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Trauma Recidivism Predicts Long-term Mortality: Missed Opportunities for Prevention (Retrospective Cohort Study). Ann Surg 2017; 265:847-853. [PMID: 27280506 DOI: 10.1097/sla.0000000000001823] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The objectives of this study were to determine the association between recurrent trauma admissions (recidivism) and subsequent long-term mortality, and to identify those in most need for preventive interventions. BACKGROUND Patients with a single intentional injury have been shown to have a higher risk of future injury mortality than those with unintentional injury with 5-year mortality rates as high as 20% being reported for recurrent penetrating trauma. Trauma recidivism identifies a high-risk population, but its association with long-term mortality is largely unknown. METHODS Patients with 1 or more previous admissions to an urban trauma center (recidivists) were identified and compared with those with single admissions (nonrecidivists) from 1997 to 2008. The trauma registry was linked to the National Death Index to determine both the cause and time to death after hospital discharge. Statistical analysis included chi-square tests, Kaplan-Meier survival curves, and Cox proportional-hazards models. RESULTS Trauma recidivists were 7% of the total trauma population from 1997 to 2008, representing 3147 patients. Recidivists were more likely to be male (P < 0.0001), Black (P < 0.0001), have a blood alcohol content above 80 mg/dL (P < 0.0001), and suffer a penetrating injury (P < 0.0001) compared with nonrecidivists. Recidivists with both initial blunt and penetrating injuries had higher rates of long-term mortality after discharge. Recidivists were more likely to die of any cause based on Cox proportional-hazard ratios [hazard ratio (HR) 1.77, 95% confidence interval (CI) 1.57-2.01], injury death (HR 2.02, 95% CI 1.66-2.47), and disease death (HR 1.65, 95% CI 1.41-1.92) than nonrecidivists. CONCLUSIONS Male sex, Black race, and elevated blood alcohol content and penetrating injury are associated with trauma recidivism which leads to a higher risk of death. There is a critical public health need to develop interventions to reduce trauma recidivism and preventable death.
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Strong BL, Torain JM, Greene CR, Smith GS. Outcomes of trauma admission for falls: influence of race and age on inhospital and post-discharge mortality. Am J Surg 2016; 212:638-644. [PMID: 27640909 DOI: 10.1016/j.amjsurg.2016.06.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 03/16/2016] [Accepted: 06/27/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Racial disparities in trauma outcomes occur, but disparities in fall mortality are unknown. The objective of this study was to determine inhospital and 1-year fall mortality among patients discharged from an urban trauma center. METHODS We conducted a retrospective analysis of fall patients in our trauma registry (1997 to 2008) linked to the National Death Index to determine postdischarge mortality. Statistical analysis included chi-square tests, multivariable logistic regression, and Cox proportional hazards models. RESULTS There were 7,541 fall admissions. There was no clinically significant difference in inhospital mortality between blacks and whites with age stratification. One year after discharge, blacks younger than 65 years were more likely to die of disease (hazard ratio, 1.37; 95% confidence interval, 1.14 to 1.62). CONCLUSIONS Although rates of inhospital mortality are similar, blacks younger than 65 years have a higher risk of dying after discharge due to disease when stratified by age highlighting the need for continued medical follow-up and prevention efforts.
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Affiliation(s)
- Bethany L Strong
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, 601 West Lombard Street, Baltimore, MD 21201, USA.
| | - Jamila M Torain
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, 601 West Lombard Street, Baltimore, MD 21201, USA
| | - Christina R Greene
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, 601 West Lombard Street, Baltimore, MD 21201, USA
| | - Gordon S Smith
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, 601 West Lombard Street, Baltimore, MD 21201, USA
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Midkiff KD, Andrews EB, Gilsenan AW, Deapen DM, Harris DH, Schymura MJ, Hornicek FJ. The experience of accommodating privacy restrictions during implementation of a large-scale surveillance study of an osteoporosis medication. Pharmacoepidemiol Drug Saf 2016; 25:960-8. [PMID: 27091234 PMCID: PMC5074316 DOI: 10.1002/pds.4008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 02/15/2016] [Accepted: 03/14/2016] [Indexed: 11/15/2022]
Abstract
Purpose To explore whether privacy restrictions developed to protect patients have complicated research within a 15‐year surveillance study conducted with US cancer registries. Methods Data from enrolling 27 cancer registries over a 10‐year period were examined to describe the amount of time needed to obtain study approval. We also analyzed the proportion of patients that completed a research interview out of the total reported by the registries and examined factors thought to influence this measure. Results The average length of the research review process from submission to approval of the research was 7 months (range, <1 to 24 months), and it took 6 months or more to obtain approval of the research at 41% of the cancer registries. Most registries (78%) required additional permission steps to gain access to patients for research. After adjustment for covariates, the interview response proportion was 110% greater (ratio of response proportion = 2.1; 95% confidence interval: 1.3, 3.3) when the least restrictive versus the most restrictive permission steps were required. An interview was more often completed for patients (or proxies) if patients were alive, within a year of being diagnosed, or identified earlier in the study. Conclusions Lengthy research review processes increased the time between diagnosis and provision of patient information to the researcher. Requiring physician permission for access to patients was associated with lower subject participation. A single national point of entry for use of cancer registry data in health research is worthy of consideration to make the research approval process efficient. © 2016 The Authors. Pharmacoepidemiology and Drug Safety published by John Wiley & Sons Ltd.
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Affiliation(s)
- Kirk D Midkiff
- Department of Pharmacoepidemiology and Risk Management, RTI Health Solutions, RTI International, Research Triangle Park, NC, USA
| | - Elizabeth B Andrews
- Department of Pharmacoepidemiology and Risk Management, RTI Health Solutions, RTI International, Research Triangle Park, NC, USA
| | - Alicia W Gilsenan
- Department of Pharmacoepidemiology and Risk Management, RTI Health Solutions, RTI International, Research Triangle Park, NC, USA
| | - Dennis M Deapen
- Los Angeles Cancer Surveillance Program, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - David H Harris
- Department of Pharmacoepidemiology and Risk Management, RTI Health Solutions, RTI International, Research Triangle Park, NC, USA
| | - Maria J Schymura
- New York State Cancer Registry, New York State Department of Health, Albany, NY, USA
| | - Francis J Hornicek
- Center for Sarcoma and Connective Tissue Oncology, Massachusetts General Hospital, Boston, MA, USA
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Haider AH, Young JH, Kisat M, Villegas CV, Scott VK, Ladha KS, Haut ER, Cornwell EE, MacKenzie EJ, Efron DT. Association between intentional injury and long-term survival after trauma. Ann Surg 2014; 259:985-92. [PMID: 24487746 PMCID: PMC5995318 DOI: 10.1097/sla.0000000000000486] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the risk-adjusted mortality of intentionally injured patients within 7 to 9 years postinjury, compared with unintentionally injured patients. BACKGROUND Violent injury contributes significantly to trauma mortality in the United States. Homicide is the second leading killer of American youth, aged 15 to 24 years. Long-term survival among intentionally injured patients has not been well studied. It is also unknown whether intentionally injured patients have worse long-term survival compared with unintentionally or accidentally injured patients with equivalent injuries. METHODS Adult trauma patients admitted for 24 hours or more and discharged alive from the Johns Hopkins Hospital from January 1, 1998, to December 31, 2000, were included. The primary outcome was mortality within 7 to 9 years postinjury. Long-term patient survival was determined using the National Death Index. The association between injury intentionality and mortality was investigated using a Cox proportional hazard regression model, adjusted for confounders such as injury severity and patient race, socioeconomic status, and comorbid conditions. Overall differences in survival between those with intentional versus unintentional injury were also determined by comparing adjusted Kaplan-Meier survival curves. RESULTS A total of 2062 patients met inclusion criteria. Of these, 56.4% were intentionally injured and 43.6% were unintentionally injured. Compared with unintentionally injured patients, intentionally injured patients were younger and more often male and from a zip code with low median household income. Approximately 15% of all patients had died within 7 to 9 years of follow-up. Older age and presence of comorbidities were associated with this outcome; however, intentional injury was not found to be significantly associated with long-term mortality rates. There was also no significant difference in survival curves between groups; intentionally injured patients were much more likely to die of a subsequent injury, whereas those with unintentional injury commonly died of noninjury causes. CONCLUSIONS There was no significant difference in mortality between intentionally injured and unintentionally injured patients within 7 to 9 years postinjury. These results confirm the long-term effectiveness of lifesaving trauma care for those with intentional injury. However, given that patients with intentional injuries were more likely to suffer a subsequent violent death, interventions focused on breaking the cycle of violence are needed.
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Affiliation(s)
- Adil H Haider
- *Department of Surgery, Center for Surgical Trials and Outcomes Research, The Johns Hopkins University School of Medicine, Baltimore, MD †Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD ‡Department of Surgery, Howard University College of Medicine, Washington, DC §Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Lee IM, Wolin KY, Freeman SE, Sattlemair J, Sesso HD. Physical activity and survival after cancer diagnosis in men. J Phys Act Health 2014; 11:85-90. [PMID: 23250326 PMCID: PMC3610766 DOI: 10.1123/jpah.2011-0257] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND The number of cancer survivors is increasing rapidly; however, little is known about whether engaging in physical activity after a cancer diagnosis is associated with lower mortality rates in men. METHODS We conducted a prospective cohort study of 1021 men (mean age, 71.3 years) who were diagnosed with cancer (other than nonmelanoma skin cancer). Men reported their physical activities (walking, stair climbing, and participation in sports and recreational activities) on questionnaires in 1988, a median of 6 years after their cancer diagnosis. Physical activity was updated in 1993 and men were followed until 2008, with mortality follow-up > 99% complete, during which 777 men died (337 from cancer, 190 from cardiovascular disease). RESULTS In multivariate analyses, the relative risks for all-cause mortality associated with expending < 2100, 2100-4199, 4200-8399, 8400-12,599, and ≥ 12,600 kJ/week in physical activity were 1.00 (referent), 0.77, 0.74, 0.76, and 0.52, respectively (P-trend < 0.0001). Higher levels of physical activity also were associated with lower rates of death from cancer and cardiovascular disease (P- trend = 0.01 and 0.002, respectively). CONCLUSIONS Engaging in physical activity after cancer diagnosis is associated with better survival among men.
