Background: Despite profound disparities in stroke mortality, there is limited research on geographic variation across and within US racial and ethnic populations. Research Question/Hypothesis: Do geographic trends in stroke mortality vary across and within racial and ethnic populations living in the US? We hypothesized that changes in county-level stroke mortality would vary across and within racial and ethnic groups. Methods: We applied validated small-area estimation methods to US National Vital Statistics System death certificates to estimate stroke mortality rates by county (N=3110) and race and ethnicity (American Indian or Alaska Native [AIAN], Asian, Black, Hispanic or Latino [Latino], and White) from 2000-19. Mortality estimates were corrected for race and ethnicity misclassification on death certificates and age-standardized to the 2010 Census. Results: In 2019, age-standardized county-level stroke mortality rates per 100,000 ranged from 10.9 to 170.6 among AIAN, 11.8 to 96.9 among Asian, 17.4 to 179.7 among Black, 6.5 to 114.3 among Latino, and 14.5 to 139.7 among White populations. Despite stroke mortality declining nationally among all racial and ethnic populations, there were counties where mortality increased (AIAN: 15/474; Asian: 46/667; Black: 11/1488; Latino: 154/1478; White: 46/3051), Fig . Among these counties, median absolute increases were 3.5 (IQR 1.9-5.3; max: 26.8) among AIAN, 4.1 (1.1-5.4; max: 12.2) among Asian, 7.1 (1.0-10.2; max: 52.5) among Black, 2.4 (1.3-4.6; max: 18.3) among Latino, and 5.6 (1.9-12.3; max: 47.5) among White populations. Increased stroke mortality largely occurred in the Carolinas, Florida, and Georgia (72.4% of counties with increases) for all racial and ethnic groups except AIAN, which were mostly in Oklahoma (n=9). Geographic and temporal trends also varied across stroke type. Conclusions: Stroke mortality increased in over 200 counties nationally, with differential effects by race and ethnicity. Most increases occurred in the lower South Atlantic states. These findings underscore the importance of understanding drivers of stroke mortality disparities, as well as creating prevention and treatment strategies that target populations and places at high risk.

Stroke

10.1161/circ.150.suppl_1.4142467

Cite

Citations (0)

Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990–2019: a systematic analysis from the Global Burden of Disease Study 2019

The Lancet (2021)

Marissa B Reitsma Parkes Kendrick Emad Ababneh Cristiana Abbafati Mohsen Abbasi‐Kangevari

Summary

Background

Ending the global tobacco epidemic is a defining challenge in global health. Timely and comprehensive estimates of the prevalence of smoking tobacco use and attributable disease burden are needed to guide tobacco control efforts nationally and globally.

Methods

We estimated the prevalence of smoking tobacco use and attributable disease burden for 204 countries and territories, by age and sex, from 1990 to 2019 as part of the Global Burden of Diseases, Injuries, and Risk Factors Study. We modelled multiple smoking-related indicators from 3625 nationally representative surveys. We completed systematic reviews and did Bayesian meta-regressions for 36 causally linked health outcomes to estimate non-linear dose-response risk curves for current and former smokers. We used a direct estimation approach to estimate attributable burden, providing more comprehensive estimates of the health effects of smoking than previously available.

Findings

Globally in 2019, 1·14 billion (95% uncertainty interval 1·13–1·16) individuals were current smokers, who consumed 7·41 trillion (7·11–7·74) cigarette-equivalents of tobacco in 2019. Although prevalence of smoking had decreased significantly since 1990 among both males (27·5% [26·5–28·5] reduction) and females (37·7% [35·4–39·9] reduction) aged 15 years and older, population growth has led to a significant increase in the total number of smokers from 0·99 billion (0·98–1·00) in 1990. Globally in 2019, smoking tobacco use accounted for 7·69 million (7·16–8·20) deaths and 200 million (185–214) disability-adjusted life-years, and was the leading risk factor for death among males (20·2% [19·3–21·1] of male deaths). 6·68 million [86·9%] of 7·69 million deaths attributable to smoking tobacco use were among current smokers.

