Studies have shown that laws banning smoking in public places reduce exposure to secondhand smoke, but the impact of such laws on exposure to smoke outside the home and on household smoking policies has not been well documented. The goal of this study was to evaluate the effects of 2009 Wisconsin Act 12, a statewide smoke-free law enacted in July 2010, among participants in the Survey of the Health of Wisconsin (SHOW).
Smoking history and demographic information was gathered from 1341 survey participants from 2008 to 2010. Smoking behaviors of independent samples of participants surveyed before and after the legislation was enacted were compared.
The smoking ban was associated with a reduction of participants reporting exposure to smoke outside the home (from 55% to 32%; P < 0.0001) and at home (13% to 7%; P = 0.002). The new legislation was associated with an increased percentage of participants with no-smoking policies in their households (from 74% to 80%; P = .04). The results were stronger among participants who were older, wealthier, and more educated.
Smoke-free legislation appears to reduce secondhand smoke exposure and to increase no-smoking policies in households. Further research should be conducted to see if these effects are maintained.
Rationale: Sleep-disordered breathing (SDB) has been associated with total and cardiovascular mortality, but an association with cancer mortality has not been studied. Results from in vitro and animal studies suggest that intermittent hypoxia promotes cancer tumor growth.
Objectives: The goal of the present study was to examine whether SDB is associated with cancer mortality in a community-based sample.
Methods: We used 22-year mortality follow-up data from the Wisconsin Sleep Cohort sample (n = 1,522). SDB was assessed at baseline with full polysomnography. SDB was categorized using the apnea-hypopnea index (AHI) and the hypoxemia index (percent sleep time below 90% oxyhemoglobin saturation). The hazards of cancer mortality across levels of SDB severity were compared using crude and multivariate analyses.
Measurements and Main Results: Adjusting for age, sex, body mass index, and smoking, SDB was associated with total and cancer mortality in a dose–response fashion. Compared with normal subjects, the adjusted relative hazards of cancer mortality were 1.1 (95% confidence interval [CI], 0.5–2.7) for mild SDB (AHI, 5–14.9), 2.0 (95% CI, 0.7–5.5) for moderate SDB (AHI, 15–29.9), and 4.8 (95% CI, 1.7–13.2) for severe SDB (AHI ≥ 30) (P-trend = 0.0052). For categories of increasing severity of the hypoxemia index, the corresponding relative hazards were 1.6 (95% CI, 0.6–4.4), 2.9 (95% CI, 0.9–9.8), and 8.6 (95% CI, 2.6–28.7).
Conclusions: Our study suggests that baseline SDB is associated with increased cancer mortality in a community-based sample. Future studies that replicate our findings and look at the association between sleep apnea and survival after cancer diagnosis are needed.
cancer; cohort study; mortality; obstructive sleep apnea; sleep-disordered breathing
Sleep disordered breathing (SDB) has been associated with cardiovascular disease, hypertension, and insulin resistance. This article examines the association between SDB and the prevalence of metabolic syndrome (MS) in a community-based sample.
A subset of participants in the Wisconsin Sleep Cohort Study (N=546) participated in an ancillary study to measure vascular and metabolic function. SDB was characterized using the apnea-hypopnea index (AHI) obtained in the polysomnography study closest to the collection of the metabolic measures. MS was defined using the National Cholesterol Education Program definition, and the homeostasis model assessment method (HOMA) was used to characterize insulin resistance.
SDB was significantly correlated with insulin resistance (Spearman r correlation between AHI and HOMA=0.30, P<0.0001). Compared with those without SDB (AHI <5), the age-sex-adjusted odds ratios of MS associated with mild (AHA 5-14.9) and moderate/severe SDB (AHI >15 or CPAP) were 4.0 (95% CI 2.6, 6.3) and 5.3 (95% CI 3.2, 8.8), respectively. Additional adjustment for markers of sympathetic or neuroendocrine activation (urinary norepinephrine, cortisol, heart rate variability) did not materially alter these estimates. These associations were weaker but remained statistically significant after adjusting for body mass index.
SDB might be considered an integral component of MS.
Individual biomarkers of inflammation, endothelial dysfunction and oxidative stress have been associated with cognitive impairment. This study explored whether a combination of biomarkers could prospectively identify those who developed cognitive decline.