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Affiliation(s)
- I-Min Lee
- Division of Preventive Medicine, Harvard Medical School, Boston, MA
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Schneider RH, Grim CE, Rainforth MV, Kotchen T, Nidich SI, Gaylord-King C, Salerno JW, Kotchen JM, Alexander CN. Stress reduction in the secondary prevention of cardiovascular disease: randomized, controlled trial of transcendental meditation and health education in Blacks. Circ Cardiovasc Qual Outcomes 2012; 5:750-8. [PMID: 23149426 DOI: 10.1161/circoutcomes.112.967406] [Citation(s) in RCA: 133] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Blacks have disproportionately high rates of cardiovascular disease. Psychosocial stress may contribute to this disparity. Previous trials on stress reduction with the Transcendental Meditation (TM) program have reported improvements in cardiovascular disease risk factors, surrogate end points, and mortality in blacks and other populations. METHODS AND RESULTS This was a randomized, controlled trial of 201 black men and women with coronary heart disease who were randomized to the TM program or health education. The primary end point was the composite of all-cause mortality, myocardial infarction, or stroke. Secondary end points included the composite of cardiovascular mortality, revascularizations, and cardiovascular hospitalizations; blood pressure; psychosocial stress factors; and lifestyle behaviors. During an average follow-up of 5.4 years, there was a 48% risk reduction in the primary end point in the TM group (hazard ratio, 0.52; 95% confidence interval, 0.29-0.92; P=0.025). The TM group also showed a 24% risk reduction in the secondary end point (hazard ratio, 0.76; 95% confidence interval, 0.51-0.1.13; P=0.17). There were reductions of 4.9 mmHg in systolic blood pressure (95% confidence interval -8.3 to -1.5 mmHg; P=0.01) and anger expression (P<0.05 for all scales). Adherence was associated with survival. CONCLUSIONS A selected mind-body intervention, the TM program, significantly reduced risk for mortality, myocardial infarction, and stroke in coronary heart disease patients. These changes were associated with lower blood pressure and psychosocial stress factors. Therefore, this practice may be clinically useful in the secondary prevention of cardiovascular disease. Clinical Trial Registration- URL: www.clinicaltrials.gov Unique identifier: NCT01299935.
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Affiliation(s)
- Robert H Schneider
- Institute for Natural Medicine and Prevention, Maharishi University of Management, Fairfield, IA, USA
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Wolfe F, Michaud K. Effect of body mass index on mortality and clinical status in rheumatoid arthritis. Arthritis Care Res (Hoboken) 2012; 64:1471-9. [DOI: 10.1002/acr.21627] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Ford ES, Bergmann MM, Boeing H, Li C, Capewell S. Healthy lifestyle behaviors and all-cause mortality among adults in the United States. Prev Med 2012; 55:23-7. [PMID: 22564893 PMCID: PMC4688898 DOI: 10.1016/j.ypmed.2012.04.016] [Citation(s) in RCA: 168] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Revised: 04/20/2012] [Accepted: 04/23/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To examine the links between three fundamental healthy lifestyle behaviors (not smoking, healthy diet, and adequate physical activity) and all-cause mortality in a national sample of adults in the United States. METHOD We used data from 8375 U.S. participants aged ≥ 20 years of the National Health and Nutrition Examination Survey 1999-2002 who were followed through 2006. RESULTS During a mean follow-up of 5.7 years, 745 deaths occurred. Compared with their counterparts, the risk for all-cause mortality was reduced by 56% (95% confidence interval [CI]: 35%-70%) among adults who were nonsmokers, 47% (95% CI: 36%, 57%) among adults who were physically active, and 26% (95% CI: 4%, 42%) among adults who consumed a healthy diet. Compared with participants who had no healthy behaviors, the risk decreased progressively as the number of healthy behaviors increased. Adjusted hazard ratios and 95% confidence interval were 0.60 (0.38, 0.95), 0.45 (0.30, 0.67), and 0.18 (0.11, 0.29) for 1, 2, and 3 healthy behaviors, respectively. CONCLUSION Adults who do not smoke, consume a healthy diet, and engage in sufficient physical activity can substantially reduce their risk for early death.
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Affiliation(s)
- Earl S Ford
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.
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Ford ES. Combined television viewing and computer use and mortality from all-causes and diseases of the circulatory system among adults in the United States. BMC Public Health 2012; 12:70. [PMID: 22269463 PMCID: PMC3398267 DOI: 10.1186/1471-2458-12-70] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Accepted: 01/23/2012] [Indexed: 12/27/2022] Open
Abstract
Background Watching television and using a computer are increasingly common sedentary behaviors. Whether or not prolonged screen time increases the risk for mortality remains uncertain. Methods Mortality for 7,350 adults aged ≥ 20 years who participated in the National Health and Nutrition Examination Survey during 1999-2002 and were followed through 2006 was examined. Participants were asked a single question about the amount of time they spent watching television or videos or using a computer during the past 30 days. Results During a median follow-up of 5.8 years, 542 participants died. At baseline, 12.7% of participants reported watching television or using a computer less than 1 h per day, 16.4% did so for 1 h, 27.8% for 2 h, 18.7% for 3 h, 10.9% for 4 h, and 13.5% for 5 or more h. After extensive adjustment, the hazard ratio for all-cause mortality for the top category of exposure was 1.30 (95% confidence interval: 0.82, 2.05). No significant trend across categories of exposure was noted. The amount of screen time was also not significantly related to mortality from diseases of the circulatory system. Conclusions In the present study, screen time did not significantly predict mortality from all-causes and diseases of the circulatory system.
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Affiliation(s)
- Earl S Ford
- Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.
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Wang H, Steffen LM, Jacobs DR, Zhou X, Blackburn H, Berger AK, Filion KB, Luepker RV. Trends in cardiovascular risk factor levels in the Minnesota Heart Survey (1980-2002) as compared with the National Health and Nutrition Examination Survey (1976-2002): A partial explanation for Minnesota's low cardiovascular disease mortality? Am J Epidemiol 2011; 173:526-38. [PMID: 21273396 DOI: 10.1093/aje/kwq367] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The authors compared trends in and levels of coronary heart disease (CHD) risk factors between the Minneapolis-St. Paul, Minnesota, metropolitan area (Twin Cities) and the entire US population to help explain the ongoing decline in US CHD mortality rates. The study populations for risk factors were adults aged 25-74 years enrolled in 2 population-based surveillance studies: the Minnesota Heart Survey (MHS) in 1980-1982, 1985-1987, 1990-1992, 1995-1997, and 2000-2002 and the National Health and Nutrition Examination Survey (NHANES) in 1976-1980, 1988-1994, 1999-2000, and 2001-2002. The authors found a continuous decline in CHD mortality rates in the Twin Cities and nationally between 1980 and 2000. Similar decreasing rates of change in risk factors across survey years, parallel to the CHD mortality rate decline, were observed in MHS and in NHANES. Adults in MHS had generally lower levels of CHD risk factors than NHANES adults, consistent with the CHD mortality rate difference. Approximately 47% of women and 44% of men in MHS had no elevated CHD risk factors, including smoking, hypertension, high cholesterol, and obesity, versus 36% of women and 34% of men in NHANES. The better CHD risk factor profile in the Twin Cities may partly explain the lower CHD death rate there.
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Affiliation(s)
- Huifen Wang
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, 55454, USA
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Wolfe F, Hassett AL, Walitt B, Michaud K. Mortality in fibromyalgia: A study of 8,186 patients over thirty-five years. Arthritis Care Res (Hoboken) 2010; 63:94-101. [DOI: 10.1002/acr.20301] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2010] [Accepted: 07/07/2010] [Indexed: 11/08/2022]
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Brown DW. Complete edentulism prior to the age of 65 years is associated with all-cause mortality. J Public Health Dent 2010; 69:260-6. [PMID: 19453862 DOI: 10.1111/j.1752-7325.2009.00132.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE We examine the relationship between complete edentulism prior to the age of 65 years and all-cause mortality after adjustment for socioeconomic characteristics. METHODS Using data from 41,000 adult participants in the 1986 National Health interview Survey with mortality follow-up data on each cohort member through December 31, 2002 (16 years follow-up), we estimated the relative odds of all-cause mortality among adults (age > or =18 years) with complete edentulism prior to the age of 65 years compared with that among those without the condition. Multivariable-adjusted logistic regression analyses were repeated for complete edentulism at any age. RESULTS The age-standardized prevalence of complete edentulism was 12.3 percent [95 percent confidence interval (CI), 12.0-12.6]. Among persons aged <65 years, the risk of death from all causes was 19 percent for persons with complete edentulism compared to 10 percent for persons without. Compared with those without complete tooth loss, the risk of death from all causes was 1.5 (95 percent CI, 1.3-1.7) (P < 0.001) times greater for persons with complete edentulism prior to the age of 65 years after multivariable adjustment. Similar results were observed for complete edentulism among persons aged > or =65 years. CONCLUSIONS Complete edentulism prior to the age of 65 years was associated with all-cause mortality after multivariable adjustment for several socioeconomic characteristics. These results provide further evidence supporting the notion that poor oral health as evidenced by complete edentulism is an important public health issue across the lifespan.
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Affiliation(s)
- David W Brown
- Centers for Disease Control and Prevention, 4770 Buford Highway NE (MS K67), Atlanta, GA 30341, USA.
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Brown DW, Anda RF, Felitti VJ, Edwards VJ, Malarcher AM, Croft JB, Giles WH. Adverse childhood experiences are associated with the risk of lung cancer: a prospective cohort study. BMC Public Health 2010; 10:20. [PMID: 20085623 PMCID: PMC2826284 DOI: 10.1186/1471-2458-10-20] [Citation(s) in RCA: 215] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2009] [Accepted: 01/19/2010] [Indexed: 11/27/2022] Open
Abstract
Background Strong relationships between exposure to childhood traumatic stressors and smoking behaviours inspire the question whether these adverse childhood experiences (ACEs) are associated with an increased risk of lung cancer during adulthood. Methods Baseline survey data on health behaviours, health status and exposure to adverse childhood experiences (ACEs) were collected from 17,337 adults during 1995-1997. ACEs included abuse (emotional, physical, sexual), witnessing domestic violence, parental separation or divorce, or growing up in a household where members with mentally ill, substance abusers, or sent to prison. We used the ACE score (an integer count of the 8 categories of ACEs) as a measure of cumulative exposure to traumatic stress during childhood. Two methods of case ascertainment were used to identify incident lung cancer through 2005 follow-up: 1) hospital discharge records and 2) mortality records obtained from the National Death Index. Results The ACE score showed a graded relationship to smoking behaviors. We identified 64 cases of lung cancer through hospital discharge records (age-standardized risk = 201 × 100,000-1 population) and 111 cases of lung cancer through mortality records (age-standardized mortality rate = 31.1 × 100,000-1 person-years). The ACE score also showed a graded relationship to the incidence of lung cancer for cases identified through hospital discharge (P = 0.0004), mortality (P = 0.025), and both methods combined (P = 0.001). Compared to persons without ACEs, the risk of lung cancer for those with ≥ 6 ACEs was increased approximately 3-fold (hospital records: RR = 3.18, 95%CI = 0.71-14.15; mortality records: RR = 3.55, 95%CI = 1.25-10.09; hospital or mortality records: RR = 2.70, 95%CI = 0.94-7.72). After a priori consideration of a causal pathway (i.e., ACEs → smoking → lung cancer), risk ratios were attenuated toward the null, although not completely. For lung cancer identified through hospital or mortality records, persons with ≥ 6 ACEs were roughly 13 years younger on average at presentation than those without ACEs. Conclusions Adverse childhood experiences may be associated with an increased risk of lung cancer, particularly premature death from lung cancer. The increase in risk may only be partly explained by smoking suggesting other possible mechanisms by which ACEs may contribute to the occurrence of lung cancer.
