Mohammed, Zaki Ur Rahman

Background: Sudden cardiac death (SCD) is a leading cause of mortality in the U.S., with emerging evidence pointing to racial disparities and the impact of social vulnerability. Yet, geographic patterns integrating race and county-level vulnerability remain underexplored. Objective: To identify U.S. counties where socially vulnerable communities, stratified by race/ethnicity, experience disproportionate burdens of SCD-related mortality. Methods: We analyzed county-level data (1999-2020), integrating age-adjusted mortality rates (AAMR) for SCD with the 2020 CDC Social Vulnerability Index (SVI). Counties were categorized into SVI quartiles (Q1: Low to Q4: High Social Vulnerability). Analyses were stratified by race/ethnicity: Black or African American, Hispanic/Latino, White, American Indian/Alaska Native (AI/AN), and Asian/Pacific Islander (API). We used RStudio (v2023.06.1) for data cleaning, ANOVA testing, and descriptive analysis. “Unreliable” mortality values were handled as missing or set to zero, with only valid AAMR > 0 included. Hotspot counties were identified by selecting the top decile of AAMR SCD within Q4 SVI counties. Results: Significant disparities emerged across SVI quartiles for Black (p = 0.0003), Hispanic (p < 0.0001), and White (p < 0.0001) groups. Mean AAMR more than doubled from low to high SVI counties in Black communities (17.0 to 39.4 per 100,000). White and Hispanic groups showed smaller but consistent increases. API (p = 0.60) or AI/AN (p = 0.63) groups showed no significant trends. Madison Parish, LA appeared in the top-10 highest-burden counties across all groups. Black populations faced extreme rates in some SVI counties (e.g., Madison Parish, LA: 351.4 per 100,000), while API groups had low AAMR even in vulnerable areas. Data misclassification limited interpretation in the Hispanic group. Conclusions: Black, Hispanic, and White populations showed significant differences in SCD mortality tied to social vulnerability. Black populations in the most vulnerable areas experienced more than twice the rate of mortality compared to those in less vulnerable areas, suggesting a strong correlation between social vulnerability and SCD mortality in Black communities. API and AI/AN groups showed no significant associations, likely due to small sample sizes. Madison Parish, LA reflects the compounded impact of structural disadvantage. Findings support targeted interventions in socially and racially vulnerable counties to reduce preventable cardiac deaths.

Background: Obstructive sleep apnea (OSA) increases the risk of stroke and cardiovascular diseases. However, its impact on geriatric patients with a prior history of stroke/transient ischemic attack (TIA) has not been adequately studied. Methods: We utilized the 2019 National Inpatient Sample in the US to identify geriatric patients with OSA (G-OSA) who had a prior history of stroke/TIA. We then compared subsequent stroke (SS) rates among sex and race subgroups. We also compared the demographics and comorbidities of SS+ and SS− groups and utilized logistic regression models to assess outcomes. Results: Out of 133,545 G-OSA patients admitted with a prior history of stroke/TIA, 4.9% (6520) had SS. Males had a higher prevalence of SS, while Asian-Pacific Islanders and Native Americans had the highest prevalence of SS, followed by Whites, Blacks, and Hispanics. The SS+ group had higher all-cause in-hospital mortality rates, with Hispanics showing the highest rate compared to Whites and Blacks (10.6% vs. 4.9% vs. 4.4%, p < 0.001), respectively. Adjusted analysis for covariates showed that complicated and uncomplicated hypertension (aOR 2.17 [95% CI 1.78–2.64]; 3.18 [95% CI 2.58–3.92]), diabetes with chronic complications (aOR 1.28 [95% CI 1.08–1.51]), hyperlipidemia (aOR 1.24 [95% CI 1.08–1.43]), and thyroid disorders (aOR 1.69 [95% CI 1.14–2.49]) were independent predictors of SS. The SS+ group had fewer routine discharges and higher healthcare costs. Conclusions: Our study shows that about 5% of G-OSA patients with a prior history of stroke/TIA are at risk of hospitalization due to SS, which is associated with higher mortality and healthcare utilization. Complicated and uncomplicated hypertension, diabetes with chronic complications, hyperlipidemia, thyroid disorders, and admission to rural hospitals predict subsequent stroke.