesterol según las indicaciones dadas.

El estudio estuvo afectado por varias limitaciones. Cada participante informó con qué frecuencia tomaba sus medicamentos; por eso, es posible que los resultados estén afectados por el sesgo de memoria. Algunos factores sociales y comportamentales no se consideraron en este estudio, como los niveles de ingresos y los motivos por los cuales los pacientes no tomaban las dosis indicadas. Por último, las personas que participaron del estudio pertenecían a una sola comunidad del sur de Texas que incluía, de manera predominante, a personas adultas blancas no hispanas y mexicoamericanas nacidas en los EE. UU.; por eso, es posible que estas conclusiones no puedan traspolarse de manera generalizada a otras poblaciones como las personas mexicoamericanas que han inmigrado a los EE. UU.

“Los resultados de este estudio mantienen una buena correspondencia con observaciones previas de bases de datos nacionales y estudios longitudinales basados en poblaciones, que mostraban una frecuencia superior de incumplimiento terapéutico para la prevención del ataque o derrame cerebral secundario en las mujeres”, afirmó Fernando D. Testai, M.D., Ph.D., FAHA, profesor de neurología y rehabilitación en la University of Illinois College of Medicine de Chicago, quien se desempeñó también como presidente de la reciente declaración científica de la asociación, Cardiac Contributions to Brain Health (Contribuciones del corazón a la salud cerebral).

“El valor incremental de este estudio radica en que analiza la adherencia durante los meses críticos posteriores a un ataque o derrame cerebral agudo, período en el cual el riesgo de experimentar un segundo ataque o derrame cerebral es mayor. Abordar factores que contribuyan a desigualdades asociadas con el sexo en la atención del ataque o derrame cerebral, particularmente en las minorías raciales y étnicas, debería ser una prioridad para una sociedad que procure eliminar las desigualdades e inequidades sociales”.

Detalles, antecedentes y diseño del estudio:

• Los datos utilizados en este análisis se obtuvieron del proyecto Brain Attack Surveillance in Corpus Christi (BASIC), que reclutó participantes del condado de Nueces, Texas.
• El estudio incluyó a 1,324 personas adultas de 45 años o más que tuvieron un primer ataque o derrame cerebral isquémico entre 2008 y 2019. Las mujeres representaron el 48.4% del total de participantes. El 58% de las personas participantes se identificaron como mexicoamericanas, el 34.3% como blancas no hispanas y el 7.7% como pertenecientes a “otra” raza/etnia.
• En una entrevista con traducción al español, se pidió a cada participante que mostrara a los entrevistadores todos los envases de los medicamentos que se les habían recetado para que tomaran en ese momento. Respecto de cada uno de los cuatro tipos de medicamentos de prevención del ataque o derrame cerebral (antihipertensivos, medicamentos para reducir el colesterol, antiplaquetarios y anticoagulantes), se preguntó a los participantes: “¿Con qué frecuencia, en una semana habitual, usted omitió una dosis indicada de este medicamento? Nunca, Rara vez, Ocasionalmente, Con frecuencia, Con mucha frecuencia, Abandoné o no completé el tratamiento, o No lo sé”.
• Los investigadores consideraron que había adhesión a cada medicamento recetado cuando las personas informaban que “Nunca” o “Rara vez” omitían una dosis en una semana habitual, y todas las demás respuestas se consideraron como falta de adhesión.

Lisabeth señaló que deben realizarse nuevas investigaciones para analizar otros factores que no están incluidos en el estudio actual y que pueden contribuir a las diferencias entre sexos al tomar los medicamentos conforme a las indicaciones dadas, lo cual incluye factores psicológicos e interpersonales, como las preocupaciones de los pacientes por posibles efectos secundarios, percepciones de los pacientes sobre los beneficios de los medicamentos, roles de cuidado y si los pacientes recibían cuidado de profesionales de cuidado de la salud del mismo sexo, lo cual se ha demostrado que mejora la adhesión terapéutica.

Según la American Stroke Association (la Asociación Americana del Derrame Cerebral), más de 9 millones de americanos son supervivientes de ataque o derrame cerebral, y aproximadamente 1 de cada 4 de ellos sufre un segundo episodio. Los investigadores señalaron que las mujeres se ven afectadas de manera desproporcionada después de un ataque o accidente cerebral, con discapacidades más graves, mayor riesgo de muerte, y ataques y derrames cerebrales más recurrentes que los hombres. Las investigaciones demuestran que los medicamentos de prevención del ataque o derrame cerebral secundario pueden reducir el riesgo de muerte y ataque o derrame cerebral recurrente. No obstante, la adhesión terapéutica después de un ataque o derrame cerebral es fundamental para reducir el riesgo y prevenir que vuelvan a producirse.

Los coautores y los datos públicos se enumeran en el artículo. El estudio contó con el financiamiento parcial de una subvención otorgada por la American Heart Association.

Los estudios publicados en las revistas médicas de la American Heart Association están sujetos a revisiones de pares. Las declaraciones y conclusiones hechas en cada manuscrito son únicamente las de los autores del estudio y no reflejan necesariamente la política o la posición de la AHA. La AHA no hace manifestaciones ni brinda garantías sobre su precisión o confiabilidad. La AHA recibe financiamiento principalmente de personas físicas; las fundaciones y sociedades (incluidos los fabricantes de dispositivos y las empresas farmacéuticas y de otro tipo) también hacen donaciones y financian programas y eventos específicos de la AHA. La AHA mantiene políticas estrictas para evitar que estas relaciones influyan en el contenido científico. Los ingresos de las empresas farmacéuticas y biotécnicas, los fabricantes de dispositivos y los proveedores de seguro de salud, así como AHA, se encuentran disponibles aquí.

