The obesity epidemic raises concerns about the impact of excessive and insufficient weight gain during pregnancy.
We examined the association between gestational weight gain (GWG) and preterm birth, term small- and large-for-gestational-age (SGA and LGA), term birthweight, and term primary Cesarean delivery, considering prepregnancy body mass index (BMI) and ethnicity in a cohort of 33,872 New York City residents who gave birth between 1995 and 2003 and delivered in hospitals elsewhere in New York State.
Preterm birth (<37 weeks’ gestation) showed a modest U-shaped relationship, with projected GWG of <10 kg and 20+ kg associated with odds ratios of 1.4 and 1.3, respectively, relative to 10 to 14 kg. The pattern was stronger for preterm birth <32 weeks’ and for underweight women with low GWG and overweight/obese women with high GWG. Term SGA decreased and term LGA and birthweight increased monotonically with increasing GWG. Primary Cesarean delivery followed the same pattern as LGA, but less strongly.
Although the study is limited by potential selection bias and measurement error, our findings support the contention that GWG may be a modifiable predictor of pregnancy outcome that warrants further investigation, particularly randomized trials, to assess whether the relation is causal.
Birth Weight; Cesarean Delivery; Fetal Growth Retardation; Fetal Macrosomia; Infant; Small-for-Gestational Age; Premature Birth; Weight Gain
Maternal marriage is protective against preterm birth (PTB), while advanced maternal age is associated with increased PTB risk. As relations between social factors and health may vary over the life course, we assessed how the relation between marital status and PTB risk may change with maternal age.
We assessed the interaction between marital status and maternal age as a determinant of PTB among all live singleton births in Michigan between 1995-2006. We also fit stratified models by race. We calculated absolute differences in predicted PTB as well as odds ratios of PTB by marital status for each age group.
In adjusted models, there was a significant interaction (pinteraction<0.001) between marital status and maternal age. The predicted probability of PTB by marital status was marginally different among mothers aged 20-25 years (absolute difference of 1.5%); this difference was substantially higher (3.9% or higher) after 31 years of age. Odds of PTB followed a similar trajectory. Findings were similar among Black and White mothers.
The relationship between marriage and PTB may vary with maternal age suggesting that the influence of social factors on risk for adverse birth outcomes may differ through the maternal life trajectory. We discuss plausible explanations for these findings.
Preterm birth; maternal age; marital status; life course
To examine the effect of correcting coronary heart disease (CHD) risk factors for long-term within-person variation on CHD risk.
Using 5533 men and 7301 women from the Atherosclerosis Risk in Communities (ARIC) Study, we compared models incorporating risk factors measured at a single visit and models incorporating additional measurements for systolic blood pressure, total cholesterol and high-density lipoprotein cholesterol taken 3 years prior to baseline.
The largest change away from null was seen for systolic blood pressure: Hazard ratio (HR) 1.38 to 1.69 (+81%) in women and HR 1.26 to 1.41 (+56%) in men. Hazard ratios also decreased for age (−32% in women, −9% in men), race (−67% in women), diabetes (−13% in men and women), and medication use for hypertension (−27% in women, −26% in men) and cholesterol (−97% in women, HR 1.06 to 0.93 in men). The area under the ROC curve did not improve significantly in men or women, while reclassification was only significant in women (NRI 5.4%, p = 0.016).
Modeling long-term variation in CHD risk factors had a substantial impact on HR estimates, with new effect estimates further from the null for some risk factors and closer for others including age and medication use, but only improved risk classification in women.
epidemiology; risk factors; statistics; heart diseases; models, cardiovascular; risk assessment
This study examines associations between racial discrimination, mood disorders, and cardiovascular disease (CVD) among Black Americans.
Weighted logistic regression analyses on a nationally representative sample of Black Americans (n = 5022) in the National Survey of American Life (NSAL; 2001–2003). Racial discrimination and CVD were assessed via self-report. Mood disorder was measured using the World Health Organization Composite International Diagnostic Interview.
Model-adjusted risk ratios (RR) revealed that participants with a history of mood disorder had greater CVD risk (RR = 1.28 95% confidence interval [CI] = 1.12, 1.45). This relationship was found specifically among those younger than 50 years of age (RR = 1.56, 95% CI = 1.27, 1.91). There was a significant interaction between racial discrimination and mood disorder in predicting CVD in the total (F = 2.86, 3 df, p = 0.047) and younger sample (F = 2.98, 3 df, p = 0.047). Participants with a history of mood disorder who reported high levels of racial discrimination had the greatest CVD risk.
