Monika M Safford
Dados Biográficos
| ID | 84378 |
|---|---|
| NOME | Monika M Safford |
| PRENOMES | Monika M |
| SOBRENOME | Safford |
| ASSINATURA | SAFFORD M M |
| AFILIAÇÕES | University of Alabama at Birmingham |
| ORCID | 0000-0002-3060-0563 |
| VERIFICADO | Sim |
| TOTAL DE OBRAS | 41 |
| TOTAL DE CITAÇÕES | 8 |
| TOTAL COMO AUTOR | 41 |
| TOTAL COMO EDITOR | 0 |
| PRIMEIRO ANO DE PUBLICAÇÃO | 2003 |
| ANO MAIS RECENTE DE PUBLICAÇÃO | 2026 |
| ÍNDICE H | 2 |
Neighborhood factors and incident stroke
Research linking adverse neighborhood context with disparities in incident stroke may reflect publication bias for chance associations. We compared results from the REasons for Geographic and Racial Differences in Stroke (REGARDS, n = 25,126, aged ≥45 years, 41 % Non-Hispanic Black, 12 % 50 years, 15 % Non-Hispanic Black, 20 % < high school degree, 2004-2022). We estimated Cox models predicting stroke for 44 census tract variables representing de…
Long-term impacts of hurricanes on mortality among Medicare beneficiaries
Objectives Hurricane-related flooding has long-term socioeconomic effects on impacted areas; however, little is known about the long-term health effects on vulnerable, older residents who remain in impacted neighborhoods. We examined mortality rates among older adults who continued living in ZIP Code Tabulation Areas (ZCTAs) impacted by flooding from Hurricane Sandy for up to 5 years after landfall. Methods We conducted a propensity-score matched…
Centering Community Engagement in a Hypertension Clinical Trial
Black Americans residing in rural communities are often excluded from clinical trials for hypertension, despite having a high prevalence of the disease and frequent complications. This report describes our research team's experience to support recruitment and retention of rural Black patients with uncontrolled hypertension in the southeastern United States in a cluster-randomized clinical trial. While the focus of this report is on enrollment and…
Loneliness and Risk of 30-Day Hospital Readmission After Acute Myocardial Infarction
BACKGROUND: Poor social health is linked to incident cardiovascular disease, but less is known about how loneliness affects health care utilization after an acute myocardial infarction (AMI). OBJECTIVE: Determine the association between loneliness and 30-day emergency department (ED) visit or readmission after AMI hospitalization. RESEARCH DESIGN: The REasons for Geographic and Racial Differences in Stroke (REGARDS) study is a national prospectiv…
Clusters of long Covid among patients hospitalized for Covid-19 in New York City
The cluster analysis identified social isolation and loneliness as important features associated with long-COVID symptoms and recovery after hospitalization. It also confirms that social isolation and loneliness, though connected, are not necessarily the same. Physicians need to be aware of how social characteristics relate to long-COVID and patient's ability to cope with the resulting symptoms
Development and validation of mortality prediction models based on the social determinants of health
BACKGROUND: There is no standardised approach to screening adults for social risk factors. The goal of this study was to develop mortality risk prediction models based on the social determinants of health (SDoH) for clinical risk stratification. METHODS: Data were used from REasons for Geographic And Racial Differences in Stroke (REGARDS) study, a national, population-based, longitudinal cohort of black and white Americans aged ≥45 recruited betw…
Ambulatory Care Fragmentation and Total Health Care Costs
BACKGROUND: The magnitude of the relationship between ambulatory care fragmentation and subsequent total health care costs is unclear. OBJECTIVE: To determine the association between ambulatory care fragmentation and total health care costs. RESEARCH DESIGN: Longitudinal analysis of 15 years of data (2004-2018) from the national Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, linked to Medicare fee-for-service claims. SUB…
The association between social functioning and health literacy among rural Southeastern African Americans with hypertension
African Americans living in low socioeconomic circumstances are at high risk of poor health outcomes; this is particularly true for those with hypertension. Many African Americans with chronic hypertension living in the rural impoverished Southeastern USA have low health literacy and are socially isolated. These factors are known to have a negative impact on health outcomes, but it is possible that social support may overcome some of the effect o…
Treatment Intensity, Prescribing Patterns, and Blood Pressure Control in Rural Black Patients with Uncontrolled Hypertension
Rural/urban differences in the prevalence of stroke risk factors
PURPOSE: We previously described the magnitude of rural-urban differences in the prevalence of stroke risk factors and stroke mortality. In this report, we sought to extend the understanding of rural-urban differences in the prevalence of stroke risk factors by using an enhanced definition of rural-urban status and assessing the impact of neighborhood socioeconomic status (nSES) on risk factor differences. METHODS: This analysis included 28,242 p…