Biomarkers were obtained during the baseline examination of the Beaver Dam Eye Study (1988–90), and cognitive status was assessed during the 5-year follow-up examination of the Epidemiology of Hearing Loss Study (1998–2000). Cognitive impairment was defined as a score of < 24 points on the Mini-Mental State Examination or self- or proxy report of Alzheimer Disease or dementia. Among those with cognitive data, interleukin-6, isoprostanes, protein carbonyl, soluble inter-cellular adhesion molecule-1 and vascular cell adhesion molecule-1 were available for 950 participants and 2,336 had high sensitivity C-reactive protein.
Biomarkers of inflammation and endothelial dysfunction were not associated with cognitive impairment. There was a weak inverse association between higher levels of protein carbonyl content and cognitive impairment (OR, 0.8 per quartile of protein carbonyl content, p=0.045 unadjusted for multiple comparisons). This was not significant on multiple testing and may have been a chance finding.
We found that many markers of inflammation and endothelial dysfunction were not associated with cognitive impairment. An inverse association with carbonyl protein, a marker of oxidative stress needs further confirmation.
oxidative stress; inflammation; biomarkers; cognitive impairment
Standard clinical advice for the prevention and treatment of hypertension includes limitation of salt intake. Previous studies of the association between perception of salt taste and hypertension prevalence have not reported consistent results and have usually been conducted in small study populations.
To determine the cross-sectional relationship between intensity of salt taste, discretionary salt use, and hypertension. METHODS: Subjects (n=2371, mean age=48.8 years) were participants in the Beaver Dam Offspring Study (BOSS), an investigation of sensory loss and aging conducted in 2005–2008. Salt taste intensity was measured using a filter paper disk impregnated with 1.0 M sodium chloride and a general Labeled Magnitude Scale (gLMS). Hypertension was defined as systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg, or use of high blood pressure medication.
Nearly 32% of the participants rated the salt disk as weak or having no taste while approximately 10% considered it to be very strong or stronger. The intensity was reported to be less strong by males (P < 0.001) and college graduates (P = 0.02) and was inversely associated with frequency of adding salt to foods (P = 0.02). There was no significant association between hypertension and the intensity of salt taste, before and after adjustment for covariates. Exclusion of subjects with a history of physician diagnosed hypertension did not appreciably alter these findings.
The perception of salt taste was related to the frequency of discretionary salt use but not to hypertension status or mean blood pressure.
high blood pressure; hypertension; population; salt taste; salt use; taste intensity
Increasing numbers of individuals are choosing to opt out of population-based sampling frames due to privacy concerns. This is especially a problem in the selection of controls for case–control studies, as the cases often arise from relatively complete population-based registries, whereas control selection requires a sampling frame. If opt out is also related to risk factors, bias can arise.
We linked breast cancer cases who reported having a valid driver’s license from the 2004–2008 Wisconsin women’s health study (N = 2,988) with a master list of licensed drivers from the Wisconsin Department of Transportation (WDOT). This master list excludes Wisconsin drivers that requested their information not be sold by the state. Multivariate-adjusted selection probability ratios (SPR) were calculated to estimate potential bias when using this driver’s license sampling frame to select controls.
A total of 962 cases (32%) had opted out of the WDOT sampling frame. Cases age <40 (SPR = 0.90), income either unreported (SPR = 0.89) or greater than $50,000 (SPR = 0.94), lower parity (SPR = 0.96 per one-child decrease), and hormone use (SPR = 0.93) were significantly less likely to be covered by the WDOT sampling frame (α = 0.05 level).
Our results indicate the potential for selection bias due to differential opt out between various demographic and behavioral subgroups of controls. As selection bias may differ by exposure and study base, the assessment of potential bias needs to be ongoing.
SPRs can be used to predict the direction of bias when cases and controls stem from different sampling frames in population-based case–control studies.
Atherosclerosis may be associated with cognitive function; however the studies are few, especially among midlife adults.
Participants in the Beaver Dam Offspring Study who had cognitive test data and gradable carotid artery ultrasound scans were included (n=2794, mean age: 49 years). Atherosclerosis was measured by carotid intima-media thickness (IMT) and presence of plaque. Cognitive function was measured by the Trail Making Test (TMT), Grooved Pegboard Test (GPT) and Mini-Mental State Examination (MMSE). Generalized cognitive function was defined by a summary score calculated from the TMT and GPT. Linear regression was used to evaluate the associations between carotid atherosclerosis and cognitive function tests.