Recursos adicionales:

• En la columna derecha del enlace de publicación se ofrece material multimedia para consultar.
• Comunicado de prensa en Inglés
• Después del 4 de diciembre de 2024, lea el artículo en línea.
• Comentario de la AHA: Nonadherence to Preventive Medications after Ischemic Stroke: Opportunities to Target Interventions by Sex, Race, and Ethnicity (Incumplimento terapéutico relativo a medicamentos de prevención después de un ataque o derrame cerebral isquémico: oportunidades para orientar las intervenciones según el sexo, la raza y el origen étnico; dic. de 2024)
• Comunicado de prensa de la AHA: New Spanish language stroke prevention website aims to remove barriers to equitable health (Nuevo sitio web en español sobre prevención del ataque o derrame cerebral procura eliminar los obstáculos que impiden el acceso equitativo a la salud; septiembre de 2024)
• Pauta de la AHA/ASA: Guía 2021 para la prevención del ataque cerebral en pacientes con ataque cerebral y accidente isquémico transitorio: Una guía de la American Heart Association/American Stroke Association (mayo de 2021)
• Siga las noticias de AHA/ASA en X @HeartNews
• Siga las noticias de la revista profesional de la American Heart Association @JAHA_AHA

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Acerca de la American Heart Association

La American Heart Association es una fuerza implacable que trabaja para lograr un mundo con vidas más largas y saludables. Nos dedicamos a garantizar la igualdad en materia de salud en todas las comunidades. A través de la colaboración con numerosas organizaciones y el impulso de millones de voluntarios, financiamos investigaciones innovadoras, defendemos la salud pública y compartimos recursos para salvar vidas. La organización con sede en Dallas ha sido una fuente de información sobre salud líder durante un siglo. Durante 2024, el año de nuestro centenario, celebraremos 100 años de historia y logros relevantes. Mientras nos preparamos para el segundo siglo de descubrimiento e impacto, nuestra visión es promover la salud y la esperanza para todos, en todo el mundo. Comuníquese con nosotros en heart.org, Facebook, X o llamando al 1-800-AHA-USA1.

Para realizar consultas desde medios de comunicación y conocer el punto de vista de un experto de la AHA/ASA: 214-706-1173

Amanda Ebert: Amanda.Ebert@heart.org

Para consultas públicas: 1-800-AHA-USA1 (242-8721)

heart.org y stroke.org

Aspectos destacados de la declaración:

• Una nueva declaración científica describe el papel de los profesionales de atención primaria en la ayuda a sus pacientes para lograr Los Ocho Pases Esenciales Para Mi Salud, las medidas clave para mejorar y mantener la salud cardiovascular definidas por la American Heart Association.
• La nueva declaración destaca cómo los médicos de atención primaria pueden ayudar a los pacientes a seguir y mantener las métricas de salud Los Ocho Pases Esenciales Para Mi Salud de la Asociación, para una salud cardiovascular óptima, que incluyen cuatro conductas de salud (dieta, actividad física, exposición a la nicotina y sueño) y cuatro métricas de salud (índice de masa corporal, colesterol, glucemia y presión arterial).
• A pesar de su potencial para impactar positivamente en la salud cardiovascular, el campo de la atención primaria afronta numerosos desafíos, incluidas las brechas en el acceso a la atención, una fuerza laboral pequeña que enfrenta agotamiento, dificultades en la coordinación de la atención y compensación insuficientes por la atención.

Prohibida su divulgación hasta las 4:00 a. m. CT/5:00 a. m. ET, del miércoles, 13 de noviembre de 2024

DALLAS, 13 de noviembre de 2024 — Los médicos y los consultorios de atención primaria están en una posición única para ayudar a las personas a lograr una salud cardiovascular óptima a través de la detección, el diagnóstico y el tratamiento de los factores y las conductas de salud establecidos en las métricas de salud Los Ocho Pases Esenciales Para Mi Salud  de la American Heart Association (la Asociación Americana del Corazón) para reducir el riesgo de enfermedades cardíacas y ataque o derrame cerebral, según una nueva declaración científica publicada hoy en la revista profesional de la Asociación Circulation: Calidad y resultados cardiovasculares.

La enfermedad cardiovascular es la principal causa de muerte en los EE. UU., sin embargo, se estima que 1 de cada 4 muertes por enfermedad cardiovascular podrían evitarse abordando los factores de riesgo modificables con cambios en el estilo de vida y tratamiento. Las medidas Los Ocho Pases Esenciales Para Mi Salud de la Asociación son clave para mejorar y mantener una salud cardiovascular óptima y reducir el riesgo de enfermedades cardíacas, derrame cerebral y otros problemas de salud importantes. Los Ocho Pases Esenciales Para Mi Salud describe cuatro conductas de salud: dieta, actividad física, exposición a la nicotina y sueño; y cuatro factores de salud: índice de masa corporal, lípidos en sangre, glucemia y presión arterial.

“La atención primaria desempeña un papel central en la salud de las personas y en sus cuidados de salud a lo largo de la vida”, afirmó la Presidenta del grupo de redacción de la declaración, Madeline R. Sterling, M.D., M.P.H., M.S., FAHA, Profesora Adjunta de Medicina en Weill Cornell Medicine en New York. “Los profesionales de atención primaria tienen el potencial de mejorar enormemente la identificación y el tratamiento de los factores de riesgo cardiovascular y las conductas de salud en sus pacientes”.

En particular, datos recientes revelan que la atención primaria, en lugar de la atención especializada, es la principal fuente de atención que puede ayudar a los pacientes a abordar los factores y conductas de salud descritas en Los Ocho Pases Esenciales Para Mi Salud de la American Heart Association para una salud cardiovascular óptima.