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Affiliation(s)
- David W Brown
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
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Brown DW, Anda RF, Tiemeier H, Felitti VJ, Edwards VJ, Croft JB, Giles WH. Adverse childhood experiences and the risk of premature mortality. Am J Prev Med 2009; 37:389-96. [PMID: 19840693 DOI: 10.1016/j.amepre.2009.06.021] [Citation(s) in RCA: 643] [Impact Index Per Article: 42.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2009] [Revised: 06/05/2009] [Accepted: 06/30/2009] [Indexed: 11/28/2022]
Abstract
BACKGROUND Strong, graded relationships between exposure to childhood traumatic stressors and numerous negative health behaviors and outcomes, healthcare utilization, and overall health status inspired the question of whether these adverse childhood experiences (ACEs) are associated with premature death during adulthood. PURPOSE This study aims to determine whether ACEs are associated with an increased risk of premature death during adulthood. METHODS Baseline survey data on health behaviors, health status, and exposure to ACEs were collected from 17,337 adults aged >18 years during 1995-1997. The ACEs included abuse (emotional, physical, sexual); witnessing domestic violence; parental separation or divorce; and growing up in a household where members were mentally ill, substance abusers, or sent to prison. The ACE score (an integer count of the eight categories of ACEs) was used as a measure of cumulative exposure to traumatic stress during childhood. Deaths were identified during follow-up assessments (between baseline appointment date and December 31, 2006) using mortality records obtained from a search of the National Death Index. Expected years of life lost (YLL) and years of potential life lost (YPLL) were computed using standard methods. The relative risk of death from all causes at age < or =65 years and at age < or =75 years was estimated across the number of categories of ACEs using multivariable-adjusted Cox proportional hazards regression. Analysis was conducted during January-February 2009. RESULTS Overall, 1539 people died during follow-up; the crude death rate was 91.0 per 1000; the age-adjusted rate was 54.7 per 1000. People with six or more ACEs died nearly 20 years earlier on average than those without ACEs (60.6 years, 95% CI=56.2, 65.1, vs 79.1 years, 95% CI=78.4, 79.9). Average YLL per death was nearly three times greater among people with six or more ACEs (25.2 years) than those without ACEs (9.2 years). Roughly one third (n=526) of those who died during follow-up were aged < or =75 years at the time of death, accounting for 4792 YPLL. After multivariable adjustment, adults with six or more ACEs were 1.7 (95% CI=1.06, 2.83) times more likely to die when aged < or =75 years and 2.4 (95% CI=1.30, 4.39) times more likely to die when aged < or =65 years. CONCLUSIONS ACEs are associated with an increased risk of premature death, although a graded increase in the risk of premature death was not observed across the number of categories of ACEs. The increase in risk was only partly explained by documented ACE-related health and social problems, suggesting other possible mechanisms by which ACEs may contribute to premature death.
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Affiliation(s)
- David W Brown
- Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.
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Wolfe F, Caplan L, Michaud K. Rheumatoid arthritis treatment and the risk of severe interstitial lung disease. Scand J Rheumatol 2009; 36:172-8. [PMID: 17657669 DOI: 10.1080/03009740601153774] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Interstitial lung disease (ILD) is an important complication of rheumatoid arthritis (RA) or its treatment, and is associated with substantially increased mortality. Reports have suggested that infliximab with or without azathioprine might lead to rapidly progressive or fatal ILD. We used an RA data bank to assess the associations of treatments for RA and severe ILD. METHODS ILD was identified in hospitalisations and death records in 100 of 17,598 RA patients and studied in relation to RA therapy with Cox regression analyses. RESULTS The incidence of hospitalisation for ILD (HILD) was 260 per 100,000 patient years. Among those hospitalised for ILD, 27.0% died. In multivariable models of current and past RA treatment, the only current treatment associated with HILD was prednisone: hazard ratio (HR) 2.5 [95% confidence interval (CI) 1.5-4.1]. Among past therapies, prednisone (HR 3.0, 95% CI 1.0-8.9), infliximab (HR 2.1, 95% CI 1.1-3.8), etanercept (HR 1.7, 95% CI 1.0-3.0), and cyclophosphamide (HR 3.7, 95% CI 0.9-15.5) were associated with HILD. Pre-existing lung problems were identified in 67% of HILD. Only one case of HILD in the 100 hospitalisations suggested a possible temporal relationship between infliximab and HILD. CONCLUSIONS Associations between RA treatment and HILD are confounded by the prescription of treatments for ILD such as prednisone, infliximab, etanercept, and cyclophosphamide. There is no clear pattern of causal association of treatment and ILD, and there is no clear evidence to support a causal relationship between infliximab, azathioprine, and HILD.
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Affiliation(s)
- F Wolfe
- National Data Bank for Rheumatic Diseases, Arthritis Research Center Foundation, Wichita, KS 67214, USA.
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Reis JP, Araneta MR, Wingard DL, Macera CA, Lindsay SP, Marshall SJ. Overall obesity and abdominal adiposity as predictors of mortality in u.s. White and black adults. Ann Epidemiol 2009; 19:134-42. [PMID: 19185808 DOI: 10.1016/j.annepidem.2008.10.008] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2008] [Revised: 10/02/2008] [Accepted: 10/21/2008] [Indexed: 11/17/2022]
Abstract
PURPOSE The association of overall obesity and abdominal adiposity in predicting risk of all-cause mortality in white and black adults was compared. METHODS This prospective study included a national sample of 3219 non-Hispanic white and 2,561 non-Hispanic black adults 30 to 64 years of age enrolled in the third National Health and Nutrition Examination Survey during 1988-1994. Multiple measures of adiposity were measured and calculated, including body mass index (BMI), waist circumference, waist-to-hip ratio (WHR), and waist-to-thigh ratio (WTR). Vital status was ascertained with the National Death Index through 2000. RESULTS During 12 years of follow-up (51,133 person-years), 188 white and 222 black adults died. After adjustment for age, education, smoking, and existing disease, positive dose-response associations between WTR and mortality in both sexes and races, and WHR in white and black women were observed (p(trend) < 0.05 for all). These results were unchanged after additional adjustment for BMI. In contrast, BMI and waist circumference alone exhibited curvilinear-shaped associations with mortality. A higher WTR was associated with a higher risk of mortality among normal weight (BMI: 18.5-24.9 kg/m(2)) and obese (BMI: > or =30.0 kg/m(2)) white and black adults. CONCLUSIONS These results suggest ratio measures of abdominal adiposity, particularly WTR in both sexes and WHR in women, strongly and positively predict mortality, independent of BMI, among white and black adults. Furthermore, WTR offers additional prognostic information beyond that provided by BMI alone.
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Affiliation(s)
- Jared P Reis
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
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Using the National Death Index to Validate the Noninformative Censoring Assumption of Survival Estimation. Ann Thorac Surg 2008; 85:1256-60. [DOI: 10.1016/j.athoracsur.2007.12.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2007] [Revised: 12/03/2007] [Accepted: 12/04/2007] [Indexed: 11/21/2022]
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Berger AK, Duval S, Jacobs DR, Barber C, Vazquez G, Lee S, Luepker RV. Relation of length of hospital stay in acute myocardial infarction to postdischarge mortality. Am J Cardiol 2008; 101:428-34. [PMID: 18312752 DOI: 10.1016/j.amjcard.2007.09.090] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2007] [Revised: 09/07/2007] [Accepted: 09/07/2007] [Indexed: 11/30/2022]
Abstract
Hospital length of stay (LOS) after acute myocardial infarction (AMI) has steadily decreased because of both improved treatments and cost considerations. Early discharge may adversely affect some patients who might benefit from extended monitoring. The Minnesota Heart Survey was a population-based study of patients with AMI in acute-care hospitals in the Minneapolis-St. Paul, Minnesota, metropolitan area. Medical records were abstracted for a random sample of patients hospitalized with AMI in 1985, 1990, 1995, and 2001. Case fatality rates, adjusted for age and gender, were identified using mortality data from the index hospitalization and Minnesota death certificates. A total of 4,940 patients with a validated AMI were identified from the combined 1985 (n = 1,306), 1990 (n = 1,550), 1995 (n = 1,087), and 2001 (n = 515) surveys. Median LOSs were 9, 8, 6, and 4 days, respectively. Patients hospitalized <or=4 days formed an increasing proportion of the population, from 11% (1985) to 58% (2001). In-hospital case fatality rates decreased from 1985 to 2001 (11.6% to 5.4%; p <0.0001 for trend). There was a significant decrease in both 1- (3.3% to 2.4%; p = 0.002 for trend) and 6-month (8.9% to 5.4%, p <0.0001) mortality rates after discharge from 1985 to 2001. In conclusion, the progressive and substantial decrease in hospital LOS after AMI in the past 2 decades was not associated with increased mortality after discharge. These decreases in LOS were associated with increasing use of effective therapies.
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Affiliation(s)
- Alan K Berger
- Department of Medicine, Section of Cardiovascular Medicine, University of Minnesota, Minneapolis, Minnesota, USA.
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Shahar E, Lee S. Historical trends in survival of hospitalized heart failure patients: 2000 versus 1995. BMC Cardiovasc Disord 2007; 7:2. [PMID: 17227584 PMCID: PMC1781956 DOI: 10.1186/1471-2261-7-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2006] [Accepted: 01/16/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Population-based secular trends in survival of patients with congestive heart failure (CHF) are central to public health research on the burden of the syndrome. METHODS Patients 35-79 years old with a CHF discharge code in 1995 or 2000 were identified in 22 Minneapolis-St. Paul hospitals. A sample of the records was abstracted (50% of 1995 records; 38% of 2000 records). A total of 2,257 patients in 1995 and 1,825 patients in 2000 were determined to have had a CHF-related hospitalization. Each patient was followed for one year to ascertain vital status. RESULTS The risk profile of the 2000 patient cohort was somewhat worse than that of the 1995 cohort in both sex groups, but the distributions of age and left ventricular ejection fraction were similar. Within one year of admission in 2000, 28% of male patients and 27% of female patients have died, compared to 36% and 27% of their counterparts in 1995, respectively. In various Cox regression models the average year effect (2000 vs. 1995) was around 0.75 for men and 0.95 to 1.00 for women. The use of angiotensin converting-enzyme inhibitors and beta-blockers was associated with substantially lower hazard of death during the subsequent year. CONCLUSION Survival of men who were hospitalized for CHF has improved during the second half of the 1990s. The trend in women was very weak, compatible with little to no change. Documented benefits of angiotensin converting-enzyme inhibitors and beta-blockers were evident in these observational data in both men and women.