Larger IMT was associated with lower GPT, MMSE and the summary score adjusting for multiple factors, the coefficients were: 13.8 seconds (p<0.0001), −0.6 (p=0.007), and 0.47 (p=0.01), respectively for 1 mm increase in IMT. Plaque scores were significantly associated with TMT-B, GPT, MMSE, and the summary score adjusting for age, sex and education. The associations remained statistically significant after further adjustments except for the association with TMT-B, which was attenuated and no longer significant.
Our results show significant associations between markers of carotid atherosclerosis and cognitive function in a cohort of persons aged 21 to 84 years. Longitudinal studies are needed to further examine these associations.
atherosclerosis; cognitive function; epidemiology
To assess the prevalence of tinnitus along with factors potentially associated with having tinnitus.
Data were from the Beaver Dam Offspring Study, an epidemiological cohort study of aging.
After a personal interview and audiometric examination, participants (n=3267, ages 21-84 years) were classified as having tinnitus if in the past year they reported having tinnitus of at least moderate severity or that caused difficulty in falling asleep.
The prevalence of tinnitus was 10.6%. In a multivariable logistic regression model adjusting for age and sex, the following factors were associated with having tinnitus: hearing impairment (Odds Ratio (OR) = 3.20), currently having a loud job (OR = 1.90), history of head injury (OR = 1.84), depressive symptoms (OR = 1.82), history of ear infection (men, OR = 1.75), history of target shooting (OR = 1.56), arthritis (OR = 1.46), and use of NSAID medications (OR = 1.33). For women, ever drinking alcohol in the past year was associated with a decreased risk of having tinnitus (OR = 0.56).
These results suggest that tinnitus is a common symptom in this cohort and may be associated with some modifiable risk factors.
Tinnitus; Demographics/Epidemiology; Hearing Conservation; Aging
Recent cross-sectional studies have reported an association between retinal vessel caliber and chronic kidney disease (CKD), but the direction of the association between these two processes is not clear. In a prospective study with multiple measurements of retinal vessel diameters and serum creatinine, we examined if baseline retinal vessel diameters are associated with future risk of CKD, or vice versa.
Population-based cohort study
Setting and participants
3,199 Wisconsin adults aged 43-84 years who were followed prospectively for 15 years.
Baseline retinal arteriolar and venular diameters for analysis 1, and baseline estimated glomerular filtration rate (eGFR) categories for analysis 2.
Outcomes and measurements
For analysis 1, incident CKD defined as eGFR <60 mL/min/1.73m2 accompanied by a 25% decrease in eGFR during follow up. For analysis 2, incident retinal arteriolar narrowing defined as a central retinal arteriolar equivalent measurement of <144.0μm and incident retinal venular dilation defined as a central retinal venular equivalent measurement of >243.8μm.
Baseline retinal arteriolar and venular diameters were not found to be associated with the 15-year risk of incident CKD. After adjustment for age, sex, diabetes, hypertension and other confounders, the multivariable hazard ratio (HR) (95% confidence interval (CI) of incident CKD comparing the narrowest with the widest quartile was 1.15 (0.74-1.80) for retinal arteriolar and 1.05 (0.67-1.67) for retinal venular diameter. Similarly, there was no significant association between eGFR and 15-year risk of incident retinal arteriolar narrowing or retinal venular widening. Compared to eGFR >90 mL/min/1.73m2 (referent), the multivariable HR (95% CI) among those with eGFR <45 mL/min/1.73m2 was 1.66 (0.93-2.96) for incident retinal arteriolar narrowing and 0.60 (0.17-1.85) for retinal venular widening.
Lack of data on albuminuria and loss to follow-up.
Retinal vessel diameters and CKD may run together through shared mechanisms but are not causally related.
Retinal arteriolar diameter; retinal venular diameter; retinal vessel diameter; chronic kidney disease; eGFR; CKD; glomerular filtration rate
To estimate the prevalence of hearing impairment (HI) and evaluate the cross-sectional associations of environmental and cardiovascular disease risk factors and HI in middle-aged adults.