Cada área dentro de Los Ocho Pases Esenciales Para Mi Salud se puede modificar con cambios de conducta o administración de medicamentos, y los profesionales de atención primaria suelen ser los que rutinariamente examinan, diagnostican y tratan la presión arterial alta, el azúcar en sangre y el colesterol. Además, la detección y el asesoramiento para dejar de fumar y el control del peso se realizan con mucha más frecuencia en consultas de atención primaria que en entornos de atención especializada.

Tal como se destaca en la declaración científica, la atención primaria efectiva se centra en la persona, se basa en el trabajo en equipo, se alinea con la comunidad y está diseñada para lograr una mejor salud a menor costo. Se ha demostrado que la atención primaria mejora la identificación y el tratamiento de los factores de riesgo y las conductas de salud cardiovascular, como se describe en Los Ocho Pases Esenciales Para Mi Salud, que incluye:

• Nutrición y actividad física: los médicos y equipos de atención primaria desempeñan un papel central en el asesoramiento sobre nutrición y planes de alimentación saludables para el corazón, como la dieta mediterránea y la dieta de Enfoques dietéticos para detener la hipertensión (Dietary Approaches to Stop Hypertension, DASH), así como en la implementación de programas e intervenciones relacionadas con la dieta y la actividad física.
• Exposición a la nicotina: La exposición a la nicotina a través del consumo de tabaco, el vapeo y el humo de segunda mano es la principal causa prevenible de morbilidad y mortalidad en los Estados Unidos y es responsable del 20 % de las muertes por enfermedades cardiovasculares (ECV) anualmente. Las intervenciones conductuales y basadas en medicamentos son efectivas y pueden ser abordadas por profesionales de atención primaria.
• Sueño: La falta de sueño o el sueño de mala calidad se asocian con factores de riesgo para enfermedades cardíacas, que incluyen presión arterial alta y diabetes tipo 2. Los profesionales de atención primaria pueden detectar problemas de sueño, examinar sus posibles causas e iniciar ajustes de medicación y derivaciones a especialistas cuando sea necesario.
• Control de peso: la obesidad afecta al 42 % de los adultos en los Estados Unidos, y la atención primaria es un entorno ideal para detectar exceso de peso, remitir a las personas a programas de nutrición y pérdida de peso, recetar medicamentos y, cuando sea apropiado, proporcionar referencias para cirugía bariátrica u otras intervenciones. Un metaanálisis y revisión sistemática reciente revelaron que las intervenciones de control del peso para adultos con obesidad, llevadas a cabo en centros de atención primaria, fueron efectivas para la pérdida de peso.
• Presión arterial, glucemia y colesterol: la detección de factores de riesgo como presión arterial elevada, glucemia y lípidos son pilares de la prevención primaria de enfermedades cardiovasculares y se llevan a cabo en el ámbito de la atención primaria. Los médicos y centros de atención primaria pueden brindar asesoramiento sobre estilo de vida y recetar tratamientos que a menudo incluyen intervenciones educativas, autocontrol de la presión arterial, programas de entrenamiento para mejorar el control dirigido por el paciente, intervenciones como asesoría nutricional o medicamentos. Una revisión actual de 42 ensayos clínicos controlados aleatorizados halló que tanto las intervenciones a nivel individual como organizacional (manejo por parte de personal de enfermería y de farmacia, trabajadores comunitarios de salud, etc.) en el ámbito de la atención primaria fueron efectivas para mejorar el control glucémico entre personas con diabetes tipo 2 mal controlada. Se han observado resultados similares en personas con presión arterial alta tratadas en centros de atención primaria.

Según el informe Estadísticas sobre enfermedades cardíacas y derrames cerebrales (ataques cerebrales) 2024 de la American Heart Association, la incidencia de enfermedades cardiovasculares ha disminuido en los Estados Unidos. Sin embargo, solo 1 de cada 5 adultos en ese país tiene lo que se considera una salud cardiovascular óptima, lo cual se asocia con una mayor longevidad y una mejor calidad de vida.

También existen marcadas disparidades en la atención y la salud debido a factores sociales y ambientales, como el nivel socioeconómico, la raza y factores comunitarios, como la disponibilidad de espacios seguros para hacer ejercicio y el acceso a alimentos saludables.

“La atención primaria como campo puede abordar algunas de estas disparidades al brindar atención preventiva para detectar factores de riesgo de enfermedades cardiovasculares en los pacientes, alentar a las personas a adoptar hábitos de vida saludables para el corazón para evitar que se desarrollen o empeoren los problemas de salud, e iniciar un tratamiento para mejorar la salud cardiometabólica si es necesario”, dijo Jeremy Sussman, M.D., M.P.H., M.S., Profesor Adjunto de Medicina en University of Michigan y Vicepresidente de la declaración científica.

A pesar del potencial de promover Los Ocho Pases Esenciales Para Mi Salud, los profesionales y las prácticas de atención primaria enfrentan desafíos que pueden limitar su éxito en el apoyo a los pacientes para reducir los riesgos cardiovasculares. Las investigaciones muestran que una mayor proporción de médicos de atención primaria por persona se asocia con un costo total de atención más bajo y una disminución de la morbilidad y la mortalidad. Sin embargo, existen preocupaciones sobre la disminución de la fuerza laboral en atención primaria, que enfrenta altos niveles de agotamiento, dificultades en la coordinación de la atención con otros profesionales de la salud y compensación y apoyo financiero insuficientes. La falta de cobertura de seguro de salud, el acceso desigual a la atención y los recursos limitados en áreas rurales también pueden crear barreras para una mejor salud.

“La atención primaria como profesión está infravalorada y cuenta con pocos recursos: representa el 35 % de las visitas de cuidados de salud en los Estados Unidos y solo el 5 % de los gastos de atención médica”, afirmó Sterling. “Para que la atención primaria tenga el máximo impacto en las variables descritas en Los Ocho Pases Esenciales Para Mi Salud, debe ser apoyada, promovida y valorada por la comunidad de cuidados de salud, los sistemas de salud pública y los formuladores de políticas”.