The association between racial discrimination and CVD is moderated by history of mood disorder. Future studies may examine pathways through which racial discrimination and mood disorders impact CVD risk among Black Americans.
Black Americans; cardiovascular disease; mood disorders; racial discrimination
To estimate the effect of hypothetical changes in modifiable predictors on the incidence of fair-poor self-rated health (SRH) in breast cancer survivors.
In 2007-2008, we interviewed 832 breast cancer survivors 1 year after diagnosis (baseline) and 1 year later. First, multivariable logistic regression models estimated the association between the predictors (sociodemographic factors, access to medical care, comorbid conditions, psychosocial factors, perceived neighborhood conditions, cancer-related behaviors, clinical factors) and SRH. Second, we estimated the probabilities of fair-poor SRH for values of the predictors for each breast cancer survivor. Third, we estimated the population-wide effect of potential changes in modifiable predictors on the incidence of fair-poor SRH.
7.6% of participants (92.4% white; mean age: 58.0 years) whose SRH was rated good-excellent at baseline reported fair-poor SRH one year later. The largest potential reduction in incidence of fair-poor SRH could be obtained by eliminating surgical side effects (27.8% reduction) and comorbidity (21.8% reduction) and by engaging in any physical activity (19.6% reduction).
A significant portion of the decline in SRH can be avoided by reducing surgical side effects, preventing comorbidity and improving physical activity using evidence-based strategies.
Breast Cancer; Intervention; Disability
Previous research has led to the expectation that the gap in mortality between sexes narrows in older ages as sex differences in fecundity decrease. However, the patterns and explanations of variations in sex disparities in mortality across the life span and underlying causes of death are not well understood. We conducted a population-based study to further test this hypothesis.
By using a nationally representative sample of adults (N = 25,254) with mortality follow-ups for 18 years, we modeled age variations in sex differences in risks of mortality from leading causes of death.
Male excesses in mortality decrease at older ages significantly for some but not all causes. Differential exposures to social, physiological, and morbidity risk factors account for the late life reductions of the sex mortality gaps completely in circulatory diseases, partially or minimally in the other causes of death. Social status and relationship are more important risk factors for mortality in younger ages, health behaviors are significant for all ages, and physiological dysregulation is more predictive of mortality in older ages.
Sex differences in the risk of mortality have strong age variations and are cause specific. Additional studies of age acceleration of cancer mortality risk are needed.
Biological Aging; Mortality; Physiological Processes; Postmenopause; Sex Differences; Social Behavior
Replicability is a crucial element of good science, particularly so when the subject matter is sensitive and political. Therefore, we welcome close scrutiny of our brief report in the Annals of Epidemiology in 2011, “Adolescent Marijuana Use from 2002 to 2008: Higher in States with Medical Marijuana Laws, Cause Still Unclear.” We were glad to see that Harper et al. (1) were able to replicate our results showing that states with medical marijuana laws (MML) showed greater rates of marijuana use among their residents during 2002 to 2008 and that states that passed MML after 2002 already had greater use among their residents before they passed the law. However, we have several concerns with the additional analyses run by Harper et al. and further concerns with the way their results were presented. We summarize our concerns in this commentary.
Previous studies of neighborhood deprivation and mental disorders have yielded mixed results, possibly because they were based on different substrata of the population. We conducted a national multilevel study to determine whether neighborhood deprivation is independently associated with psychiatric medication prescription in a national population.
Nationwide outpatient and inpatient psychiatric medication data were analyzed for all Swedish adults (N=6,998,075) after 2.5 years of follow-up. Multilevel logistic regression was used to estimate the association between neighborhood deprivation (index of education, income, unemployment, and welfare assistance) and prescription of psychiatric medications (antipsychotics, antidepressants, anxiolytics, or hypnotics/sedatives), after adjusting for broadly measured individual-level sociodemographic characteristics.
For each psychiatric medication class, a monotonic trend of increasing prescription was observed by increasing level of neighborhood deprivation. The strongest associations were found for antipsychotics and anxiolytics, with adjusted odds ratios of 1.40 (95% CI, 1.36–1.44) and 1.24 (95% CI, 1.22–1.27), respectively, comparing the highest- to the lowest-deprivation neighborhood quintiles.