Data were collected as part of the Beaver Dam Offspring Study (BOSS), an epidemiological cohort study of aging. HI was defined as a pure-tone average (PTA) 0.5,1,2,4kHz >25 db HL in either ear. Word recognition in competing message (WRCM) was measured using the Northwestern University #6 word list. Questionnaire information about behaviors, environmental factors and medical history was collected.
Participants (n=3,285) were offspring of participants of the population-based Epidemiology of Hearing Loss Study, and ranged in age from 21–84 years (mean age=49 years).
The prevalence of HI was 14.1%, and the median WRCM score was 64% (standard deviation=15%). In a multivariate model, controlling for age, sex, education, and occupational noise, a history of ear surgery (Odds Ratio (OR) = 4.11, 95%Confidence Interval (CI) = 2.37, 7.15), larger central retinal venular equivalent (CRVE) (OR = 1.77, 95%CI = 1.20, 2.60; 4th q vs. 1st q), and higher hematocrit percentage (OR = 0.77, 95% CI = 0.63, 0.95; per 5%) were independently associated with HI. Factors associated with lower WRCM scores were similar but also included mean intima-media thickness (mean difference= −0.63% (−1.06, −0.19) P= 0.005; per 0.1mm) and statin use (mean difference= −2.09% (−3.58, −0.60) P=0.005).
HI is a common condition in middle-aged adults. CVD risk factors may be important correlates of age-related auditory dysfunction.
This study investigated the long-term effects of socioeconomic status (SES) on atherosclerosis.
Data from the Epidemiology of Hearing Loss Study and the Beaver Dam Eye Study (Beaver Dam, WI, 1998-2000), were used to examine adult SES (education, household income, longest-held job) and childhood SES (household density and parental home ownership at age 13) associations with carotid intima-media thickness (IMT) and carotid plaque in a cohort of 2,042 men and women aged 53 to 94 years.
For education, income, and occupation (women), those in the lowest SES group had statistically larger age-sex-adjusted IMT than those in the highest SES group (<12 vs. >12 years education: 0.92 vs. 0.86 mm respectively, P<0.0001), (<$10,000 vs. >$45,000: 0.97 vs. 0.87 mm, P<0.0001), (operator/fabricator/labor vs. manager/professional: 0.89 vs. 0.82 mm, P<0.001). Associations were similar using carotid plaque as the outcome. Participants with low levels of both adult and childhood SES measures had age-sex-adjusted IMT greater than those with persistently high levels of SES (0.93 vs. 0.84 mm, P<0.0001).
Measures of SES at two points in the life-span were associated with subclinical atherosclerosis.
Socioeconomic Status; Intima-media Thickness; Atherosclerosis; Carotid Artery plaque; Cardiovascular disease; Life-course epidemiology
In animal models, inflammatory processes have been shown to have an important role in the development of kidney disease. In humans, however, the independent relation between markers of inflammation and the risk of chronic kidney disease (CKD) is not known. To clarify this, we examined the relationship of several inflammatory biomarker levels (high-sensitivity C-reactive protein, tumor necrosis factor-α receptor 2, white blood cell count, and interleukin-6) with the risk of developing CKD in a population-based cohort of up to 4926 patients with 15 years of follow-up. In cross-sectional analyses, we found that all these inflammation markers were positively associated with the outcome of interest, prevalent CKD. However, in longitudinal analyses examining the risk of developing incident CKD among those who were CKD-free at baseline, only tumor necrosis factor-α receptor 2, white blood cell count, and interleukin-6 levels (hazard ratios comparing highest with the lowest tertile of 2.10, 1.90, and 1.45, respectively), and not C-reactive protein (hazard ratio 1.09), were positively associated with incident CKD. Thus, elevations of most markers of inflammation predict the risk of developing CKD. Each marker should be independently verified.
chronic kidney disease; CRP; inflammation; tumor necrosis factor-alpha
This study of participants in a U.S. drug treatment court describes the relationship between the imposition of short-term jail sanctions and substance abuse treatment drop-out, and examines offender characteristics moderating or modifying the impact of jail sanctions on treatment drop-out.
Data were derived from administrative information collected by the Dane County Wisconsin Drug Treatment Court from 1996–2004 on all 573 participants achieving a final disposition of treatment completion or failure during those program years. Iterative Cox proportional hazards models of time to treatment failure were created; jail sanctions during drug court participation were framed as time-dependent co-variates. A theoretical framework and specific statistical criteria guided construction of a final parsimonious model of time to treatment drop-out.