La declaración destaca formas de abordar estos desafíos, como la reforma de los sistemas de pago, el aprovechamiento de la tecnología y la promoción de la atención basada en equipos. Cabe señalar que los profesionales de atención primaria se encuentran entre los médicos con los salarios más bajos en Estados Unidos. 

“El apoyo efectivo a la atención primaria requeriría legislación federal y estatal para aumentar la proporción general del gasto en cuidados de salud destinado a la atención primaria y actualizar la forma en que se paga la atención y los programas de apoyo”, afirmó Sussman.

También se necesita un enfoque de atención basado en el trabajo en equipos para apoyar a los profesionales de atención primaria y promover la colaboración a través de iniciativas basadas en el sistema de salud y en las clínicas. La tecnología y la infraestructura de datos, como los sistemas de registros electrónicos de salud, las herramientas de apoyo a la decisión clínica y las consultas por telemedicina, pueden mejorar la prestación de servicios de cuidados de salud y ofrecer un mejor apoyo a las prácticas de atención primaria y, a su vez, a los pacientes. También es necesario incorporar los tratamientos basados en evidencia de manera más eficiente y consistente en la atención.

Esta declaración científica fue preparada por el grupo de redacción de voluntarios en nombre del Comité de Ciencias de Atención Primaria de la American Heart Association del Consejo de Calidad de la Atención y la Investigación de Resultados y del Consejo de Enfermería Cardiovascular y de Derrame Cerebral; el Consejo de Cuidados Cardiopulmonares, Críticos, Perioperatorios y de Reanimación; y el Consejo de Salud Cardiometabólica y de Estilo de Vida. Las declaraciones científicas de la American Heart Association promueven una mayor conciencia sobre las enfermedades cardiovasculares y los derrames cerebrales y ayudan a facilitar la toma de decisiones informadas sobre el cuidado de salud. Las declaraciones científicas describen lo que se sabe actualmente sobre un tema y qué áreas necesitan más investigación. Si bien las declaraciones científicas informan el desarrollo de pautas, no hacen recomendaciones de tratamiento. Las pautas de la American Heart Association proporcionan las recomendaciones de práctica clínica oficiales de la Asociación.

Otros coautores y miembros del grupo de redacción de la declaración son Erin Ferranti, Ph.D., M.P.H., R.N., FAHA; Beverly B. Green, M.D., M.P.H., FAHA; Nathalie Moise, M.D., M.S., FAHA; Randi Foraker, Ph.D., M.A., FAHA; Soohyun Nam, Ph.D., A.P.R.N., A.N.P.-B.C., FAHA; Stephen P. Juraschek, M.D., Ph.D., A.H.S.C.P.-C.H.S., FAHA; Cheryl A.M. Anderson, Ph.D., M.P.H., M.S., FAHA; y Paul St. Laurent, D.N.P., R.N. Los datos públicos de los autores se encuentran en el artículo.

La Asociación recibe financiación de personas particulares principalmente. Algunas fundaciones y empresas (incluidas compañías farmacéuticas y fabricantes de dispositivos, entre otras) también realizan donaciones y financian eventos o programas específicos de la Asociación. La Asociación tiene políticas estrictas para evitar que estas relaciones influyan en el contenido científico. Los ingresos de las compañías farmacéuticas y de biotecnología, los fabricantes de dispositivos y los proveedores de seguros de salud y la información financiera general de la Asociación están disponibles aquí.

Recursos adicionales:

• Los recursos multimedia se encuentran en la columna derecha del enlace de la publicación.
• comunicado de prensa en inglés
• Después del 13 de noviembre de 2024, lea el artículo en línea.
• Comunicado de prensa de la AHA: Nueva guía: Prevenir un primer derrame cerebral puede ser posible con una prueba de detección y cambios en el estilo de vida (octubre de 2024)
• Consejo del presidente de la AHA:  Previsión de la carga de enfermedades cardiovasculares y derrames cerebrales en los Estados Unidos hasta 2050: Prevalencia de factores de riesgo y enfermedades (junio de 2024)
• Consejo del presidente de la AHA: Salud cardiovascular, renal y metabólica (octubre de 2023)
• Consejo del presidente de la AHA Los Ocho Pases Esenciales Para Mi Salud Actualización y mejora del constructo de salud cardiovascular de la American Heart Association: (junio de 2022)
• Siga las noticias de AHA/ASA en X @HeartNews
• Siga las noticias de Circulation: Calidad y resultados cardiovasculares, la revista profesional de la AHA @CircOutcomes

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Acerca de la American Heart Association

La American Heart Association es una fuerza incansable cuyo objetivo es prolongar la vida y la salud de todos. Nos dedicamos a garantizar la igualdad en materia de salud en todas las comunidades. A través de la colaboración con numerosas organizaciones y el impulso de millones de voluntarios, financiamos investigaciones innovadoras, defendemos la salud pública y compartimos recursos para salvar vidas. La organización con sede en Dallas ha sido una fuente de información sobre salud líder durante un siglo. Durante 2024, el año de nuestro centenario, celebraremos 100 años de historia y logros relevantes. Mientras nos preparamos para el segundo siglo de descubrimiento e impacto, nuestra visión es promover la salud y la esperanza para todos, en todo el mundo. Comuníquese con nosotros a través de heart.org, Facebook, X o llamándonos al 1-800-AHA-USA1.