These findings suggest that neighborhood deprivation is associated with psychiatric medication prescription independent of individual-level sociodemographic characteristics. Further research is needed to elucidate the mechanisms by which neighborhood deprivation may affect mental health and to identify the most susceptible groups in the population.
Anti-Anxiety Agents; Antidepressive Agents; Antipsychotic Agents; Hypnotics and Sedatives; Residence Characteristics
To examine the association between small for gestational age (SGA) in the first pregnancy and risk for infant mortality in the second pregnancy.
This is a population-based, retrospective cohort study in which we used the Missouri maternally linked cohort dataset for 1978–2005. Analyses were restricted to women who had two singleton pregnancies during the study period. The exposure was SGA in the first pregnancy, whereas the primary outcome was infant mortality in the second pregnancy. Kaplan-Meier Estimate and Cox proportional hazard regression were conducted.
Infant mortality was significantly greater among mothers with previous SGA (P < .01). A persistent association of previous SGA with subsequent infant mortality was observed (adjusted hazard ratio [AHR] 1.35, 95% confidence interval [95% CI] 1.24–1.48). Race-specific data illustrated that black women with a previous SGA birth were 40% more likely to experience infant mortality (AHR 1.40, 95% CI 1.21–1.63) than their counterparts without a history of SGA, but white women with a previous SGA had an increased risk of 31% (AHR 1.31, 95% CI 1.17–1.46).
Women with previous SGA bear increased risks for subsequent infant mortality, which was greater among black mothers. Hence, SGA plays an important role in the black–white disparity in infant mortality. Women’s previous childbearing experiences could serve as important criterion in determining appropriate interconception strategies to improve infant health and survival.
Small for gestational age; Infant mortality; Pregnancy; Birth outcomes
To test whether females in families with cleft lip and/or palate (CL/P) have increased breast cancer risk
Using the Danish Facial Cleft Registry, females with CL/P, mothers of children with CL/P, and sisters to CL/P cases were identified for the Danish birth cohorts 1911 to 1975. These females were compared to a 5% random sample of these cohorts regarding the incidence and age of onset for breast cancer registered in the Danish Hospital Discharge Register 1977–2005.
Examining 48,404 person-years for 1,809 female CL/P cases (49 breast cancer cases) and 212,795 person-years for 7935 female relatives (188 breast cancer cases) we found no increased breast cancer risk for either CL/P cases (hazard ratio (HR) = 1.23, 95% confidence interval (CI): 0.92–1.63), mothers of children with CL/P (HR = 0.93, 95%, CI: 0.80–1.08), or sisters of CL/P cases (HR = 0.94, 95% CI: 0.55–1.60). Neither were there any significant differences in age of onset.
Both epidemiological and genetic studies have suggested common etiological factors for breast cancer and cleft lip and/or palate (CL/P). However, this population-based study was not able to confirm a general increase in breast cancer risk among females in families with CL/P.
Cleft lip; cleft palate; breast cancer; recurrence; family study
This study assessed medication use and associated costs among 8- and 15-yearold children with autism spectrum disorders (ASD) identified by the South Carolina Autism and Developmental Disabilities Monitoring (SCADDM) Network.
All Medicaid-eligible SCADDM-identified children with ASD from surveillance years 2006 and 2007 were included (n=263). Children were classified as ASD cases when documented behaviors consistent with the DSM-IV-TR criteria for autistic disorder, Asperger disorder, or pervasive developmental disorder- not otherwise specified (PDD-NOS) were present in health and education evaluation records. Medication and cost data were obtained by linking population-based and Medicaid data.
All 263 SCADDM-identified children had Medicaid data available; 56% (n=147) had a prescription of any type, 40% (n=105) used psychotropic medication, and 20% (n=52) used multiple psychotropic classes over the study period. Common combinations were (1) attention deficit hyperactivity disorder (ADHD) medications and an antihypertensive, antidepressant or antipsychotic; and (2) antidepressants and an antipsychotic. Multiple psychotropic classes were more common among older children. Both the overall distribution of the number of prescription claims and medication costs varied significantly by age.
Results confirm that medication use in ASD, alone or in combination, is common, costly, and may increase with age.
Autism; Psychotropic Medication; Medicaid; Public Health Surveillance
Little research has focused on the social patterning of diabetes among African Americans. We examined the relationship between socioeconomic status (SES) and the prevalence, awareness, treatment and control of diabetes among African Americans.
Education, income and occupation were examined among 4,303 participants (women=2,726; men=1,577). Poisson regression estimated relative probabilities (RP) of diabetes outcomes by SES.