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Affiliation(s)
- Eyal Shahar
- Division of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ, USA
| | - Seungmin Lee
- Department of Food and Nutrition, College of Human Ecology, Sungshin Women's University, Seoul, Korea
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Wolfe F, Rasker JJ, Boers M, Wells GA, Michaud K. Minimal disease activity, remission, and the long-term outcomes of rheumatoid arthritis. ACTA ACUST UNITED AC 2007; 57:935-42. [PMID: 17665487 DOI: 10.1002/art.22895] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine the prevalence of minimal disease activity (MDA) and remission in patients with rheumatoid arthritis (RA), to assess the effect of anti-tumor necrosis factor (anti-TNF) therapy on MDA, and to determine the extent to which MDA status improves long-term outcomes. METHODS Using the Patient Activity Scale (PAS) as a surrogate, we assessed the prevalence of MDA and remission in 18,062 patients with RA using the newly developed Outcome Measures in Rheumatology Clinical Trials (OMERACT) criteria for MDA. RESULTS MDA was noted in 20.2% of 18,062 patients and persistent MDA, operationally defined as having MDA during >or=2 consecutive 6-month observation periods, occurred in 13.5% of 7,433 patients followed longitudinally. Disease activity at remission levels was noted in 7%. Among patients with MDA, 82% received disease-modifying antirheumatic drugs or biologic agents. Following anti-TNF initiation, the cumulative probability of achieving MDA at 2 and 6 years was 4.1% and 7.6%, respectively, and persistent MDA probabilities were 2.7% and 4.5%, respectively. Regardless of RA duration, patients with MDA had substantially better outcomes, including a 10-fold reduction in work disability and an approximately 2-fold reduction in total joint replacement and mortality. CONCLUSION Remission remains uncommon in RA, and the prevalence of new remission in community practice is substantially lower than noted in published trials of biologic therapy. On average, persons with MDA appear to have persistently mild RA. This might be the effect of milder RA and/or more effective treatment in early RA. The PAS had satisfactory levels of agreement with the full MDA criteria and appears suitable for use in clinical and epidemiologic research.
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Affiliation(s)
- Frederick Wolfe
- National Data Bank for Rheumatic Diseases, Wichita, Kansas 67214, USA.
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21
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Brown DW, Young KE, Anda RF, Giles WH. Asthma and risk of death from lung cancer: NHANES II Mortality Study. J Asthma 2006; 42:597-600. [PMID: 16169796 DOI: 10.1080/02770900500216234] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Although smoking is the most important risk factor for lung cancer, nearly 10% of lung cancer is not attributable to smoking. Insights into risk factors for lung cancer other than smoking will become increasingly important, given decreasing trends in the prevalence of smoking. Prior research suggests asthma may increase the risk of lung cancer, particularly among nonsmokers. METHODS We used Cox regression analyses of data from a nationally representative sample of 9087 adults aged 30-75 years included in the NHANES II Mortality Study (1976-1992) to estimate the relative risk (RR) of death from lung cancer associated with self-reported asthma, independent of smoking. RESULTS Age-adjusted prevalence of smoking was 36.0%, and the age-adjusted prevalence of asthma was 6.1% (6.2% among nonsmokers) at baseline. During approximately 17 years of follow-up, 196 adults died of lung cancer (ICD-9 160-165). Among 6144 nonsmokers, the RR of lung cancer death comparing adults with asthma to those without was 1.69 (95% CI: 0.94-3.04) although the association was not statistically significant. For nonsmokers without a history of cancer, the RR was 2.53 (95% CI: 1.42-4.52). After exclusion of adults with emphysema and chronic bronchitis, the RR of lung cancer death associated with asthma was 3.54 (95% CI: 1.93-6.42). CONCLUSIONS Consistent with prior reports, we observed an increased risk of lung cancer mortality associated with asthma among nonsmokers without a history of cancer.
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Affiliation(s)
- David W Brown
- Emerging Investigations and Analytic Methods Branch, Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA
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Wolfe F, Caplan L, Michaud K. Treatment for rheumatoid arthritis and the risk of hospitalization for pneumonia: Associations with prednisone, disease-modifying antirheumatic drugs, and anti–tumor necrosis factor therapy. ACTA ACUST UNITED AC 2006; 54:628-34. [PMID: 16447241 DOI: 10.1002/art.21568] [Citation(s) in RCA: 311] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Pneumonia is a major cause of mortality and morbidity in rheumatoid arthritis (RA). This study was undertaken to determine the rate and predictors of hospitalization for pneumonia and the extent to which specific RA treatments increase pneumonia risk. METHODS RA patients (n = 16,788) were assessed semiannually for 3.5 years. Pneumonia was confirmed by medical records or detailed patient interview. Covariates included RA severity measures, diabetes, pulmonary disease, and myocardial infarction. Cox proportional hazards regression was used to determine the multivariable risk associated with RA treatments. RESULTS After adjustment for covariates, prednisone use increased the risk of pneumonia hospitalization (hazard ratio [HR] 1.7 [95% confidence interval 1.5-2.0]), including a dose-related increase in risk (< or = 5 mg/day HR 1.4 [95% confidence interval 1.1-1.6], > 5-10 mg/day HR 2.1 [95% confidence interval 1.7-2.7], > 10 mg/day HR 2.3 [95% confidence interval 1.6-3.2]). Leflunomide also increased the risk (HR 1.2 [95% confidence interval 1.0-1.5]). HRs for etanercept (0.8 [95% confidence interval 0.6-110]) and sulfasalazine (0.7 [95% confidence interval 0.5-1.0]) did not reflect an increased risk of pneumonia. HRs for infliximab, adalimumab, and methotrexate were not significantly different from zero. CONCLUSION There is a dose-related relationship between prednisone use and pneumonia risk in RA. No increase in risk was found for anti-tumor necrosis factor therapy or methotrexate. These data call into question the belief that low-dose prednisone is safe. Because corticosteroid use is common in RA, the results of this study suggest that prednisone exposure may have important public health consequences.
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Affiliation(s)
- Frederick Wolfe
- National Data Bank for Rheumatic Diseases and University of Kansas School of Medicine, Wichita, Kansas 67214, USA.
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Mensah GA, Brown DW, Croft JB, Greenlund KJ. Major coronary risk factors and death from coronary heart disease: baseline and follow-up mortality data from the Second National Health and Nutrition Examination Survey (NHANES II). Am J Prev Med 2005; 29:68-74. [PMID: 16389129 DOI: 10.1016/j.amepre.2005.07.030] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2005] [Revised: 07/25/2005] [Accepted: 07/25/2005] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although the major risk factors for coronary heart disease (CHD) are well-established, intense efforts persist in the search for "novel" or "emerging" risk factors because of the notion that as many as half of CHD victims may not have the traditional risk factors. OBJECTIVE Compare prevalences of major risk factors among persons with fatal CHD in a nationally representative population sample. METHODS Baseline data from the Second National Health and Nutrition Examination Survey and 17-year follow-up mortality data were examined for 8,069 adults (3,701 men; 4,368 women) aged 30 to 75 years in 1976-1980. We calculated sex-specific prevalences of hypertension, elevated total cholesterol (> or = 240 mg/dL), cigarette smoking, and the presence of at least one of these three major risk factors. The relative risk of death from CHD associated with the three major risk factors was calculated in sex-specific multivariable models adjusted for age, race, and education. RESULTS Overall, nearly 75% of US adults had at least one of the three major risk factors. Those who died of CHD, compared to those who did not die of CHD, had respectively, greater prevalences of hypertension (men: 48% vs. 38%; women: 76% vs. 33%). Similarly, persons who had fatal CHD were more likely to have elevated total cholesterol (men: 53% vs. 30%; women: 55% vs. 34%), although the finding was not statistically significant in women. Smoking prevalence was also greater among persons who died of CHD than those who did not for both men (64% vs. 40%) and women (43% vs. 33%). The proportion of persons with at least one of the three major risk factors was significantly (P < or = 0.01) greater among those who died from CHD compared with those who did not (men: 92% vs. 74%; women: 98% vs. 70%). The risk of fatal CHD was 51% lower among men and 71% lower among women with none of the 3 risk factors compared to those with at least one. Had all three major risk factors not occurred, 64% of all CHD deaths among women and 45% of all CHD deaths among men could have been avoided. CONCLUSIONS Nine out of ten US adults who died of CHD had at least one of the three major established risk factors. Thus, the notion that many CHD victims do not have the traditional risk factors is a misconception. Policies and strategies that increase the prevalence of a low risk profile are needed, and aggressive efforts in the prevention and control of the major established risk factors remain the key to continued reductions in CHD mortality.
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Affiliation(s)
- George A Mensah
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia 30341-3717, USA.
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Schneider RH, Alexander CN, Staggers F, Rainforth M, Salerno JW, Hartz A, Arndt S, Barnes VA, Nidich SI. Long-term effects of stress reduction on mortality in persons > or = 55 years of age with systemic hypertension. Am J Cardiol 2005; 95:1060-4. [PMID: 15842971 PMCID: PMC1482831 DOI: 10.1016/j.amjcard.2004.12.058] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2004] [Revised: 12/28/2004] [Accepted: 12/28/2004] [Indexed: 10/25/2022]
Abstract
Psychosocial stress contributes to high blood pressure and subsequent cardiovascular morbidity and mortality. Previous controlled studies have associated decreasing stress with the Transcendental Meditation (TM) program with lower blood pressure. The objective of the present study was to evaluate, over the long term, all-cause and cause-specific mortality in older subjects who had high blood pressure and who participated in randomized controlled trials that included the TM program and other behavioral stress-decreasing interventions. Patient data were pooled from 2 published randomized controlled trials that compared TM, other behavioral interventions, and usual therapy for high blood pressure. There were 202 subjects, including 77 whites (mean age 81 years) and 125 African-American (mean age 66 years) men and women. In these studies, average baseline blood pressure was in the prehypertensive or stage I hypertension range. Follow-up of vital status and cause of death over a maximum of 18.8 years was determined from the National Death Index. Survival analysis was used to compare intervention groups on mortality rates after adjusting for study location. Mean follow-up was 7.6 +/- 3.5 years. Compared with combined controls, the TM group showed a 23% decrease in the primary outcome of all-cause mortality after maximum follow-up (relative risk 0.77, p = 0.039). Secondary analyses showed a 30% decrease in the rate of cardiovascular mortality (relative risk 0.70, p = 0.045) and a 49% decrease in the rate of mortality due to cancer (relative risk 0.49, p = 0.16) in the TM group compared with combined controls. These results suggest that a specific stress-decreasing approach used in the prevention and control of high blood pressure, such as the TM program, may contribute to decreased mortality from all causes and cardiovascular disease in older subjects who have systemic hypertension.
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Affiliation(s)
- Robert H Schneider
- Institute for Natural Medicine and Prevention, Maharishi University of Management, Fairfield, Iowa, USA.
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Shahar E, Lee S, Kim J, Duval S, Barber C, Luepker RV. Hospitalized heart failure: rates and long-term mortality. J Card Fail 2004; 10:374-9. [PMID: 15470646 DOI: 10.1016/j.cardfail.2004.02.003] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Heart failure has been called the "new epidemic of cardiovascular disease," but few studies have described key epidemiologic measures of the syndrome in geographically defined US populations. METHODS AND RESULTS We obtained lists of discharge diagnosis codes in 1995 from 22 Minneapolis-St. Paul metropolitan area hospitals; identified patients 35 to 84 years old with a heart failure discharge code; and sampled and abstracted 50% of the hospital records. To identify heart failure-related hospitalizations, we applied 6 published definitions of the syndrome to the sample and selected cases that met at least 4 of the 6 definitions (n = 2887). The patient cohort was followed for 5 to 6 years to ascertain deaths. The rate of hospitalized heart failure ranged from a few dozen hospitalized patients per 100,000 residents ages 35 to 44 years to more than 2000 per 100,000 residents ages 75 to 84, and was consistently higher among men than among women (age-adjusted rate ratio 1.46; 95% CI 1.39-1.54). Within 1-year of the index admission, 37% of male patients and 30% of female patients have died-10 times the annual mortality of the source population. By the end of the follow-up, cumulative mortality reached 72% in men and 66% in women. In multivariable regression of the hazard of death on age, sex, and left ventricular ejection fraction (LVEF), age was a strong determinant of mortality and male patients had modestly higher hazard of death than female patients (adjusted hazard ratio, 1.29; 95% CI 1.18-1.41). LVEF was not a strong predictor of death. CONCLUSION A heart failure-related hospitalization is a marker of grave prognosis: only one quarter to one third of the patients survives 5 years after admission. Both the risk of hospitalization for heart failure and the risk of subsequent death are moderately higher in men than in women. LVEF, when measured in the context of heart failure-related hospitalization, is not a strong predictor of death.