Treatment failure was associated with unemployment [hazard ratio (HR) in unemployed vs. employed = 1.41, p-value 0.0079], lower educational attainment (HR in high school non-graduate vs. graduate = 1.41, p = 0.02), and application of the first jail sanction (HR 2.71, p < 0.0001). The association between treatment failure and a first sanction was considerably stronger for sanctions administered earlier in participation (HR for sanction 1 at < 30 days 11.34, p-value 0.0002).
An initial jail sanction for non-adherence may be more likely to foster treatment compliance in less refractory individuals (i.e. those not already acclimated or socialized to incarceration or other corrections interventions). More stringent supervisory conditions and individualized services may be required to reintegrate such offenders and promote longer term public safety.
Rationale: Cerebrovascular regulation is impaired in patients with moderate to severe obstructive sleep apnea; however, it is unknown whether this impairment exists in individuals with less severe sleep-disordered breathing.
Objectives: To test the hypothesis that cerebrovascular responses to hypercapnia are attenuated in a nonclinical population-based cohort.
Methods: A rebreathing test that raised end-tidal CO2 tension by 10 mm Hg was performed during wakefulness in 373 participants of the Wisconsin Sleep Cohort.
Measurements and Main Results: We measured cerebral flow velocity (transcranial Doppler ultrasound); heart rate (electrocardiogram); blood pressure (photoplethysmograph); ventilation (pneumotachograph); and end-tidal CO2 (expired gas analysis). Cerebrovascular CO2 responsiveness was quantified as the slope of the linear relationship between flow velocity and end-tidal CO2 during rebreathing. Linear regression analysis was performed using cerebrovascular CO2 responsiveness as the outcome variable. Main independent variables were the apnea–hypopnea index and the mean level of arterial oxygen saturation during sleep. We observed a positive correlation between cerebrovascular CO2 responsiveness and the mean level of oxygen saturation during sleep that was statistically significant in unadjusted analysis and after adjustment for known confounders and the increase in arterial pressure during rebreathing. Each 5% decrease in SaO2 during sleep predicted a decrease in cerebrovascular reactivity of 0.4 ± 0.2 cm/second/mm Hg PETCO2. In contrast, the negative correlation between cerebrovascular CO2 responsiveness and apnea–hypopnea index was statistically significant only in the unadjusted analysis.
Conclusions: Hypercapnic vasodilation in the cerebral circulation is blunted in individuals with sleep-disordered breathing. This impairment is correlated with hypoxemia during sleep.
sleep apnea syndromes; cerebrovascular circulation; blood flow velocity; hypercapnia; endothelial function
Depression and obesity are both important public health problems. However, it is not clear whether obesity contributes to depression. Our study aims to evaluate the association between obesity and possible depression.
During the Beaver Dam Offspring Study (BOSS) examination, participants’ body weight and height were measured with a Detecto 758C digital scale with height bar, and depression symptoms were measured with the Center for Epidemiological Studies-Depression Scale (CES-D). Other relevant information (such as demographic factors, lifestyle factors, comorbidities and use of anti-depressants) was also collected during the examination. There were 2641 participants included in the analyses.
Obesity was associated with possible depression measured by CES-D scale (OR =1.6, 95% CI: 1.3–2.0) after controlling for age and gender. The association remained similar after further adjustments. Obesity was significantly associated with all four domains measured by CES-D scale after controlling for age and sex, with the largest effect on “Somatic complaints” domain (beta 0.15, 95% CI: 0.0836–0.223). The association with “Interpersonal difficulties” was not significant after further adjustments.
Obesity was associated with a higher risk of possible depression, and had different influences on specific domains of depression symptoms measured by CES-D scale. These findings suggest the need for longitudinal studies on the effects of obesity on specific depression symptoms.
obesity; depression; epidemiology
To determine the prevalence of age-related macular degeneration (AMD) and examine relationships of retinal drusen, retinal pigmentary abnormalities and early AMD to age, sex and other risk factors in 2810 people 21-84 years of age, participating in the Beaver Dam Offspring Study (BOSS).