Interpretation

In the absence of intervention, the annual toll of 7·69 million deaths and 200 million disability-adjusted life-years attributable to smoking will increase over the coming decades. Substantial progress in reducing the prevalence of smoking tobacco use has been observed in countries from all regions and at all stages of development, but a large implementation gap remains for tobacco control. Countries have a clear and urgent opportunity to pass strong, evidence-based policies to accelerate reductions in the prevalence of smoking and reap massive health benefits for their citizens.

Funding

Bloomberg Philanthropies and the Bill & Melinda Gates Foundation.

Global Health

Smoking prevalence

10.1016/s0140-6736(21)01169-7

Cite

Citations (1,014)

Sex differences in the associations of water, coffee and tea consumption with cardiovascular diseases: a prospective cohort study

Frontiers in Nutrition (2025)

Dandan Ke Yueqing Wang Yabing Hou Weihao Shao Parkes Kendrick

Background Water, coffee and tea are the primary sources of daily hydration. However, the sex-specific relationship between these beverages and cardiovascular disease (CVD) among remains unclear. Methods In total, 210,239 men and 251,383 women from the UK Biobank were included. The consumption of water, coffee and tea were self-reported. CVDs, including coronary heart disease (CHD), stroke and heart failure (HF) were followed till March 1st, 2023. Sex-specific Cox models were utilized to evaluate the hazard ratios (HRs) and 95% confidence intervals (CIs) for the associations. Results During a median follow-up of 8.7 years, 11,098 (2.40%) participants developed new-onset HF, 33,426 (7.24%) participants developed new-onset CHD, and 9,706 (2.10%) participants developed new-onset stroke. After adjustments, higher water consumption was generally associated with reduced risk of CVDs among both men and women. In contrast, heavy coffee consumption (particularly ≥6 cups/day) was associated with a greater risk of HF [1.16 (1.03–1.31) in men vs. 1.25 (1.12–1.40) in women], a greater risk of CHD [1.27 (1.18–1.36) in men vs. 1.21 (1.14–1.29) in women] and a greater risk of stroke [1.13 (0.99–1.29) in men vs. 1.20 (1.03–1.31) in women]. Similarly, heavy tea consumption was associated with an increased risk of HF (men: HR 1.19 [1.08–1.31]; women: HR 1.12 [1.02–1.23]) and CHD (men: HR 1.12 [1.05–1.18]; women: HR 1.18 [1.12–1.24]). Conclusion Our study revealed that water consumption was associated with a lower risk of CVDs, with a lower risk of CVDs, while heavy coffee or tea consumption was linked to a higher risk. Notably, coffee and tea consumption partially attenuated the protective association of water intake with CVDs. Furthermore, significant sex differences were observed in the associations between coffee or tea consumption and CHD incidence.

Stroke

10.3389/fnut.2025.1530908

Cite

Citations (0)

Mechanism of chronic stress to promote tumor development and the intervention.

PubMed (2022)

Yi Liu Yue Zeng Yizheng Li Parkes Kendrick Yue Pan

Chronic stress is a serial of non-specific neuroendocrine reactions in the body when stimulated by stressors for a long time, which has been shown to have a significant effect on tumor development. Chronic stress can activate the hypothalamus-pituitary-adrenal axis and the sense-adrenal myelin system, promote catecholamine and adrenal corticosteroid secretion, regulate the downstream pathways at all levels, and modulate the secretion of immune cells and immune factors, inhibit protective immune response, and induce inflammation, thus promoting tumor cell proliferation and metastasis. Some drugs and psychotherapy can alleviate the patient's stress state, block the nerve signal transmission at all levels of access, regulate the immune system, or can become an effective means to intervene in chronic stress in tumor patients for clinical treatment to provide reference for intervention ideas. However, due to lack of relevant clinical trials, the clinical intervention effect of various drugs and psychotherapy is uncertain and needs more studies to verify the effect.