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Affiliation(s)
- Eyal Shahar
- Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis 55454, USA
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Wolfe F, Michaud K. Lymphoma in rheumatoid arthritis: the effect of methotrexate and anti-tumor necrosis factor therapy in 18,572 patients. ACTA ACUST UNITED AC 2004; 50:1740-51. [PMID: 15188349 DOI: 10.1002/art.20311] [Citation(s) in RCA: 429] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The risk of lymphoma is increased in patients with rheumatoid arthritis (RA), and spontaneous reporting suggests that methotrexate (MTX) and anti-tumor necrosis factor (anti-TNF) therapy might be associated independently with an increased risk of lymphoma. However, data from clinical trials and clinical practice do not provide sufficient evidence concerning these issues because of small sample sizes and selected study populations. The objective of this study was to determine the rate of and standardized incidence ratio (SIR) for lymphoma in patients with RA and in RA patient subsets by treatment group. Additionally, we sought to determine predictors of lymphoma in RA. METHODS We prospectively studied 18,572 patients with RA who were enrolled in the National Data Bank for Rheumatic Diseases (NDB). Patients were surveyed biannually, and potential lymphoma cases received detailed followup. The SEER (Survey, Epidemiology, and End Results) cancer data resource was used to derive the expected number of cases of lymphoma in a cohort that was comparable in age and sex with the RA cohort. RESULTS The overall SIR for lymphoma was 1.9 (95% confidence interval [95% CI] 1.3-2.7). The SIR for biologic use was 2.9 (95% CI 1.7-4.9) and for the use of infliximab (with or without etanercept) was 2.6 (95% CI 1.4-4.5). For etanercept, with or without infliximab, the SIR was 3.8 (95% CI 1.9-7.5). The SIR for MTX was 1.7 (95% CI 0.9-3.2), and was 1.0 (95% CI 0.4-2.5) for those not receiving MTX or biologics. Lymphoma was associated with increasing age, male sex, and education. CONCLUSION Lymphomas are increased in RA. Although the SIR is greatest for anti-TNF therapies, differences between therapies are slight, and confidence intervals for treatment groups overlap. The increased lymphoma rates observed with anti-TNF therapy may reflect channeling bias, whereby patients with the highest risk of lymphoma preferentially receive anti-TNF therapy. Current data are insufficient to establish a causal relationship between RA treatments and the development of lymphoma.
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Affiliation(s)
- Frederick Wolfe
- National Data Bank for Rheumatic Diseases, Arthritis Research Foundation, Wichita, KS 67214, USA.
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Brown DW, Ford ES, Giles WH, Croft JB, Balluz LS, Mokdad AH. Associations between White Blood Cell Count and Risk for Cerebrovascular Disease Mortality: NHANES II Mortality Study, 1976–1992. Ann Epidemiol 2004; 14:425-30. [PMID: 15246331 DOI: 10.1016/j.annepidem.2003.11.002] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2003] [Accepted: 11/06/2003] [Indexed: 11/29/2022]
Abstract
PURPOSE To examine associations between elevated white blood cell count (WBC) and cerebrovascular disease (CeVD) mortality independent of cigarette smoking and by gender. METHODS We used Cox regression analyses of data from 8459 adults (3982 men; 4477 women) aged 30 to 75 years in the NHANES II Mortality Study (1976-1992) to estimate the relative risk of death from CeVD across quartiles of WBC. RESULTS During 17 years of follow-up, there were 192 deaths from CeVD (93 men; 99 women). Compared with those with WBC (cells/mm(3))<5700, adults with WBC>8200 were at increased risk of CeVD mortality (relative risk [RR], 2.1; 95% confidence interval [CI], 1.2-3.7) after adjustment for smoking and other cardiovascular disease risk factors. Similar results were observed among never smokers (RR, 2.0; 95% CI, 1.0-3.8). The adjusted relative risk of CeVD mortality comparing those with WBC>8200 to those with WBC<5700 was 1.5 (95% CI, 0.7-3.5) among men and 2.7 (95% CI, 1.4-5.0) among women. CONCLUSIONS Elevated WBC may predict CeVD mortality even after considering the effects of smoking and other cardiovascular disease risk factors.
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Affiliation(s)
- David W Brown
- Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.
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Abstract
OBJECTIVE To test the relationship between racial segregation and mortality using a multidimensional questionnaire-based measure of exposure to segregation. DATA SOURCES Data for this analysis come from the National Survey of Black Americans (NSBA), a national multistage probability sample of 2,107 African Americans (aged 18-101). The NSBA was conducted as a household survey. The NSBA was matched with the National Death Index (NDI). STUDY DESIGN Prospective cohort study, where Cox regression analysis was used to examine the effect of baseline variables on time to death over a 13-year period. PRINCIPAL FINDINGS Respondents who were exposed to racial segregation were significantly less likely to survive the study period after controls for age, health status, and other predictors of mortality. CONCLUSION The results support previous studies linking segregation with health outcomes.
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Affiliation(s)
- Thomas A LaVeist
- John Hopkins University, Morgan-Hopkins Center for Health Disparities Solutions, Bloomberg School of Public Health, Baltimore, MD 21205, USA
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Lee LM, Fleming PL. Estimated Number of Children Left Motherless by AIDS in the United States, 1978???1998. J Acquir Immune Defic Syndr 2003; 34:231-6. [PMID: 14526213 DOI: 10.1097/00126334-200310010-00014] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
When a mother dies of AIDS, basic needs of her children may be left unmet. To estimate the number and characteristics of maternal AIDS orphans in the United States, demographic techniques were applied to data from several sources. From the national HIV/AIDS surveillance system, reporting delays were adjusted for the number of deaths among women aged 15-44 diagnosed with AIDS through 1998 and reported as deceased by December 1999. No fertility was assumed in the year preceding death. To the adjusted number of deaths the annual age- and race-specific cumulative fertility and infant mortality rates from national vital statistics were applied. A perinatal infection rate of 25% was assumed among children born through 1994, and 10% among children born after 1994. Through 1998, 51,473 women died leaving 97,376 children motherless. Of the estimated 76,661-87,0018 uninfected children, 83% were younger than 21 years when orphaned. After increasing each year, the annual number of orphaned children younger than 21 years peaked in 1995. In 1998, between 4252-4489 uninfected youth were added to 47,863-54,025 existing orphans younger than age 21. Due to declines in AIDS deaths, the annual number of children orphaned by AIDS has declined. Nevertheless, each year thousands of youth are orphaned.
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Affiliation(s)
- Lisa M Lee
- Division of HIV/AIDS Prevention--Surveillance and Epidemiology, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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Gardner LI, Holmberg SD, Williamson JM, Szczech LA, Carpenter CCJ, Rompalo AM, Schuman P, Klein RS. Development of proteinuria or elevated serum creatinine and mortality in HIV-infected women. J Acquir Immune Defic Syndr 2003; 32:203-9. [PMID: 12571531 DOI: 10.1097/00126334-200302010-00013] [Citation(s) in RCA: 122] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Data on the incidence and prognostic significance of renal dysfunction in HIV disease are limited. OBJECTIVE To determine the incidence of proteinuria and elevated serum creatinine in HIV-positive and HIV-negative women and to determine whether these abnormalities are predictors of mortality or associated with causes of death listed on the death certificate in HIV-positive women. DESIGN The incidence of proteinuria or elevated serum creatinine and mortality was assessed in a cohort of 885 HIV-positive women and 425 at-risk HIV-negative women. SETTING Women from the general community or HIV care clinics in four urban locations in the United States. OUTCOME MEASURES Creatinine of >or=1.4 mg/dL, proteinuria 2 or more, or both. Deaths confirmed by a death certificate (92%) or medical record/community report (8%). RESULTS At baseline, 64 (7.2%) HIV-positive women and 10 (2.4%) HIV-negative women had proteinuria or elevated creatinine. An additional 128 (14%) HIV-positive women and 18 (4%) HIV-negative women developed these abnormalities over the next (mean) 21 months. Relative hazards of mortality were significantly increased (adjusted relative hazard = 2.5; 95% confidence interval: 1.9-3.3), and there were more renal causes recorded on death certificates (24/92 (26%) vs. 3/127 (2.7%), p<.0001) in HIV-infected women with, compared with those without these renal abnormalities. CONCLUSIONS Proteinuria, elevated serum creatinine, or both frequently occurred in these HIV-infected women. These renal abnormalities in HIV-infected women are associated with an increased risk of death after controlling for other risk factors and with an increased likelihood of having renal causes listed on the death certificate. The recognition and management of proteinuria and elevated serum creatinine should be a priority for HIV-infected persons.
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Affiliation(s)
- Lytt I Gardner
- Centers for Disease Control and Prevention, Mailstop E-45 Division of HIV/AIDS, 1600 Clifton Road NE, Atlanta, GA 30333, USA.
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Vargas A, Doliszny K, Herlitz J, Karlsson T, McGovern P, Brandrup-Wognsen G, Luepker RV. Characteristics and outcomes among patients undergoing coronary artery bypass grafting in western Sweden and Minneapolis-St Paul, Minnesota. Am Heart J 2001; 142:1080-7. [PMID: 11717615 DOI: 10.1067/mhj.2001.118114] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND The purpose of this study was to compare patient selection, operative factors, and survival for coronary artery bypass grafting (CABG) for coronary heart disease in Minneapolis-St Paul (MSP), Minnesota, and Western Sweden (WS). METHODS AND RESULTS All patients from WS between 1988 and 1991 (n = 2365) and a 17% random sample of MSP patients between 1985 and 1990 (n = 1659) who underwent CABG surgery were studied. CABG was 3 times greater in MSP. MSP patients had significantly more obesity, cigarette smoking, prior CABG, and prior coronary angioplasty. WS patients had more and longer angina pectoris, better left ventricular function, and waited longer from previous acute MI until CABG. WS patients had more internal mammary artery graphs and a shorter aortic cross-clamp time. At discharge, WS patients received more beta-blockers and antiplatelet agents, whereas MSP patients received more calcium channel blockers and digitalis. Age-adjusted mortality rate at 28 days was significantly higher in MSP but not at 3 years. Adjustment for patient characteristics and treatment factors reduced or eliminated these differences. CONCLUSIONS Although coronary heart disease rates were higher in WS, age-adjusted CABG rates were 3-fold higher in MSP. Better survival among WS patients was associated with differences in patient selection and clinical and treatment characteristics because MSP patients were more severely ill and at increased risk. Health system characteristics and practice may account for these differences.