The association between neighborhood social and economic environment and prevalent diabetes in urban and rural communities
Participants living in the most disadvantaged neighborhoods had a higher diabetes prevalence in each urban/rural community type and these associations were only partly explained by individual-level sociodemographic factors. In addition to addressing individual-level factors, identifying neighborhood characteristics and how they operate across urban and rural settings may be helpful for informing interventions that target chronic health conditions
Comparing six cardiovascular risk prediction models in Haiti
clinicaltrials.gov NCT03892265
Peer Support Intervention Improves Pain‐Related Outcomes Among Rural Adults With Diabetes and Chronic Pain at 12‐Month Follow‐Up
PURPOSE: Adults with diabetes mellitus (DM) suffer often from chronic pain, yet evidence-based interventions for comorbid pain and DM are scarce. We tested the effect of a peer-led cognitive behavioral training (CBT) intervention on pain self-efficacy (PSE), pain intensity, and pain-related functional limitations (PRFL) in adults with DM, 1 year after trial initiation. METHODS: The yearlong "Living Healthy" cluster-randomized trial included 230 r…
Health care experiences during the Covid-19 pandemic by race and social determinants of health among adults age ≥ 58 years in the REGARDS study
In this national study of older US adults, many participants with potential COVID-19 symptoms and asymptomatic participants who desired testing did not receive COVID-19 testing
Does a physical activity supportive environment ameliorate or exacerbate socioeconomic inequities in incident coronary heart disease
BACKGROUND: Efforts to reduce socioeconomic inequities in cardiovascular disease include interventions to change the built environment. We aimed to explore whether socioeconomic inequities in coronary heart disease (CHD) incidence are ameliorated or exacerbated in environments supportive of physical activity (PA). METHODS: We used data from the Reasons for Geographic and Racial Differences in Stroke study, which recruited US residents aged 45 or …
Ambulatory Care Fragmentation and Subsequent Hospitalization
BACKGROUND: Previous studies have suggested that highly fragmented ambulatory care increases the risk of subsequent hospitalization, but those studies used claims only and were not able to adjust for many clinical potential confounders. OBJECTIVE: The objective of this study was to determine the association between fragmented ambulatory care and subsequent hospitalization, adjusting for demographics, medical conditions, medications, health behavi…
Racial Disparities in Preventable Adverse Events Attributed to Poor Care Coordination Reported in a National Study of Older US Adults
BACKGROUND: Previous work found that Black patients experience worse care coordination than White patients. OBJECTIVE: The aim was to determine if there are racial disparities in self-reported adverse events that could have been prevented with better communication. RESEARCH DESIGN: We used data from a cross-sectional survey that was administered to participants in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study in 2017…
The Haiti cardiovascular disease cohort
The Haiti CVD Cohort is the largest population-based cohort study evaluating CVD risk factors and CVD among adults in urban Haiti with the goal of understanding the drivers of the CVD epidemic in Haiti. Study outcomes are comparable with existing international cohorts, and the biobank will provide important data for future research. Our goal is to translate findings from this study into pragmatic prevention and treatment interventions to fight th…
The Association of Neighborhood Medical Facilities with Aging in Place and Risk of Incident Myocardial Infarction
Objectives: Aging in place (residential stability) is a desirable means of aging where adults remain in their homes, even when facing challenges that impair their capacity for self-care. Residential stability, especially following acute health challenges, depends on individual and community factors, possibly including proximity to medical facilities. Methods: We explored the association between the density of medical facilities around homes with …
Black–White Differences in Cardiovascular Disease Mortality
Objectives. To determine factors that explain the higher Black:White cardiovascular disease (CVD) mortality rates among US adults. Methods. We analyzed data from the Reasons for Geographic and Racial Differences in Stroke study from 2003 to 2017 to estimate Black:White hazard ratios (HRs) for CVD mortality within subgroups younger than 65 years and aged 65 years or older. Results. Among 29 054 participants, 41.0% who were Black and 54.9% who were…
Prevalence of workplace discrimination and mistreatment in a national sample of older U.S. workers