Chronic Stress

10.11817/j.issn.1672-7347.2022.210589

Cite

Citations (0)

Adjuvant EGFR tyrosine kinase inhibitors for patients with resected EGFR-mutated non-small-cell lung cancer: a network meta-analysis

Future Oncology (2022)

Wentao Tian Nuopei Tan Parkes Kendrick Jian Zou Xiaohan Liu

Aim: To investigate the efficacy and safety of adjuvant EGFR tyrosine kinase inhibitors for resected EGFR-mutated non-small-cell lung cancer. Materials & methods: Eligible phase II/III randomized controlled trials were included for the network meta-analyses (PROSPERO CRD42021275150). Results: Nine records and 831 patients were involved. Adjuvant chemotherapy followed with osimertinib significantly prolonged disease-free survival compared with chemotherapy (hazard ratio [HR]: 0.2; 95% CI: 0.14–0.29), chemotherapy followed with erlotinib (HR: 0.33; 95% CI: 0.18–0.6), chemotherapy followed with gefitinib (HR: 0.36; 95% CI: 0.16–0.82), gefitinib (HR: 0.26; 95% CI: 0.17–0.41) and icotinib (HR: 0.56; 95% CI: 0.3–0.98). Icotinib was the least likely to cause grade ≥3 adverse events. Conclusion: Chemotherapy followed with osimertinib brings about the best disease-free survival. Icotinib monotherapy shows the best safety.

Osimertinib

10.2217/fon-2021-1614

Cite

Citations (1)

Cause-specific mortality by county, race, and ethnicity in the USA, 2000–19: a systematic analysis of health disparities

The Lancet (2023)

Laura Dwyer‐Lindgren Parkes Kendrick Yekaterina O Kelly Mathew M Baumann Kelly Compton

Race and health

10.1016/s0140-6736(23)01088-7

Cite

Citations (57)

Life expectancy by county, race, and ethnicity in the USA, 2000–19: a systematic analysis of health disparities

The Lancet (2022)

Laura Dwyer‐Lindgren Parkes Kendrick Yekaterina O Kelly Dillon O Sylte Chris Schmidt

10.1016/s0140-6736(22)00876-5

Cite

Citations (152)

Disparities in wellbeing in the USA by race and ethnicity, age, sex, and location, 2008–21: an analysis using the Human Development Index

The Lancet (2024)

Laura Dwyer‐Lindgren Parkes Kendrick Mathew M Baumann Zhuochen Li Chris Schmidt

Human Development Index

10.1016/s0140-6736(24)01757-4

Cite

Citations (5)

Cardiovascular health and risks of atrial fibrillation and its prognosis

American Journal of Preventive Cardiology (2024)

Zuolin Lu Parkes Kendrick Hongxi Yang Xiaoxuan Zhang Yachen Wang

Atrial fibrillation (AF) is the most common cardiac arrhythmia around the world with an increased risk of a broad spectrum of adverse comorbidities and death. Whether cardiovascular health (CVH) is associated with AF development remains unclear. 238,420 participants without cardiovascular disease at baseline were selected from the UK Biobank study cohort from 2006 to 2010. CVH was defined based on "Life's Essential 8″ scores. Sex-specific multi-state Markov and flexible parametric survival models were used to estimate the hazard ratio (HR) and 95 % confidence intervals (95 % CI) for the associations of CVH with incident AF and its prognosis. In fully-adjusted models, CVH is significantly associated with a reduced risk of incident AF among both men and women, after accounting for the potential impact of death. Among AF patients without other evaluated diseases, a higher CVH score was generally linked with a reduced risk of death in both sexes. Among AF patients with incident prognostic diseases, only CVH associated with death following heart failure (0.78, 0.63-0.97) was observed among men, whereas CVH was significantly associated with death following coronary heart disease (0.80, 0.69-0.93), stroke (0.73, 0.61-0.89) and dementia (0.79, 0.71-1.03) among women. We found significant associations between CVH and the risk reduction of incident AF and its prognostic outcomes, with these associations being more pronounced among women. Findings suggest a potential of screening CVH for both primary prevention of new-onset AF and the secondary prevention to improve AF prognosis.

10.1016/j.ajpc.2024.100915

Cite

Citations (0)