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Affiliation(s)
- A Vargas
- Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis 55454-1015, USA
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Abstract
BACKGROUND An association between hematocrit (Hct) and coronary heart disease (CHD) mortality has been previously observed. However, the relationship of Hct and CHD independent of other cardiovascular disease (CVD) risk factors and differences between men and women remain unclear. METHODS We examined the association between Hct and CHD mortality with Cox regression analyses of data from 8896 adults, aged 30-75 years, in the Second National Health and Nutrition Examination Survey (NHANES II) Mortality Study (1976-1992). Covariates included age, sex, race, education, smoking status, hypertensive status, total serum cholesterol, body mass index, white blood cell count, and history of CVD and diabetes. Hct was categorized by use of sex-specific tertiles, and all analyses were stratified by sex. RESULTS During 16.8 years of follow-up, there were 545 (men 343, women 202) deaths from CHD (International Classification of Diseases, 9th revision [ICD-9] 410-414), 778 (men 426, women 279) deaths from diseases of the heart (ICD-9 390-398, 402, 404, 410-414, 415-417, 420-429), and 2046 (men 1216, women 830) all-cause deaths. Among men, the crude CHD mortality rate per 10,000 population was 42.6, 31.9, and 46.3 among those with Hct in the lower, middle, and upper tertiles, respectively. The corresponding crude CHD mortality rates among women were 12.6, 18.6, and 27.7. After adjustment for age and other CVD risk factors, there was no association between Hct in the upper tertile compared with the lower tertile and mortality from either CHD, diseases of the heart, or all causes among men. Women with Hct in the upper tertile were 1.3 times (95% CI 0.9-1.9) more likely to die from CHD than were women with Hct in the lowest tertile, after multivariate adjustment. The effect of high Hct on CHD mortality among women younger than 65 years of age was slightly stronger (relative risk 2.2, 95% CI 1.0-4.6). CONCLUSIONS These results suggest that the association between Hct and mortality from CHD and all causes is complex, differing both by sex and age. Further research is needed to gain a better understanding of these age and sex differences.
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Affiliation(s)
- D W Brown
- Cardiovascular Health Branch, Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341-3717, USA
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McGovern PG, Jacobs DR, Shahar E, Arnett DK, Folsom AR, Blackburn H, Luepker RV. Trends in acute coronary heart disease mortality, morbidity, and medical care from 1985 through 1997: the Minnesota heart survey. Circulation 2001; 104:19-24. [PMID: 11435332 DOI: 10.1161/01.cir.104.1.19] [Citation(s) in RCA: 296] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Coronary heart disease (CHD) mortality continued to decline from 1985 to 1997. METHODS AND RESULTS We tabulated CHD deaths (ICD-9 codes 410 through 414) in the Minneapolis/St Paul, Minnesota, area. For 1985, 1990, and 1995, trained nurses abstracted the hospital records of patients 30 to 74 years old with a discharge diagnosis of acute CHD (ICD-9 codes 410 or 411). Acute myocardial infarction (AMI) events were validated and followed for 3-year all-cause mortality. Between 1985 and 1997, age-adjusted CHD mortality rates in Minneapolis/St Paul fell 47% and 51% in men and women, respectively; the comparable declines in US whites were 34% and 29%. In-hospital mortality declined faster than out-of-hospital mortality. The rate of AMI (ICD-9 code 410) hospital discharges declined almost 20% between 1985 and 1995, whereas the discharge rate for unstable angina (ICD-9 code 411) increased substantially. The incidence of hospitalized definite AMI declined approximately 10%, whereas recurrence rates fell 20% to 30%. Three-year case fatality rates after hospitalized AMI decreased consistently by 31% and 41% in men and women, respectively. In-hospital administration of thrombolytic therapy, emergency angioplasty, ACE inhibitors, beta-blockers, heparin, and aspirin increased greatly. CONCLUSIONS Declining out-of-hospital death rates, declining incidence and recurrence of AMI in the population, and marked improvements in the survival of AMI patients all contributed to the 1985 to 1997 decline of CHD mortality in the Minneapolis/St Paul metropolitan area. The effects of early and late medical care seem to have had the greatest contribution to rates during this time period.
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Affiliation(s)
- P G McGovern
- Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, USA.
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Schall LC, Buchanich JM, Marsh GM, Bittner GM. Utilizing multiple vital status tracing services optimizes mortality follow-up in large cohort studies. Ann Epidemiol 2001; 11:292-6. [PMID: 11399442 DOI: 10.1016/s1047-2797(00)00217-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PURPOSE To compare the three national-scale death identification services used in our two-stage vital status tracing protocol, Pension Benefit Information Company (PBI), Social Security Administration (SSA), and the Health Care Financing Administration (HCFA), with respect to death identification and confirmation rate, and relevant demographic variables. METHODS Information on 31,223 subjects with unconfirmed vital status in an ongoing occupational cohort mortality study was simultaneously submitted to PBI, SSA, and HCFA to identify subjects deceased as of December 31, 1992. Subjects whose dates of death were between 1979 and 1992 were then sent to the National Death Index (NDI) to obtain death certificate numbers and supplemental states of death. RESULTS PBI identified and confirmed the highest number deaths in this cohort. PBI and SSA identified a higher proportion of deaths for persons who died in earlier years and/or who died at a younger age, for both confirmed and unconfirmed deaths. HCFA identified fewer deaths overall and had a smaller proportion of unconfirmed deaths. These deaths occurred in later years among older subjects and had the highest proportion of females. NDI provided exact matches for 92-96% of deaths identified by each of the three services. CONCLUSIONS PBI was the most comprehensive service, especially for identifying younger subjects and those with an earlier date of death, while HCFA may help to identify deceased female subjects. SSA data can be purchased and used for periodic updates or interactively to identify deaths among subjects with poor identifiers (such as incorrect or missing social security numbers or misspelled names). Because each service makes a valuable contribution to the identification of deceased cohort subjects, all three should be considered for optimal mortality follow-up.
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Affiliation(s)
- L C Schall
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, USA
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Brown DW, Giles WH, Croft JB. White blood cell count: an independent predictor of coronary heart disease mortality among a national cohort. J Clin Epidemiol 2001; 54:316-22. [PMID: 11223329 DOI: 10.1016/s0895-4356(00)00296-1] [Citation(s) in RCA: 164] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
An association between elevated white blood cell (WBC) count and coronary heart disease (CHD) mortality has been previously observed. However, the relationship between WBC count and CHD mortality independent of cigarette smoking and the possible interaction between WBC count and smoking remains unclear. We examined the association between WBC count and CHD mortality with Cox regression analyses of data from 8914 adults, aged 30-75, in the NHANES II Mortality Study (1976-1992). Covariates included age, sex, race, education, physical activity, smoking status, hypertensive status, total serum cholesterol, body mass index, hematocrit, and history of cardiovascular disease, stroke, and diabetes. During 17 follow-up years, there were 548 deaths from CHD (ICD-9 410-414) and 782 deaths from diseases of the heart (ICD-9 390-398, 402, 404, 410-414, 415-417, 420-429). Mean WBC count (x10(9) cells/L) was greater among persons who died from CHD (7.6 vs 7.2, P <.001). Compared to persons with a WBC count <6.1, persons with a WBC count > 7.6 were at increased risk of death from CHD (relative risk = 1.4, 95% confidence interval = 1.1-1.8) after adjustment for smoking status and other CVD risk factors. Similar results were observed among nonsmokers (RR = 1.4, 95% CI = 0.9-2.0). These results suggest that higher WBC counts are a predictor of CHD mortality independent of the effects of smoking and other traditional CVD risk factors, which may indicate a role for inflammation in the pathogenesis of CHD. Additional studies are needed to determine whether interventions to decrease inflammation can reduce the risk for CHD associated with elevated WBC.
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Affiliation(s)
- D W Brown
- Cardiovascular Health Branch, Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, Atlanta, GA 30341-3717, USA
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Brown DW, Giles WH, Croft JB. Left ventricular hypertrophy as a predictor of coronary heart disease mortality and the effect of hypertension. Am Heart J 2000; 140:848-56. [PMID: 11099987 DOI: 10.1067/mhj.2000.111112] [Citation(s) in RCA: 156] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Although associations between hypertension, left ventricular hypertrophy (LVH), and coronary heart disease (CHD) have been described, it is less clear whether LVH is associated with increased rates of CHD in the absence of hypertension. METHODS We examined this association with Cox regression analyses of data from 7924 adults 25 to 74 years of age from the Second National Health and Nutrition Examination Survey (NHANES II) Mortality Study (1976 to 1992). Covariates included age, race, sex, history of cardiovascular diseases and diabetes, cholesterol, body mass index, blood pressure, and smoking. RESULTS During 16.8 follow-up years, there were 462 (26%) deaths from CHD (ICD-9 410-414) and 667 (38%) deaths from diseases of the heart (ICD-9 390-398, 402, 404, 410-414, 415-417, 420-429). LVH prevalence was 13.3 per 1000 population. Hypertension prevalence was 29.1%. LVH prevalence was higher among hypertensive adults than among normotensive adults (29.9 vs 6.4 per 1000, P <.001). Persons with LVH were twice as likely to die of CHD (relative risk, 2.0; 95% confidence interval, 1.2, 3.5) and diseases of the heart (relative risk, 1.9; 95% confidence interval, 1.1, 3.0) after adjustment for hypertension and covariates. In age-adjusted predicted survival, probability plots for CHD, and diseases of the heart, normotensives with LVH had survival similar to hypertensive adults with LVH and lower survival than normotensive and hypertensive adults with no LVH. CONCLUSIONS Our results confirm previous findings that the presence of LVH is a strong predictor of future cardiovascular death. Although LVH appears to be rare among normotensives, clinicians should be aware that such individuals may have an increased risk for death similar to that of hypertensive adults with LVH.
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Affiliation(s)
- D W Brown
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Sesso HD, Paffenbarger RS, Lee IM. Comparison of National Death Index and World Wide Web death searches. Am J Epidemiol 2000; 152:107-11. [PMID: 10909946 DOI: 10.1093/aje/152.2.107] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The authors used the National Death Index and a World Wide Web Internet site that searches the Social Security Administration master files of deaths to determine the mortality status of 1,000 US subjects from the College Alumni Health Study. Subjects were classified as definitely dead, possibly dead, or presumed alive. Of 246 definite deaths pinpointed by the National Death Index, the World Wide Web identified 94.7% of them. Of 438 men presumed alive according to the National Death Index, the World Wide Web identified 97.5% of them. However, the World Wide Web was not useful for identifying deaths of women. This study demonstrated that the World Wide Web may provide an alternative, inexpensive method of determining the mortality status of subjects in relatively small epidemiologic studies.