Para consultas de medios de comunicación: 214-706-1173

Amanda Ebert: Amanda.Ebert@heart.org

Para consultas públicas: 1-800-AHA-USA1 (242-8721)

heart.org y stroke.org

Research Highlights:

• A version of the Multi-Ethnic Study of Atherosclerosis (MESA) heart disease risk score that did not include race predicted heart disease risk just as well as the original version that includes race.
• The original MESA risk score, developed in 2015[1], combines traditional risk factors, sex and race with a coronary artery calcium score.
• The MESA formula without race may be used for people who identify with more than one racial or ethnic group or those who prefer not to disclose their race or ethnicity.
• Note: The study featured in this news release is a research abstract. Abstracts presented at the American Heart Association’s scientific meetings are not peer-reviewed, and the findings are considered preliminary until published as full manuscripts in a peer-reviewed scientific journal

Embargoed until 4 a.m. CT/5 a.m. ET, Monday, Nov. 11, 2024

CHICAGO, Nov. 11, 2024 — A version of the MESA heart disease risk score that did not include race predicted heart disease risk just as well as the version that includes race, according to a preliminary study presented today at the American Heart Association’s Scientific Sessions 2024. The meeting, Nov. 16-18, 2024, in Chicago, is a premier global exchange of the latest scientific advancements, research and evidence-based clinical practice updates in cardiovascular science.

“Our work is part of a growing effort to assess the implications of including race and ethnicity in clinical risk prediction models,” said lead investigator Quinn White, B.A., a doctoral student at the University of Washington, Seattle. “This change broadens the potential use of the score, since it can now be calculated for those who do not fit into one of the racial or ethnic groups of the original score and for those who do not wish to disclose their race.”

The MESA score is used to predict risk for coronary heart disease (CHD) — including heart attack, cardiac arrest, revascularization and CHD death[2] — over the next 10 years. It was originally developed in 2015 from participant data in the Multi-Ethnic Study of Atherosclerosis, a community-based study that followed more than 6,000 adults, free of heart disease at the start of the study, for 10 years. Participants were from six areas of the U.S. and the study group was 39% non-Hispanic white, 12% Chinese American, 28% Black and 22% Hispanic, with equal numbers of men and women.¹

Risk scores have often used a modifier, or adjusted the calculation, to account for the statistically higher risk of heart disease among people of certain racial and ethnic groups. However, race is not a biological factor and using it to predict risk may lead to treatment decisions that perpetuate disparities.

The original risk score is based on traditional risk factors for heart disease, sex, race and coronary artery calcium (CAC) levels, which are obtained from computed tomography (CT) imaging. Traditional risk factors in the MESA score include total cholesterol; low “good” cholesterol, or HDL; high blood pressure; family history of heart disease; smoking; and Type 2 diabetes status.

In this study, researchers developed a version of the MESA risk score without including race or ethnicity, then compared its effectiveness to the original that includes race and ethnicity.

Investigator White and colleagues found virtually no difference in heart disease prediction between the risk scores:

• In a statistical analysis, the score without race had a concordance value of 0.800 while the original score had a value of 0.797. Concordance is how well the equation could identify those at risk vs. those not at risk. A value over 0.7 indicates a very good model.

• The actual rate of heart disease among participants matched the predicted rate when using either version of the risk score.

“We hope this work can continue the conversation about how researchers and clinicians can think carefully about whether it is necessary to include race and ethnicity in risk prediction models, and the impact such a decision could have for patient care,” White said.

“I think this study reinforces two important points,” said Sadiya Khan, M.D., M.Sc., Magerstadt Professor of Cardiovascular Epidemiology and associate professor at Northwestern School of Medicine in Chicago, and head of the writing group for the PREVENT equations. “First, there is the importance of a diverse population sample in which to develop models. Second is ensuring that the relevant predictors are included. With these two things in place, the model performs well, even without the social construct of race.”

Background on the MESA study:

• MESA enrolled 6,814 adults, ages 45-84, without heart disease between 2000 and 2002 as part of a long-term, observational study of the development of atherosclerosis.
• Participants in MESA were seen at clinics at Columbia University in New York; Johns Hopkins University in Baltimore; Northwestern University in Chicago; University of California in Los Angeles; University of Minnesota, Twin Cities in St. Paul and Minneapolis; and Wake Forest University in Winston-Salem, North Carolina.
• The original MESA study was funded by the National Heart, Lung, and Blood Institute, a division of the National Institutes of Health.

A limitation to White’s analysis is that the MESA study included only four racial and ethnic groups, which do not represent the full racial and ethnic diversity of people in the U.S.

White’s study was funded by the American Heart Association’s De-biasing Clinical Care Algorithms project. The de-biasing project is a two-year initiative supported by a grant from the Doris Duke Foundation to investigate and elevate the complex issue of how race and ethnicity, when factored into clinical care algorithms and risk prediction tools, affect equity in clinical decision-making. The American Heart Association supports developing unbiased tools that are not based on race or ethnicity to predict the risk of heart disease.

“This research is helping change assumptions about the role of race in risk calculation,” said Jennifer Hall, Ph.D., FAHA, chief of data science for the American Heart Association and lead scientist for the de-biasing initiative. “As other risk calculators are revised with contemporary patient data and additional measures for health, social, community and historical factors, we hope that they support more equitable clinical decision-making.”

Co-authors and disclosures are listed in the abstract.

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. Abstracts presented at the Association’s scientific meetings are not peer-reviewed, rather, they are curated by independent review panels and are considered based on the potential to add to the diversity of scientific issues and views discussed at the meeting. The findings are considered preliminary until published as a full manuscript in a peer-reviewed scientific journal.

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 and the Association’s overall financial information are available here.