The presence and severity of various characteristics of drusen and other lesions typical of AMD were determined by grading digital color fundus images using the Wisconsin Age-Related Maculopathy Grading System.
Early AMD was present in 3.4% of the cohort and varied from 2.4% in those 21-34 years of age to 9.8% in those 65 years of age or older. In a multivariable model (expressed as Odds Ratio [OR]; 95% Confidence Interval [CI]), age (1.22 per 5 years of age; 1.09, 1.36), being male (1.65; 1.01, 2.69), more pack years smoked (1 to 10 vs 0, 1.31; 0.75, 2.29; 11+ vs 0, 1.67; 1.03, 2.73), higher serum HDL cholesterol (per 5 mg/dL 0.91; 0.83, 0.998), and hearing impairment (2.28; 1.41, 3.71) were associated with early AMD. There were no associations of blood pressure level, body mass index, physical activity, history of heavy drinking, white blood cell count, hematocrit, platelet count, serum total cholesterol, or carotid intimal-medial thickness with early AMD.
These data indicate that early AMD is infrequent before age 55 years but increases with age thereafter. Early AMD is related to modifiable risk factors, e.g., smoking and serum HDL cholesterol.
age-related macular degeneration; prevalence; risk factors
Research on children's responses to wartime trauma has mostly addressed Post-Traumatic Stress Disorder (PTSD). However, PTSD is only one aspect of a complex set of responses. This study proposes to expand knowledge of well-being in children exposed to political violence through widening the conceptualization of well-being beyond PTSD, morbidity, and mortality by measuring health-related quality of life (HRQOL) and its facets, physical health, and psychosocial health.
In 2007, we used a cross-sectional random sample of kindergartens to examine factors associated with HRQOL, as measured by the PedsQL 4.0, in 350 preschoolers in the Gaza Strip, Palestine, where political violence and deprivation are widespread.
About 65% of the mothers reported severely impaired psychosocial and emotional functioning in their children. Preschoolers had lower HRQOL than the US reference sample and samples of children in other low income countries with large effect size. HRQOL was comparable to those of US children with several chronic diseases. Factors associated with lower HRQOL were older child age, male gender, and more exposures to traumatic events. Factors associated with HRQOL subscales were for lower psychosocial health: older child age, history of food, water, and electricity deprivation during incursion, and witnessing assassination of people by rockets. For lower physical health: older child age, history of food, water, and electricity deprivation during incursion, and having heard of a killing of a friend by soldiers.
HRQOL, including psychosocial health and emotional functioning is often severely impaired among preschoolers in the Gaza Strip. Exposure to both violent and non-violent negative events was associated with HRQOL in preschoolers.
To compare refraction measured pre- and post- pharmacologic cycloplegia.
This study used preliminary data from the Beaver Dam Offspring Study, which includes adult children of participants in the population-based Epidemiology of Hearing Loss Study of older adults living in Beaver Dam, Wisconsin. Data were available for 5018 eyes of 2529 participants. Refraction was defined by the spherical equivalent (SE), using autorefractor readings. Differences were calculated as the SE after drops minus the SE before drops. Myopia was defined as SE ≤ -1 diopter (D), emmetropia as -1 D< SE< 1 D, and hyperopia as SE ≥ 1 D.
The mean age was 48 years (range 22 to 84). The mean difference in SE between pre- and post- cycloplegia was 0.29 D (95% confidence interval 0.28, 0.31). The difference decreased with age, and varied by refractive status for participants younger than 50 years of age, with largest differences observed among young persons with hyperopic refractive errors. Across all age groups, agreement on classifications of refraction was high (84% to 92%).
Overall, clinically inconsequential differences were observed between SEs before and after pharmacologic cycloplegia suggesting that cycloplegia may not be necessary in epidemiological studies of refraction in adults.
Evidence-based public health requires the existence of reliable information systems for priority setting and evaluation of interventions. Existing data systems in the United States are either too crude (e.g., vital statistics), rely on administrative data (e.g., Medicare) or, because of their national scope (e.g., NHANES), lack the discriminatory power to assess specific needs and to evaluate community health activities at the state and local level. This manuscript describes the rationale and methods of the Survey of the Health of Wisconsin (SHOW), a novel infrastructure for population health research.