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Affiliation(s)
- H D Sesso
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
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Smith MA, Shahar E, McGovern PG, Kane RL, Doliszny KM, Arnett DK, Luepker RV. HMO membership and patient age and the use of specialty care for hospitalized patients with acute stroke: The Minnesota Stroke Survey. Med Care 1999; 37:1186-98. [PMID: 10599600 DOI: 10.1097/00005650-199912000-00002] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The number of older patients enrolling in health maintenance organizations (HMOs) is increasing. Concerns have been raised that older patients may be targeted by HMOs for more stringent cost-containment mechanisms, including reduced access to expensive specialty care. OBJECTIVES We investigated the relationship between membership in an HMO and the decision to consult with a neurologist or admit to a neurology ward for patients hospitalized with acute stroke. We then compared 1-year mortality of patients who received neurology care to the 1-year mortality of those who did not receive neurology care. DESIGN Retrospective medical record review. SUBJECTS A sample of hospitalized acute stroke patients (age range, 30-79 years) who were discharged from Minneapolis-St. Paul metropolitan hospitals with a diagnosis code of acute cerebrovascular disease from 1991 to 1993. MEASURES Trained nurses abstracted the medical records. Stroke events (n = 2,320) were validated using clinical criteria and neuroimaging reports. Mortality data were obtained from the Minnesota Death Index. RESULTS Among patients enrolled in HMOs, 30% of validated stroke patients did not receive neurology care in comparison with 19% of patients not enrolled in HMOs. After adjusting for patient mix and hospital characteristics, the odds of receiving neurology care were half as great for patients enrolled in HMOs as compared with patients not enrolled in HMOs (odds ratio [OR] = 0.52, 95% confidence interval [CI] 0.36-0.74). The association of membership in HMOs with lower use of neurology care was concentrated in older patients. Within each age group, the odds ratios and 95% CI of receiving neurology care for patients enrolled in HMOs versus patients not enrolled in HMOs were: < 55 years (1.06, 0.42-2.67), 55 to 64 years (0.54, 0.34-0.87), 65 to 74 years (0.51, 0.36-0.71), and >75 years (0.40, 0.24-0.68). Using Cox regression, 30-day mortality did not differ between patients who received neurology care and those who did not. Among 30-day survivors, the mortality hazards ratio (HR) during the next 11 months for patients who received neurology care was 71% of the hazard for patients who did not receive neurology care (HR = 0.71, 95% CI = 0.55-0.91). CONCLUSIONS These data suggest that membership in an HMO was associated with reduced access to neurology care for older patients with acute stroke and that patients who received neurology care had a lower risk of death during the year after their stroke. It remains to be determined if these differences in outcome are caused by true differences in stroke management or by unmeasured characteristics.
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Affiliation(s)
- M A Smith
- Department of Preventive Medicine, University of Wisconsin Medical School, Madison 53705-2397, USA
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Jacobs DR, Kroenke C, Crow R, Deshpande M, Gu DF, Gatewood L, Blackburn H. PREDICT: A simple risk score for clinical severity and long-term prognosis after hospitalization for acute myocardial infarction or unstable angina: the Minnesota heart survey. Circulation 1999; 100:599-607. [PMID: 10441096 DOI: 10.1161/01.cir.100.6.599] [Citation(s) in RCA: 140] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND We evaluated short- and long-term mortality risks in 30- to 74-year-old patients hospitalized for acute myocardial infarction or unstable angina and developed a new score called PREDICT. METHODS AND RESULTS PREDICT was based on information routinely collected in hospital. Predictors abstracted from hospital record items pertaining to the admission day, including shock, heart failure, ECG findings, cardiovascular disease history, kidney function, and age. Comorbidity was assessed from discharge diagnoses, and mortality was determined from death certificates. For 1985 and 1990 hospitalizations, the 6-year death rate in 6134 patients with 0 to 1 score points was 4%, increasing stepwise to 89% for >/=16 points. Score validity was established by only slightly attenuated mortality prediction in 3570 admissions in 1970 and 1980. When case severity was controlled for, 6-year risk declined 32% between 1970 and 1990. When PREDICT was held constant, 24% of those treated with thrombolysis died in 6 years compared with 31% of those not treated. CONCLUSIONS The simple PREDICT risk score was a powerful prognosticator of 6-year mortality after hospitalization.
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Affiliation(s)
- D R Jacobs
- Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, USA.
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Abstract
PURPOSE Previous research has found elevated mortality rates from anorexia nervosa (AN) and perhaps bulimia nervosa (BN). This study was performed using computerized record linkage to examine mortality rates in a cohort of patients with eating disorder (ED) diagnoses seen in an emergency room (ER) by a psychiatry service. METHODS ER records were retrieved for 122 consecutive ED patients seen over a 5-year period from 1985 to 1990. Demographic data, identifiers including social security number and date of birth, and clinical information were recorded; record linkage to a computerized vital status database, MINNDEX, through 1995 was then performed. Death certificates were subsequently obtained and reviewed to identify cause of death. RESULTS The average age at time of ER visit was 25.7 (SD 7.4); 91.8% were female, 8.2% male. The most common diagnosis was AN (44.3%); 34.4% were diagnosed with BN, and 21.3% with eating disorder not otherwise specified (EDNOS). Five subjects died in the 5 to 10-year follow-up period (all female). One deceased subject carried a diagnosis of BN, the other 4 had AN. Three subjects with AN were listed on death certificates as having died of that illness; the fourth died of emphysema. The deceased subject with BN died of traumatic causes. The crude mortality rates were 7.4% for AN and 2.4% for BN. The standardized mortality ratio for AN was 8.35. CONCLUSIONS This study confirms and extends prior reports of high mortality rates in AN, using an epidemiologic database with high ascertainment rates. While the crude mortality rate for BN was also high, the small sample size makes it difficult to draw conclusions.
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Affiliation(s)
- S Crow
- Department of Psychiatry, University of Minnesota, Minneapolis 55455, USA.
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Barrow SM, Herman DB, Córdova P, Struening EL. Mortality among homeless shelter residents in New York City. Am J Public Health 1999; 89:529-34. [PMID: 10191796 PMCID: PMC1508869 DOI: 10.2105/ajph.89.4.529] [Citation(s) in RCA: 193] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES This study examined the rates and predictors of mortality among sheltered homeless men and women in New York City. METHODS Identifying data on a representative sample of shelter residents surveyed in 1987 were matched against national mortality records for 1987 through 1994. Standardized mortality ratios were computed to compare death rates among homeless people with those of the general US and New York City populations. Logistic regression analysis was used to examine predictors of mortality within the homeless sample. RESULTS Age-adjusted death rates of homeless men and women were 4 times those of the general US population and 2 to 3 times those of the general population of New York City. Among homeless men, prior use of injectable drugs, incarceration, and chronic homelessness increased the likelihood of death. CONCLUSIONS For homeless shelter users, chronic homelessness itself compounds the high risk of death associated with disease/disability and intravenous drug use. Interventions must address not only the health conditions of the homeless but also the societal conditions that perpetuate homelessness.
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Affiliation(s)
- S M Barrow
- New York State Psychiatric Institute, New York 10032, USA.
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Sathiakumar N, Delzell E, Abdalla O. Using the National Death Index to obtain underlying cause of death codes. J Occup Environ Med 1998; 40:808-13. [PMID: 9777565 DOI: 10.1097/00043764-199809000-00010] [Citation(s) in RCA: 83] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study evaluated the comparability of underlying cause of death codes obtained from NDI Plus, a new feature of the National Death Index (NDI), with codes assigned by two study nosologists or by a National Center for Health Statistics (NCHS) nosologist. Two study nosologists and an NCHS nosologist independently reviewed the death certificates of 493 decedents and assigned each an International Classification of Diseases code for the underlying cause of death. Using the NCHS codes as the reference standard, we determined discrepancy rates for NDI Plus codes; for each study nosologist's original codes; and for "final study codes," derived by comparing the two sets of study nosologists' codes and resolving discrepancies by using the NCHS code. For all causes of death combined, the discrepancy rate was 4% for NDI Plus codes, 4% for the final study codes and 6%-7% for the study nosologists' original codes. The discrepancy rate for selecting the appropriate cancer site was 1% for NDI Plus codes and 3% for the final study codes. For noncancer conditions, the discrepancy rate was 5% for NDI Plus codes and 4% for the final study codes. NDI Plus underlying cause of death codes are comparable to codes developed using standard but more cumbersome procedures. The use of NDI Plus codes may enhance the validity of comparisons of an occupational cohort's mortality rates with national or state rates.
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Affiliation(s)
- N Sathiakumar
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham 35294, USA
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Liao Y, Cooper RS, Cao G, Durazo-Arvizu R, Kaufman JS, Luke A, McGee DL. Mortality patterns among adult Hispanics: findings from the NHIS, 1986 to 1990. Am J Public Health 1998; 88:227-32. [PMID: 9491012 PMCID: PMC1508177 DOI: 10.2105/ajph.88.2.227] [Citation(s) in RCA: 87] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES The purpose of this study was to assess the mortality pattern of the adult Hispanic population in the United States. METHODS This was a cohort study using data from the National Health Interview Survey from 1986 through 1990. Deaths were ascertained by matching the National Death Index through 1991. RESULTS This representative national sample included 297,640 non-Hispanic Whites, 53,552 Blacks, and 27,239 Hispanics, all aged 18 years or older at baseline. Different matching criteria resulted in modest differential estimates of the number of deaths by ethnic groups; these differences were quantitatively more important for Hispanics. Overall age-standardized mortality was lower among Hispanics. A prominent age by race interaction was apparent. The Hispanic: White mortality ratio was 1.33, 0.92, and 0.76 among men aged 18 through 44, 45 through 64, and 65 and older, respectively. Among women in the same age groups the Hispanic: White mortality ratio was 1.22, 0.75, and 0.70, respectively. CONCLUSIONS Longitudinal cohorts provide an important source of health status information on Hispanics. These results suggest that overall mortality is lower among Hispanics than among non-Hispanic Whites, especially in the oldest age group. Among younger and middle-aged persons, the mortality of Hispanics is similar to or even higher than that of Whites.
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Affiliation(s)
- Y Liao
- Department of Preventive Medicine and Epidemiology, Loyola University Stritch School of Medicine, Maywood, IL 60153, USA
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Schall LC, Marsh GM, Henderson VL. A two-stage protocol for verifying vital status in large historical cohort studies. J Occup Environ Med 1997; 39:1097-102. [PMID: 9383720 DOI: 10.1097/00043764-199711000-00010] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
When access to the Social Security Administration's Master Death Claim File was restricted in the mid-1980s, researchers were left with no time- and cost-effective protocol for verifying the vital status of large historical cohorts. A two-stage tracing protocol was designed to overcome this restriction. Stage I relies on national-scale sources to focus on the complete and accurate identification of deaths among persons unconfirmed as alive and assumes that persons not identified as deceased are alive. Stage II tests the "alive" assumption by extensively tracing a random sample of cohort members with unconfirmed vital status. Stage II provides unbiased estimates of the proportion of deaths among the assumed "alives" in the cohort (misclassification rate) and the proportion of persons untraceable in the total cohort. This paper describes our two-stage protocol and an application to a large, ongoing occupational cohort study.