Additional Resources:

• Multimedia is available on the right column of the release link https://newsroom.heart.org/news/mesa-heart-disease-risk-score-worked-well-with-or-without-race-included?preview=ef84ee743a6446f3ab0ae847fab7662d
• Spanish news release
• Link to abstract; and AHA Scientific Sessions 2024 Online Program Planner
• AHA news release: Structural racism causes poor health, premature death from heart disease and stroke (Nov. 2020)
• AHA news release: Race is a social construct and often used as proxy for biological variables, may affect patient care, outcomes (June 2023)
• AHA health information: Championing Health Equity for All
• For more news at AHA Scientific Sessions 2024, follow us on X @HeartNews, #AHA24

###

About the American Heart Association

The American Heart Association is a relentless force for a world of longer, healthier lives. We are dedicated to ensuring equitable health in all communities. Through collaboration with numerous organizations, and powered by millions of volunteers, we fund innovative research, advocate for the public’s health and share lifesaving resources. The Dallas-based organization has been a leading source of health information for a century. During 2024 - our Centennial year - we celebrate our rich 100-year history and accomplishments. As we forge ahead into our second century of bold discovery and impact, our vision is to advance health and hope for everyone, everywhere. Connect with us on heart.org, Facebook, X or by calling 1-800-AHA-USA1.

For Media Inquiries and AHA Expert Perspective:

AHA Communications & Media Relations in Dallas: 214-706-1173; ahacommunications@heart.org

Maggie Francis, maggie.francis@heart.org

For Public Inquiries: 1-800-AHA-USA1 (242-8721)

heart.org and stroke.org

Research Highlights:

• Heart disease, Type 2 diabetes, high blood pressure and obesity were more common and linked to reduced access to healthy food among people who lived in neighborhoods previously subjected to structural racism-based policies that limited home ownership — an outlawed practice known as redlining.
• Researchers say testing interventions to help improve access to healthy food or boost social and economic resources could mitigate the still-present impact of outdated policies like redlining.
• Note: The study featured in this news release is a research abstract. Abstracts presented at American Heart Association’s scientific meetings are not peer-reviewed, and the findings are considered preliminary until published as full manuscripts in a peer-reviewed scientific journal.

Embargoed until 4 a.m. CT/5 a.m. ET, Monday, Nov. 11, 2024

DALLAS, Nov. 11, 2024 — Heart disease, Type 2 diabetes, high blood pressure and obesity were more common and linked to reduced access to healthy foods among people who live in neighborhoods previously subjected to redlining, according to a preliminary study to be presented at the American Heart Association’s Scientific Sessions 2024. The meeting, Nov. 16-18, 2024, in Chicago, is a premier global exchange of the latest scientific advancements, research and evidence-based clinical practice updates in cardiovascular science.

According to the American Heart Association, the environments and conditions in which people live, work and play — factors known as social determinants of health — have a significant role in the development of cardiovascular disease and vary across racial and ethnic groups. Social determinants of health include economic stability, neighborhood safety, education, access to quality health care, access to healthy food and other factors.

“We know that redlining leads to poor health outcomes, and even though redlining has been outlawed, it is still having an impact,” said lead study author Rebekah J. Walker, Ph.D., an associate professor and chief of the division of population health at the Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo in Buffalo, New York. “We looked at what can we do to stop that relationship from continuing to happen. Many cardiovascular outcomes are diet-sensitive. So we wanted to find out if changing your diet in these neighborhoods might change your cardiovascular outcomes.”

Redlining is the unjust practice that was effectively legal in the U.S. from 1933-1968 that limited homeownership based on a person’s race. In 1933, the Home Owners’ Loan Corporation (HOLC), a government agency created as part of The New Deal, began sponsoring low-interest mortgage loans to help people recover from the financial crisis of the Great Depression. The agency developed a color-coding system for neighborhoods across the country based on “risk for investment” criteria. Areas labeled as ‘hazardous’ were coded red, hence the term redlining, and were deemed “too risky” to insure mortgages.

Residents of these redlined neighborhoods were denied home loans, which lowered tax revenues in these communities. This led to years of reduced investment in schools and government programs and services, creating numerous inequities for residents for multiple generations despite the practice being outlawed by the Fair Housing Act of 1968.

In this study, researchers examined data from more than 11,000 U.S. Census tracts across 38 states to understand if access to healthy foods served as a pathway through which historical redlining leads to increased rates of heart disease, Type 2 diabetes and cardiovascular risk factors.

After controlling for population size, researchers found that neighborhoods that were redlined were more likely to have lower access to healthy foods and in turn higher rates of heart disease, high blood pressure, obesity and Type 2 diabetes.

Specifically, the analysis found:

• An average of 11.8% of people in redlined neighborhoods had Type 2 diabetes; an average of 31.9% had high blood pressure; an average of 6% had heart disease; and 31.8% had obesity.
• A direct association was found among communities that were affected by both redlining and reduced access to healthy food resulting in higher rates of Type 2 diabetes, high blood pressure, obesity and coronary heart disease.
• An indirect association between redlining and Type 2 diabetes, high blood pressure, coronary heart disease and obesity due to reduced access to healthy food.

“The direct relationships we found were that redlining is associated with food access, and food access is associated with higher prevalence of disease,” Walker explained. “The indirect relationship was that redlining is associated with higher prevalence of disease via the pathway of food access.

“The impact that social factors, like access to healthy foods, have as a pathway through which structural racism impacts health is important to identify so health care professionals and policymakers are aware of the long-term impact of historical events on current living experiences affecting their patients’ health.”

According to the U.S. Department of Agriculture, about 1 in 10 U.S. households experienced food insecurity (lacking access to enough healthy food for an active life) in 2020. In 2022, an American Heart Association policy statement suggested achieving “nutrition security” by improving access to the availability and affordability of healthy foods and beverages that help prevent disease. A new initiative from the Association, Health Care by Food,™ explores the clinical and cost-effectiveness of incorporating healthy foods into a person’s medical treatment to improve health outcomes, lower health care use and make care more affordable.

“Redlining’s residual impact 100 years later is disheartening,” said former American Heart Association volunteer president Clyde W. Yancy, M.D., M.Sc., FAHA.