The program consists of a series of independent annual surveys gathering health-related data on representative samples of state residents and communities. Two-stage cluster sampling is used to select households and recruit approximately 800-1,000 adult participants (21-74 years old) each year. Recruitment and initial interviews are done at the household; additional interviews and physical exams are conducted at permanent or mobile examination centers. Individual survey data include physical, mental, and oral health history, health literacy, demographics, behavioral, lifestyle, occupational, and household characteristics as well as health care access and utilization. The physical exam includes blood pressure, anthropometry, bioimpedance, spirometry, urine collection and blood draws. Serum, plasma, and buffy coats (for DNA extraction) are stored in a biorepository for future studies. Every household is geocoded for linkage with existing contextual data including community level measures of the social and physical environment; local neighborhood characteristics are also recorded using an audit tool. Participants are re-contacted bi-annually by phone for health history updates.
SHOW generates data to assess health disparities across state communities as well as trends on prevalence of health outcomes and determinants. SHOW also serves as a platform for ancillary epidemiologic studies and for studies to evaluate the effect of community-specific interventions. It addresses key gaps in our current data resources and increases capacity for etiologic, applied and translational population health research. It is hoped that this program will serve as a model to better support evidence-based public health, facilitate intervention evaluation research, and ultimately help improve health throughout the state and nation.
Glomerular filtration rate (GFR)-estimating equations are used to determine the prevalence of chronic kidney disease (CKD) in population-based studies. However, it has been suggested that since the commonly used GFR equations were originally developed from samples of patients with CKD, they underestimate GFR in healthy populations. Few studies have made side-by-side comparisons of the effect of various estimating equations on the prevalence estimates of CKD in a general population sample.
Patients and methods:
We examined a population-based sample comprising adults from Wisconsin (age, 43–86 years; 56% women). We compared the prevalence of CKD, defined as a GFR of <60 mL/min per 1.73 m2 estimated from serum creatinine, by applying various commonly used equations including the modification of diet in renal disease (MDRD) equation, Cockcroft–Gault (CG) equation, and the Mayo equation. We compared the performance of these equations against the CKD definition of cystatin C >1.23 mg/L.
We found that the prevalence of CKD varied widely among different GFR equations. Although the prevalence of CKD was 17.2% with the MDRD equation and 16.5% with the CG equation, it was only 4.8% with the Mayo equation. Only 24% of those identified to have GFR in the range of 50–59 mL/min per 1.73 m2 by the MDRD equation had cystatin C levels >1.23 mg/L; their mean cystatin C level was only 1 mg/L (interquartile range, 0.9–1.2 mg/L). This finding was similar for the CG equation. For the Mayo equation, 62.8% of those patients with GFR in the range of 50–59 mL/min per 1.73 m2 had cystatin C levels >1.23 mg/L; their mean cystatin C level was 1.3 mg/L (interquartile range, 1.2–1.5 mg/L). The MDRD and CG equations showed a false-positive rate of >10%.
We found that the MDRD and CG equations, the current standard to estimate GFR, appeared to overestimate the prevalence of CKD in a general population sample.
chronic kidney disease; glomerular filtration rate; MDRD equation; Cockcroft–Gault equation; Mayo equation
Olfactory function may be important for environmental and nutritional safety and enjoyment. Population-based epidemiologic studies of olfaction are needed to understand the magnitude of the health burden, identify modifiable risk factors and develop and test prevention and treatment strategies for olfactory impairment. However, measuring olfaction in large studies is challenging, requiring repeatable, efficient methods which can measure change over time. Two large cohort studies, the Epidemiology of Hearing Loss Study (EHLS) and the Beaver Dam Offspring Study (BOSS), included olfactory testing. In both studies, the San Diego Odor Identification Test (SDOIT) was used to measure olfaction. Subjects were asked to identify eight common household odors (such as coffee and chocolate). Olfactory impairment was defined as correctly identifying fewer than 6 out of 8 odorants after two trials. EHLS participants were age 53–95 years at the time of the first measurement (1998–2000) and participants in the BOSS were age 21–84 years. The prevalence of olfactory impairment in the EHLS was 25% overall, more common in men than women and increased with age. Five years later olfaction was measured a second time and the majority (84%) of EHLS participants were classified the same. Among those with impairment at the baseline nearly one-third (31%) improved to unimpaired. This heterogeneity in olfactory impairment has unique implications for data analyses and predicting outcomes and associations. Preliminary data from the BOSS suggest the prevalence of olfactory impairment may be lower in younger generations. All these factors point to a continuing need for epidemiological studies of olfaction.