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Affiliation(s)
- L C Schall
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, PA 15261, USA
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Durazo-Arvizu R, Cooper RS, Luke A, Prewitt TE, Liao Y, McGee DL. Relative weight and mortality in U.S. blacks and whites: findings from representative national population samples. Ann Epidemiol 1997; 7:383-95. [PMID: 9279447 DOI: 10.1016/s1047-2797(97)00044-6] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE To examine the impact of relative weight on mortality in black and white men and women. METHODS Two representative national populations samples were used: the NHANES-I Epidemiologic Follow-up Study (NHEFS), and the National Health Interview Survey (NHIS). The principal analysis focused on 13,242 participants in the NHEFS and 114,954 in the NHIS. Minimum mortality was estimated from both categorical analysis and a logistic model. RESULTS Minimum mortality ranged from a body mass index (BMI) of 25 to 32 kg/m2. The model-estimated BMI of minimum mortality for NHEFS was 27.1 (24.8-29.4, 95% CI), 26.8 (24.7-28.9, 95% CI), 24.8 (23.8-25.9, 95% CI) and 24.3 (23.2-25.4, 95% CI); for black men, black women, white men and white women, respectively, whereas for NHIS the corresponding values were 30.2 (24.8-35.6, 95% CI) 26.4 (24.2-28.7, 95% CI), 27.1 (25.5-28.7, 95% CI), and 25.6 (24.2-27.0, 95% CI). In all groups the shape of the relative risk curve was virtually identical and a broad range of BMI values in the middle of the distribution was associated with low relative mortality risk. Averaging the results from both surveys, the observed BMI of minimum risk was 3.1 kg/m2 higher in black men and 1.5 kg/m2 higher in black women than in their white counterparts; when adjusted for covariates these differences were only of borderline statistical significance, however. CONCLUSIONS Because of the wide range of BMI values associated with low risk, and the consistency of the point of the up-turn in risk, group specific definitions of optimal values do not appear to be warranted.
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Affiliation(s)
- R Durazo-Arvizu
- Department of Preventive Medicine and Epidemiology, Loyola University Stritch School of Medicine, Maywood, IL 60153, USA
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McGovern PG, Pankow JS, Shahar E, Doliszny KM, Folsom AR, Blackburn H, Luepker RV. Recent trends in acute coronary heart disease--mortality, morbidity, medical care, and risk factors. The Minnesota Heart Survey Investigators. N Engl J Med 1996; 334:884-90. [PMID: 8596571 DOI: 10.1056/nejm199604043341403] [Citation(s) in RCA: 421] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Mortality from coronary heart disease (CHD) has declined in the United States since the late 1960s. To understand the reasons for the decline during the period form 1985 to 1990, we examined trends in mortality and morbidity due to CHD, medical care, and risk factors for CHD in a large metropolitan population. METHODS We identified all deaths from CHD in residents of the Minneapolis-St. Paul, Minnesota, metropolitan area who were 30 to 74 years old and classified the deaths according to whether they occurred in or out of the hospital. For 1985 and 1990, we obtained lists of patients in this age range who were discharged with a diagnosis of acute CHD from all area hospitals, and we selected the medical records of 50 percent of these patients for abstraction. Definite myocardial infarctions were identified with standardized diagnostic algorithm. The 1985 and 1990 cohorts of patients hospitalized for myocardial infarction were followed for at least three years to identify those who died from any cause. Trends in risk factors for CHD were investigated through surveys of 25-to-74-year-olds that were conducted in 1985 through 1987 and 1990 through 1992. RESULTS Between 1985 and 1990, mortality from CHD fell by 25 percent for both men and women, and the decline in in-hospital mortality (41 percent) exceeded the decline in out-of-hospital mortality (17 percent) among men. The rates of hospitalization for acute myocardial infarction declined slightly, by 5 to 10 percent, between 1985 and 1990. Survival among patients hospitalized for acute myocardial infarction increased substantially during that period. After adjustment for age and previous myocardial infarction, the relative risk of dying within three years of hospitalization for a myocardial infarction (for the 1990 cohort as compared with the 1985 cohort) was 0.76 for men (95 percent confidence interval, 0.65 to 0.89) and 0.84 for women (95 percent confidence interval, 0.71 to 1.00). Substantial increases in the use of thrombolytic therapy, heparin, aspirin, and coronary angioplasty paralleled the survival trends. In general, the risk-factor profile of the area population with respect to CHD also improved considerably during that time. CONCLUSIONS The recent decline in mortality due to CHD in the Minneapolis-St. Paul metropolitan area can be explained by both the declining incidence of myocardial infarction in the population and the improved survival of patients with myocardial infarction.
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Affiliation(s)
- P G McGovern
- Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis 55454-1015, USA
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Demirovic J, Blackburn H, McGovern PG, Luepker R, Sprafka JM, Gilbertson D. Sex differences in early mortality after acute myocardial infarction (the Minnesota Heart Survey). Am J Cardiol 1995; 75:1096-101. [PMID: 7762492 DOI: 10.1016/s0002-9149(99)80737-1] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Although numerous studies indicate that women have a higher early mortality from acute myocardial infarction (AMI) than men, reasons for the difference are largely unexplained. We studied the role of sex in the prognosis of 1,600 patients with AMI aged 30 to 74 years in the population-based Minnesota Heart Survey. A 50% random sample was taken of all AMI patients hospitalized in 1980 and 1985 in the Twin Cities of Minnesota (Minneapolis-St. Paul) (1,168 men, 432 women). A multiple logistic regression model was used for predicting early death (within 28 days) and included baseline characteristics: sex, age, chest pain on admission, history of previous AMI, angina pectoris, coronary artery bypass surgery or hypertension, presence of heart failure, cardiac arrhythmias requiring direct-current shock, diabetes mellitus, valvular disease, cardiomyopathy, and levels of serum enzymes and blood urea nitrogen. Age-adjusted early mortality rate was significantly higher in women than men, but only in those aged < 65 years (12.5% of women vs 6.5% of men, p < 0.01) versus those aged > or = 65 years (19.5% vs 21.6%, p > 0.05). Multivariate analysis also showed that among those < 65 years, female sex was a strong and independent predictor of early death (odds ratio 2.0, 95% confidence interval 1.2 to 3.5, p < 0.01). Rates of coronary angiography, coronary artery bypass surgery, percutaneous transluminal coronary angioplasty, and thrombolysis performed during hospital stay were higher in men, but after adjustment for age, congestive heart failure, and diabetes mellitus, a statistically significant difference persisted only in the frequency of coronary angiography (26% in men vs 17% in women, p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- J Demirovic
- Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis 55454-1015, USA
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Shahar E, McGovern PG, Sprafka JM, Pankow JS, Doliszny KM, Luepker RV, Blackburn H. Improved survival of stroke patients during the 1980s. The Minnesota Stroke Survey. Stroke 1995; 26:1-6. [PMID: 7839376 DOI: 10.1161/01.str.26.1.1] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND PURPOSE The underlying reasons for the decline in stroke mortality in the United States are not well understood and have been the subject of ongoing debate. This study was undertaken to determine whether survival of hospitalized stroke patients has changed during the 1980s, thereby contributing to the decline in stroke mortality during that period. METHODS For the years 1980, 1985, and 1990, we obtained listings of discharge diagnoses from hospitals in the Minneapolis-St Paul metropolitan area and identified all hospitalizations with a discharge diagnosis code of acute cerebrovascular disease according to the International Classification of Diseases, 9th Revision. A 50% random sample of men and women aged 30 to 74 years was selected in each survey for detailed medical record abstraction. Standardized sets of criteria for stroke were then used to validate acute stroke events throughout the 1980s. Each of the three period cohorts of hospitalized stroke patients (1980, 1985, and 1990) was followed for at least 2 years for all-cause mortality end point. RESULTS A total of 1853 patients met minimal criteria for acute stroke: 564 patients in 1980, 598 patients in 1985, and 691 patients in 1990. Controlling for age, the odds of death within 2 years after stroke were approximately 40% lower in 1990 than in 1980. The relative odds of 2-year death in 1990 (versus 1980) were 0.65 (95% confidence interval, 0.47 to 0.89) and 0.60 (95% confidence interval, 0.42 to 0.85) for men and women, respectively. The improved survival was evident in the short term (28 days) as well as for stroke patients who survived that period. Analysis according to stroke subtype revealed that improved survival of ischemic stroke and specifically of stroke with no apparent cardioembolic source largely accounted for the overall trend. The prognosis of stroke patients who were admitted in a comatose state has not changed during that decade. CONCLUSIONS Despite the absence of any clear major advances in acute stroke therapy, survival of stroke patients substantially improved during the 1980s. The underlying reasons for this unexpected yet remarkable trend remain uncertain but may include improved supportive and rehabilitative care of stroke victims as well as a change in the natural history of the disease.
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Affiliation(s)
- E Shahar
- Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis 55454-1015
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Pankow JS, McGovern PG, Sprafka JM, Jacobs DR, Blackburn H. Trends in coded causes of death following definite myocardial infarction and the role of competing risks: the Minnesota Heart Survey (MHS). J Clin Epidemiol 1994; 47:1051-60. [PMID: 7730908 DOI: 10.1016/0895-4356(94)90121-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
We investigated possible differences over time in underlying causes of death among validated definite myocardial infarction cases who were discharged following an index hospitalization in 1970, 1980, and 1985 in the Twin Cities, MN. No changes were observed in underlying causes of death assigned to patients who died prior to discharge in the 3 years. Among in-hospital survivors of definite MI, however, age-adjusted rates of death from non-cardiovascular causes more than doubled between 1970 and 1985 (P < 0.01). More specifically, mortality rates for diabetes mellitus increased significantly from 1970 to 1985 (P < 0.05), while those for neoplasms and diseases of the respiratory system increased non-significantly. Whether these data are the result of artifactual changes in cause of death assignment or real changes in disease severity and comorbidity, these trends in long-term death following acute MI may have had a modest impact on reported community-wide coronary heart disease mortality rates.
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Affiliation(s)
- J S Pankow
- Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis 55454-1015, USA
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Sprafka JM, Virnig BA, Shahar E, McGovern PG. Trends in diabetes prevalence among stroke patients and the effect of diabetes on stroke survival: the Minnesota Heart Survey. Diabet Med 1994; 11:678-84. [PMID: 7955994 DOI: 10.1111/j.1464-5491.1994.tb00332.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
This study documented trends in the prevalence of diabetes among men and women hospitalized for acute stroke and determined the effect of diabetes on short- and long-term survival following stroke. These issues were investigated in the Minnesota Heart Survey, a population-based surveillance system that has monitored trends in stroke morbidity and mortality in the Minneapolis-St Paul metropolitan area since 1970. Clinical data were obtained from the hospital records of 50% samples of residents ages 30 to 74 years who were discharged with a diagnosis of acute stroke in 1970, 1980, and 1985. Between 1970 and 1985, the prevalence of diabetes as listed on the discharge diagnoses among stroke patients increased significantly in men (22.4% vs 10.5%; p = 0.006) and non-significantly in women (24.7% vs 15.9%; p = 0.3). During this time period, both in-hospital and 28-day case fatality rates declined in non-diabetic stroke patients but remained unchanged in stroke patients with diabetes. After controlling for the effects of age, sex, survey year, and level of consciousness, diabetes status had little effect on short-term (28-day) mortality of stroke patients, but the odds of 5-year mortality among those surviving to 1 year was 2.0 (95% Cl (1.3, 3.2)) times higher in diabetic compared to non-diabetic individuals. These findings suggest that the prevalence of diabetes has been increasing among stroke patients, and that the diabetic condition is a significant predictor of poorer long-term but not short-term survival following stroke.
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Affiliation(s)
- J M Sprafka
- Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis 55454-1015
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