“Without question, redlining has had a negative effect on not just healthy food access but also healthy living,” said Yancy, vice-dean of diversity, equity and inclusion and chief of the division of cardiology at Northwestern University, Feinberg School of Medicine in Chicago.

“The greater question must address whether or not some form of "redlining" remains active? Not investing in vulnerable communities extends the consequence of redlining. The sobering awareness is not only the persistent effect of redlining but the still evident practices which "de facto" are redlining but via different means.

However, Yancy is optimistic about the future.

“We need not wring hands and hang heads over redlining,” he said. “Disruptive new strategies, provocative voices and breakthrough science applied to healthier foods is our call to action. We can make redlining a historical footnote and that should be among the American Heart Association’s goals for its next century.”

The study is limited by its observational design that shows only an association, not cause and effect, between previous redlining and cardiovascular risks. Another limitation is that the study analyzed disease rates at a community level rather than by participants’ specific address.

Study background and details:

• Researchers reviewed information from 11,457 census tracts in 201 counties in 38 states and redlining information from the Mapping Inequality Project by the Home Owners’ Loan Corporation. This project scores neighborhoods on a scale from 1-4, where 1 is best and 4 is redlined.
• The analysis was conducted in December 2023 using data from the 2020 U.S. Census.
• Food access was determined by dividing the number of healthy food retailers by the total number of food retailers per census tract.
• Health records from the CDC PLACES database, which collects community health information across the U.S., determined community-level rates of heart disease, high blood pressure, obesity and Type 2 diabetes.
• The study used statistical methods to analyze the relationships between heart disease and related risk factors and how those related to 1) census tracts with more historical redlined neighborhoods and 2) less access to healthy foods.

Co-authors, disclosures and funding sources are listed in the abstract.

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. Abstracts presented at the Association’s scientific meetings are not peer-reviewed, rather, they are curated by independent review panels and are considered based on the potential to add to the diversity of scientific issues and views discussed at the meeting. The findings are considered preliminary until published as a full manuscript in a peer-reviewed scientific journal.

 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 and the Association’s overall financial information are available here.

Additional Resources:

• Multimedia is available on the right column of the release link https://newsroom.heart.org/news/heart-disease-more-common-in-past-redlined-areas-linked-to-limited-access-to-healthy-foods?preview=f5a039e87166f2bd46ec390d6a69ddd1
• Link to abstract; and AHA Scientific Sessions 2024 Online Program Planner
• AHA health information: Fighting Food Insecurity Together
• AHA news release: Alarming trends call for action to define the future role of food in nation’s health (June 2024)
•  AHA news release: Social, environmental factors may raise risk of developing heart disease and stroke (March 2024)
• AHA news release: Addressing structural racism central to reducing cardiovascular disease disparities across the U.S. (Jan. 2024)
• AHA news release: Redlining linked to higher heart failure risk among Black adults in U.S. (July 2023)
• For more news at AHA Scientific Sessions 2024, follow us on X @HeartNews, #AHA24

###

About the American Heart Association

The American Heart Association is a relentless force for a world of longer, healthier lives. We are dedicated to ensuring equitable health in all communities. Through collaboration with numerous organizations and powered by millions of volunteers, we fund innovative research, advocate for the public’s health and share lifesaving resources. The Dallas-based organization has been a leading source of health information for a century. During 2024 - our Centennial year - we celebrate our rich 100-year history and accomplishments. As we forge ahead into our second century of bold discovery and impact, our vision is to advance health and hope for everyone, everywhere. Connect with us on heart.org, Facebook, X or by calling 1-800-AHA-USA1.

For Media Inquiries and AHA Expert Perspective:

AHA Communications & Media Relations in Dallas: 214-706-1173; ahacommunications@heart.org

Bridgette McNeill: Bridgette.mcneill@heart.org

For Public Inquiries: 1-800-AHA-USA1 (242-8721)

heart.org and stroke.org

This news release contains updated information and data not included in the abstract.

Research Highlights:

• U.S. survival rates from out-of-hospital cardiac arrests fell significantly at the beginning of the COVID-19 pandemic in 2020 and only slightly improved through 2022. Survival rates remained lower than in the pre-pandemic years of 2015-2019.
• The study of more than a half million adults in the U.S. who had an out-of-hospital cardiac arrest from 2015-2022 also found survival rates improved at a faster pace yet continued to be much lower in Black and Hispanic communities compared to predominantly white communities.
• Note: The study featured in this news release is a research abstract. Abstracts presented at American Heart Association’s scientific meetings are not peer-reviewed, and the findings are considered preliminary until published as full manuscripts in a peer-reviewed scientific journal.

Embargoed until 4 a.m. CT/5 a.m. ET, Monday, Nov. 11, 2024

DALLAS, Nov. 11, 2024 — Out-of-hospital cardiac arrest survival rates dropped significantly at the onset of the COVID-19 pandemic in 2020 and have continued to remain lower than in the pre-pandemic years of 2015-2019, according to a preliminary study to be presented at the American Heart Association’s Scientific Sessions 2024. The meeting, Nov. 16-18, 2024, in Chicago, is a premier global exchange of the latest scientific advancements, research and evidence-based clinical practice updates in cardiovascular science.

The analysis of data for more than a half million adults in the U.S. who had an out-of-hospital cardiac arrest between 2015-2022 also found lower survival rates in predominantly Black and Hispanic communities.

“Our results indicate that the onset of the COVID-19 pandemic largely erased gains in out-of-hospital cardiac arrest survival that had been achieved during the ten years before the pandemic, and it exacerbated disparities among Black and Hispanic communities,” said Eric Hall, M.D., the study’s lead author and a cardiology fellow at UT Southwestern Medical Center in Dallas. “We need to make a concerted effort toward improving survival rates across the board, with targeted efforts to support people in communities with a majority of Black and Hispanic residents.”