Olfaction; Epidemiology; Population-based; EHLS; BOSS
Peripheral arterial disease (PAD), defined by a low ankle-brachial index (ABI), is associated with an increased risk of cardiovascular events, but the risk of coronary heart disease (CHD) over the range of the ABI is not well characterized, nor described for African Americans.
The ABI was measured in 12186 white and African American men and women in the Atherosclerosis Risk in Communities Study in 1987–89. Fatal and non-fatal CHD events were ascertained through annual telephone contacts, surveys of hospital discharge lists and death certificate data, and clinical examinations, including electrocardiograms, every 3 years. Participants were followed for a median of 13.1 years. Age- and field-center-adjusted hazard ratios (HRs) were estimated using Cox regression models.
Over a median 13.1 years follow-up, 964 fatal or non-fatal CHD events accrued. In whites, the age- and field-center-adjusted CHD hazard ratio (HR, 95% CI) for PAD (ABI<0.90) was 2.81 (1.77–4.45) for men and 2.05 (1.20–3.53) for women. In African Americans, the HR for men was 4.86 (2.76–8.47) and for women was 2.34 (1.26–4.35). The CHD risk increased exponentially with decreasing ABI as a continuous function, and continued to decline at ABI values > 1.0, in all race-gender subgroups. The association between the ABI and CHD relative risk was similar for men and women in both race groups. A 0.10 lower ABI increased the CHD hazard by 25% (95% CI 17–34%) in white men, by 20% (8–33%) in white women, by 34% (19–50%) in African American men, and by 32% (17–50%) in African American women.
African American members of the ARIC cohort had higher prevalences of PAD and greater risk of CHD associated with ABI-defined PAD than did white participants. Unlike in other cohorts, in ARIC the CHD risk failed to increase at high (>1.3) ABI values. We conclude that at this time high ABI values should not be routinely considered a marker for increased CVD risk in the general population. Further research is needed on the value of the ABI at specific cutpoints for risk stratification in the context of traditional risk factors.
Untreated sleep apnea is a prevalent but treatable condition of breathing pauses during sleep. With approximately 15% of the US population affected, understanding of the total health burden is necessary to guide policy, population initiatives, and clinical practice to reduce the prevalence of this condition.
To outline the history and need for a population approach to understanding sleep apnea and provide a review of the first longitudinal population study of this disorder.
The results of cross-sectional and longitudinal data from 1500 participants in the Wisconsin Sleep Cohort, initiated 2 decades ago, illustrate the population burden of sleep apnea.
The prevalence of sleep apnea is increasing with trends of increased obesity. Prospective findings from 4- to 15-year follow-up data indicate untreated sleep apnea predicts increased blood pressure, hypertension, stroke, depression, and mortality.
The high prevalence of untreated sleep apnea and links to serious morbidity and mortality underscore the population burden of this condition and the need for greater clinical recognition and strategies to reduce prevalence.
The aim of this report is to describe the main characteristics of the design, including response rates, of the Cornella Health Interview Survey Follow-up Study.
The original cohort consisted of 2,500 subjects (1,263 women and 1,237 men) interviewed as part of the 1994 Cornella Health Interview Study. A record linkage to update the address and vital status of the cohort members was carried out using, first a deterministic method, and secondly a probabilistic one, based on each subject's first name and surnames. Subsequently, we attempted to locate the cohort members to conduct the phone follow-up interviews. A pilot study was carried out to test the overall feasibility and to modify some procedures before the field work began.
After record linkage, 2,468 (98.7%) subjects were successfully traced. Of these, 91 (3.6%) were deceased, 259 (10.3%) had moved to other towns, and 50 (2.0%) had neither renewed their last municipal census documents nor declared having moved. After using different strategies to track and to retain cohort members, we traced 92% of the CHIS participants. From them, 1,605 subjects answered the follow-up questionnaire.
The computerized record linkage maximized the success of the follow-up that was carried out 7 years after the baseline interview. The pilot study was useful to increase the efficiency in tracing and interviewing the respondents.
record linkage; cohort study; risk factors; smoking; alcohol; cancer; cardiovascular diseases; methods