Although workplace discrimination and mistreatment (WDM) has recently drawn widespread media attention, our understanding of the prevalence of these phenomena remains limited. In the current study, we generated national prevalence estimates of WDM from a community-based cohort of employed black and white men and women aged ≥48 years. Measures of WDM in the current job were obtained by computer-assisted telephone interview (2011-2013) involving di…
Using health-related quality of life to predict cardiovascular disease events
Development of a Community Health Worker–Delivered Cognitive Behavioral Training Intervention for Individuals With Diabetes and Chronic Pain
Cognitive behavioral therapy (CBT) programs have the potential to improve quality of life in individuals with chronic pain and diabetes. Rural communities often lack the infrastructure necessary to implement such programs. CBT traditionally requires trained therapists, who are rarely available in these areas. An alternative may be programs delivered by community health workers (CHWs). We present an iterative developmental approach that combined p…
Use of Medicare Claims Data for the Identification of Myocardial Infarction
OBJECTIVES: Assess the validity of Medicare claims for identifying myocardial infarction (MI). METHODS: We used data from 9951 Medicare beneficiaries 65 years and above in the Reasons for Geographic And Racial Differences in Stroke study. Between 2003 and 2012, 669 participants had an MI identified and adjudicated through study procedures (ie, the gold standard), and 552 had an overnight inpatient claim with a code for MI (ICD-9 code 410.x0 or 41…
Addressing Stroke Risk Factors in Black and White Americans
We found that addressed hypertension and hyperlipidemia in stroke naïve participants were significantly lower in Blacks than Whites. Our observations call attention to areas that require further investigation, such as why Black Americans may not be receiving evidence-based pharmacologic therapy for hypertension and hyperlipidemia or why Black Americans are not at goal blood pressure or goal LDL. A better understanding of this information is criti…
Health Behaviors and Quality of Care Among Latinos With Diabetes in Managed Care
Objectives. We evaluated whether ethnicity and language are associated with diabetes care for Latinos in managed care. Methods. Using data from 4685 individuals in the Translating Research Into Action for Diabetes (TRIAD) Study, a multicenter study of diabetes care in managed care, we constructed multivariate regression models to compare health behaviors, processes of care, and intermediate outcomes for Whites and English- and Spanish-speaking La…
Black–White Differences in Cardiovascular Disease Mortality
Objectives. To determine factors that explain the higher Black:White cardiovascular disease (CVD) mortality rates among US adults. Methods. We analyzed data from the Reasons for Geographic and Racial Differences in Stroke study from 2003 to 2017 to estimate Black:White hazard ratios (HRs) for CVD mortality within subgroups younger than 65 years and aged 65 years or older. Results. Among 29 054 participants, 41.0% who were Black and 54.9% who were…
Health Behaviors and Quality of Care Among Latinos With Diabetes in Managed Care
Objectives. We evaluated whether ethnicity and language are associated with diabetes care for Latinos in managed care. Methods. Using data from 4685 individuals in the Translating Research Into Action for Diabetes (TRIAD) Study, a multicenter study of diabetes care in managed care, we constructed multivariate regression models to compare health behaviors, processes of care, and intermediate outcomes for Whites and English- and Spanish-speaking La…
The Association Between Clinical Care Strategies and the Attenuation of Racial/Ethnic Disparities in Diabetes Care
OBJECTIVE: We sought to determine whether greater implementation of clinical care strategies in managed care is associated with attenuation of known racial/ethnic disparities in diabetes care. RESEARCH DESIGN AND METHODS: Using cross-sectional data, we examined the quality of diabetes care as measured by frequencies of process delivery as well as medication management of intermediate outcomes, for 7426 black, Latinos, Asian/Pacific Islanders, and…
Educational disparities in health behaviors among patients with diabetes
The relationship between educational attainment and health behaviors was modest in strength for most behaviors. Over the life course, the cumulative effect of reduced practice of multiple self-care behaviors among less educated patients may play an important part in shaping the social health gradient
Agreement Between Self-Reports and Medical Records Was Only Fair in a Cross-Sectional Study of Performance of Annual Eye Examinations Among Adults With Diabetes in Managed Care
The low level of agreement between self-report and medical records suggests that many providers of diabetes care do not have easily available accurate information on the eye examination status of their patients
Short-Term Statin Exposure Is Associated With Reduced All-Cause Mortality in Persons With Diabetes