Cardiac arrest occurs when the heart suddenly stops beating. It is often fatal if appropriate steps, such as activating emergency response starting with lay rescuer CPR, and early defibrillation, are not taken immediately. Most out-of-hospital cardiac arrests happen at home, in public settings or in nursing homes rather than at a hospital, according to the American Heart Association.

In this study, researchers compared out-of-hospital survival rates in the U.S. during the pre-pandemic years (2015-2019) to when COVID-19 spread rapidly (2020-2022), particularly in the early stages when cardiac arrest survival rates decreased sharply. The team also examined whether survival rates improved in the years since the pandemic began and if the improvements were shared equally among various racial and ethnic communities.

The analysis found:

• Before the pandemic, the rate of overall out-of-hospital survival-to-hospital discharge was nearly 10%. The cardiac arrest survival rate varied across communities: in those with mostly Black and Hispanic residents, it was about 8%; and in multi-race communities, it was close to 11%, compared to a survival rate of more than 11% in predominantly white communities.

• In 2020, out-of-hospital cardiac arrest survival decreased to 9% overall; however, in Black and Hispanic communities, survival declined to 6.6%, a relative decrease of -16.5% compared to before the pandemic. This was a larger relative decrease than was seen in multi-race integrated communities (-6.5%) or predominantly white communities (-8.1%).
• In 2021 and 2022, there was little improvement in survival overall after out-of-hospital cardiac arrest (9.1%), still significantly below pre-pandemic levels of 9.9%. There was modest improvement in survival after cardiac arrest in majority Black and Hispanic communities, such that the disparity in survival rates between these communities and white communities narrowed to 2.6% in 2022, compared to a gap of more than 3% for 2015-2019. Survival rates, however, remained lower for Black and Hispanic communities in comparison to predominantly white communities in every period studied.

The results surprised the research team. “We expected that survival after out-of-hospital cardiac arrest would have bounced back to levels before the pandemic,” said Saket Girotra, M.D., S.M., the study’s senior author and an associate professor of cardiology in the department of internal medicine at UT Southwestern Medical Center in Dallas. “Even in 2022, survival rates remained worse than before the pandemic.”

Girotra noted that the team is conducting additional research to better understand the role of emergency medical services in providing cardiac arrest care and to identify best practices for treating patients who experience out-of-hospital cardiac arrest.

Sarah Perman, M.D., M.S.C.E., FAHA, chair of the American Heart Association’s Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation, said other factors are likely hindering a rebound from the COVID-19 pandemic.

“During the pandemic, we saw notable delays in people seeking health care,” said Perman, an associate professor in the department of emergency medicine at Yale School of Medicine. “Now, I think we're seeing individuals who are having challenges accessing health care. So we're not in an environment where we can completely rebound.

“It’s also really important that we recognize another factor,” she said. “In 2019, we saw the addition of fentanyl into the illicit drug market, and that obviously coincided a little bit with the pandemic. That has continued to be a factor, and we are seeing a higher incidence of overdose-associated cardiac arrest. I think that also complicates how this data can be interpreted.”

Perman urged educational initiatives and community outreach to increase cardiac arrest awareness and CPR skills: “If someone who is in our circle unfortunately succumbs to a cardiac arrest, it's important to remember that you need to push hard and fast on the chest and call 911, so that you can activate emergency medical services to assist with the resuscitative efforts.”

The research has several limitations. Although the findings are based on data from the Cardiac Arrest Registry to Enhance Survival, or CARES, which covers more than half of the U.S. population, the data may not be applicable to communities that do not participate in the registry. The study’s design focused on observations, limiting the ability to assess reasons or causes for the findings. The research period ended in 2022, while the declaration to end the public health emergency status for the COVID-19 pandemic was May 11, 2023.

Study details, background and design:

• The analysis included more than 506,000 adults from the CARES registry who had experienced an out-of-hospital cardiac arrest from 2015-2022. The average age was about 62 years old; 64% were men, 22% were Black adults, and 7% were Hispanic adults.
• The study compared survival after out-of-hospital cardiac arrest for 2015-2019 before the COVID-19 pandemic to each of the years 2020, 2021 and 2022 after the beginning of the pandemic.
• Researchers also examined survival rates for differences based on the racial and ethnic composition of the people in communities served by emergency medical service agencies, defined as predominantly white communities (more than 80% white residents), predominantly Black or Hispanic communities (more than 50% Black or Hispanic residents) or multi-race integrated communities.

Co-authors, disclosures and funding sources are listed in the abstract.

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. Abstracts presented at the Association’s scientific meetings are not peer-reviewed, rather, they are curated by independent review panels and are considered based on the potential to add to the diversity of scientific issues and views discussed at the meeting. The findings are considered preliminary until published as a full manuscript in a peer-reviewed scientific journal.

 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 and the Association’s overall financial information are available here.

Additional Resources:

• Multimedia is available on the right column of the release link https://newsroom.heart.org/news/cardiac-arrest-survival-improved-since-covid-19-pandemic-waned-still-lower-than-prior-years?preview=f941fa84d3a76b1f5fa23e6f08779d10
• Spanish news release
• Link to abstract; and AHA Scientific Sessions 2024 Online Program Planner
• AHA health information - Video: Learn Hands Only CPR (en español)
• AHA health information: Bystander CPR
•  AHA news release: Nation of Lifesavers™ to turn bystanders into lifesavers through nationwide CPR & AED awareness, education (June 2023)
• AHA news release: Learning to save lives can start as early as age 4, according to new scientific statement (May 2023)
• AHA news release: Cardiac arrest from opioid overdose has unique features affecting prevention and treatment (March 2021)
• For more news at AHA Scientific Sessions 2024, follow us on X @HeartNews, #AHA24

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