BACKGROUND: The survival benefit of statins in nontrial populations of persons with diabetes is unknown. OBJECTIVE: : We sought to determine all-cause mortality in fiscal year 2001 (FY01) after statin initiation in FY 99 and/or FY00 in individuals with diabetes in the Veterans Healthcare Administration (VHA). METHODS: Using a retrospective longitudinal cohort analysis, we analyzed 201,102 veterans with diabetes from 104 VHA facilities with medica…
Educational Disparities in Rates of Smoking Among Diabetic Adults
Objectives. We assessed educational disparities in smoking rates among adults with diabetes in managed care settings. Methods. We used a cross-sectional, survey-based (2002–2003) observational study among 6538 diabetic patients older than 25 years across multiple managed care health plans and states. For smoking at each level of self-reported educational attainment, predicted probabilities were estimated by means of hierarchical logistic regressi…
Can Ambulatory Care Prevent Hospitalization for Metabolic Decompensation
OBJECTIVE: Metabolic decompensations (MD) are hospitalizations considered preventable with appropriate ambulatory care. We tested for associations between diabetes care and MD. RESEARCH DESIGN: We retrospectively compared care between cases (MD; n = 2714) and controls (without MD; n = 10,856) using merged Veterans Health Administration and Medicare data. Logistic regression tested for associations between MD and diabetes care controlling for pati…
Improving the Quality of Quality Measurement
From the University of Alabama at Birmingham, Birmingham, Alabama. Correspondence: Monika M. Safford, MD, 1717 11th Avenue South, MT643, Birmingham, AL 35223-4410, E-mail: [email protected]
Characteristics of Insured Patients With Persistent Gaps in Diabetes Care Services
BACKGROUND: Although preventing diabetes complications requires long-term management, little is known about which patients persistently fail to get recommended care. OBJECTIVE: To determine the frequency and correlates of persistent, long-term gaps in diabetes care. METHOD: : The study population included 8392 patients with diabetes. Patient surveys and medical records from 10 health plans over 3 years provided data on socioeconomic characteristi…
Placebo Adherence, Clinical Outcomes, and Mortality in the Women's Health Initiative Randomized Hormone Therapy Trials
BACKGROUND: Medication adherence may be a proxy for healthy behaviors and other factors that affect outcomes. Prior studies of the association between placebo adherence and health outcomes have been limited primarily to men enrolled in clinical trials and cardiovascular disease outcomes. We examined associations between adherence to placebo and the risk of fracture, coronary heart disease, cancer, and all-cause mortality in the 2 Women's Health I…
Quality of Diabetes Mellitus Care by Rural Primary Care Physicians
Purpose: To explore the relationship between degree of rurality and glucose (hemoglobin A1c), blood pressure (BP), and lipid (LDL) control among patients with diabetes. Methods: Descriptive study; 1,649 patients in 205 rural practices in the United States. Patients’ residence ZIP codes defined degree of rurality (Rural‐Urban Commuting Areas codes). Outcomes were measures of acceptable control (A1c P Findings: Although the proportion of patients w…
Effect of Self-referral on Bone Mineral Density Testing and Osteoporosis Treatment
BACKGROUND: Despite national guidelines recommending bone mineral density screening with dual-energy x-ray absorptiometry (DXA) in women aged 65 years and older, many women do not receive initial screening. OBJECTIVE: To determine the effectiveness of health system and patient-level interventions designed to increase appropriate DXA testing and osteoporosis treatment through (1) an invitation to self-refer for DXA (self-referral); (2) self-referr…
Psychosocial Stress as a Risk Factor for Sepsis
OBJECTIVE: To characterize the relationship between stress and future risk of sepsis. We also evaluated the role of depression in this relationship. METHODS: We used population-based data on 30,183 participants in the Reasons for Geographic and Racial Differences in Stroke cohort, characterizing stress using the Perceived Stress Scale (PSS) and depressive symptoms using the Center for Epidemiologic Studies Depression Scale (CES-D). We identified …
The impact of the combination of income and education on the incidence of coronary heart disease in the prospective Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort study
For younger individuals, low income, regardless of education, was associated with higher risk of CHD, but not observed for ≥ 65 years. Findings suggest that for younger participants, education attainment may not overcome the disadvantage conferred by low income in terms of CHD risk, whereas among those ≥ 65 years, the independent effects of income and education are less pronounced
Addressing Stroke Risk Factors in Black and White Americans
We found that addressed hypertension and hyperlipidemia in stroke naïve participants were significantly lower in Blacks than Whites. Our observations call attention to areas that require further investigation, such as why Black Americans may not be receiving evidence-based pharmacologic therapy for hypertension and hyperlipidemia or why Black Americans are not at goal blood pressure or goal LDL. A better understanding of this information is criti…
Dietary fried fish intake increases risk of CVD
Objective The objective of the present study was to examine the relationship of dietary fried fish consumption and risk of cardiovascular events and all-cause mortality. Design Prospective cohort study among participants of the REasons for Geographic And Racial Differences in Stroke (REGARDS) study who resided in the USA. Setting The primary outcome measures included the hazard ratios (HR) of incident CVD including first incident fatal or non-fat…
US Mortality
Development of a Community Health Worker–Delivered Cognitive Behavioral Training Intervention for Individuals With Diabetes and Chronic Pain
Cognitive behavioral therapy (CBT) programs have the potential to improve quality of life in individuals with chronic pain and diabetes. Rural communities often lack the infrastructure necessary to implement such programs. CBT traditionally requires trained therapists, who are rarely available in these areas. An alternative may be programs delivered by community health workers (CHWs). We present an iterative developmental approach that combined p…
Use of Medicare Claims Data for the Identification of Myocardial Infarction
OBJECTIVES: Assess the validity of Medicare claims for identifying myocardial infarction (MI). METHODS: We used data from 9951 Medicare beneficiaries 65 years and above in the Reasons for Geographic And Racial Differences in Stroke study. Between 2003 and 2012, 669 participants had an MI identified and adjudicated through study procedures (ie, the gold standard), and 552 had an overnight inpatient claim with a code for MI (ICD-9 code 410.x0 or 41…
Prevalence of workplace discrimination and mistreatment in a national sample of older U.S. workers
Although workplace discrimination and mistreatment (WDM) has recently drawn widespread media attention, our understanding of the prevalence of these phenomena remains limited. In the current study, we generated national prevalence estimates of WDM from a community-based cohort of employed black and white men and women aged ≥48 years. Measures of WDM in the current job were obtained by computer-assisted telephone interview (2011-2013) involving di…
Using health-related quality of life to predict cardiovascular disease events
The Haiti cardiovascular disease cohort
The Haiti CVD Cohort is the largest population-based cohort study evaluating CVD risk factors and CVD among adults in urban Haiti with the goal of understanding the drivers of the CVD epidemic in Haiti. Study outcomes are comparable with existing international cohorts, and the biobank will provide important data for future research. Our goal is to translate findings from this study into pragmatic prevention and treatment interventions to fight th…
The Association of Neighborhood Medical Facilities with Aging in Place and Risk of Incident Myocardial Infarction
Objectives: Aging in place (residential stability) is a desirable means of aging where adults remain in their homes, even when facing challenges that impair their capacity for self-care. Residential stability, especially following acute health challenges, depends on individual and community factors, possibly including proximity to medical facilities. Methods: We explored the association between the density of medical facilities around homes with …
Black–White Differences in Cardiovascular Disease Mortality
Objectives. To determine factors that explain the higher Black:White cardiovascular disease (CVD) mortality rates among US adults. Methods. We analyzed data from the Reasons for Geographic and Racial Differences in Stroke study from 2003 to 2017 to estimate Black:White hazard ratios (HRs) for CVD mortality within subgroups younger than 65 years and aged 65 years or older. Results. Among 29 054 participants, 41.0% who were Black and 54.9% who were…
Peer Support Intervention Improves Pain‐Related Outcomes Among Rural Adults With Diabetes and Chronic Pain at 12‐Month Follow‐Up
PURPOSE: Adults with diabetes mellitus (DM) suffer often from chronic pain, yet evidence-based interventions for comorbid pain and DM are scarce. We tested the effect of a peer-led cognitive behavioral training (CBT) intervention on pain self-efficacy (PSE), pain intensity, and pain-related functional limitations (PRFL) in adults with DM, 1 year after trial initiation. METHODS: The yearlong "Living Healthy" cluster-randomized trial included 230 r…
Medicine (37 obras) · Internal Medicine (25 obras) · Environmental health (20 obras) · Gerontology (20 obras) · Demography (16 obras) · Population (14 obras) · Confidence interval (13 obras) · Diabetes mellitus (13 obras) · Internal Medicine (13 obras) · Gerontology (11 obras)