The prevalence of diabetes was 19.6% in women and 15.9% in men. Diabetes awareness, treatment and control were 90.0%, 86.8%, and 39.2% in women, respectively, and 88.2%, 84.4%, and 35.9% in men, respectively. In adjusted models, low-income men and women had greater probabilities of diabetes than high-income men and women (RP 1.94, 95%CI: 1.28–2.92; RP 1.35, 95%CI: 1.04–1.74, respectively). Lack of awareness was associated with low education and low occupation in women (RP 2.28, 95%CI 1.01–5.18, and RP 2.62, 95%CI 1.08–6.33, respectively) but not in men. Lack of treatment was associated with low education in women. Diabetes control was not patterned by SES.
Diabetes prevalence is patterned by SES, and awareness and treatment are patterned by SES in women but not men. Efforts to prevent diabetes in African Americans need to address the factors that place those of low SES at higher risk.
diabetes prevalence; socioeconomic status; Jackson Heart Study; African Americans; disparities
To assess the validity of a GIS measure, the Normalized Difference Vegetation Index (NDVI), as a measure of neighborhood greenness for epidemiologic research.
Using remote-sensing spectral data, NDVI was calculated for a 100-m radial distance around 124 residences in greater Seattle. The criterion standard was rating of greenness for corresponding residential areas by three environmental psychologists. Pearson correlations and regression models were used to assess the association between the psychologists’ ratings of greenness and NDVI. Analyses were also stratified by residential density to assess whether the correlations differed between low and high density.
Mean NDVI among this sample of residences was .27 (SD = 0.11; range: −.04 to .54), and the mean psychologist rating of greenness was 2.84 (SD = 0.98; range: 1 to 5). The correlation between NDVI and expert ratings of greenness was high (r = .69). The correlation was equivalently strong within each strata of residential density.
NDVI is a useful measure of neighborhood greenness. In addition to showing strong correlation with expert ratings, this measure has practical advantages including availability of data and ease of application to various boundaries which would aid in replication and comparability across studies.
To investigate the effects of use of water from irrigation canals to flood residential yards on the risk of West Nile disease in El Paso, Texas.
West Nile disease confirmed cases in 2009–2010 were compared with a random sample of 50 residents of the county according to access to and use of water from irrigation canals by subjects or their neighbors, as well as geo-referenced closest distance between their home address and the nearest irrigation canal. A windshield survey of 600 meters around the study subjects’ home address recorded the presence of irrigation canals. The distance from the residence of 182 confirmed cases of West Nile disease reported in 2003–2010 to canals was compared to that of the centroids of 182 blocks selected at random.
Cases were more likely than controls to report their neighbors flooded their yards with water from canals. Irrigation canals were more often observed in neighborhoods of cases than of controls. Using the set of addresses of 182 confirmed cases and 182 hypothetic controls the authors found a statistically significant inverse relation with risk of West Nile disease.
Flooding of yards with water from canals increased the risk of West Nile disease.
West Nile Virus; Irrigation; Epidemics; Case-Controls Studies; West Nile encephalitis; Irrigation; Case-Controls Studies; Arboviral encephalitides; Housing Characteristics; United States; Epidemiologic Studies; Risk Factors
To examine the mortality risk associated with diabetes in the Mexico City Diabetes Study (MCDS) and the San Antonio Heart Study (SAHS).
Prospective cohorts conducted 1990-2007 in MCDS and 1979-2000 in SAHS. Mortality risk was examined using Cox proportional hazard models in 1,402 non-Hispanic whites (NHW), 1,907 U.S.-born Mexican Americans (MA), 444 Mexican-born MA, 2,281 Mexico City residents (MCR) between the ages of 35 and 64.
Age- and sex-adjusted mortality HRs comparing U.S.-born MA, Mexican-born MA and MCR to NHW were 1.09 (95% CI: 0.86, 1.37), 1.23 (95% CI: 0.86, 1.76) and 0.97 (95% CI: 0.77, 1.23), respectively, in non-diabetic individuals; in contrast, mortality risk varied in diabetic individuals with respective HRs of 1.77 (95% CI: 1.20, 2.61), 1.08 (95% CI: 0.59, 1.97) and 2.27 (95% CI: 1.53, 3.35) (interaction p-value=0.0003). Excluding Mexican-born MA and non-diabetic individuals, controlling for medication use, insulin use, fasting glucose levels and duration of diabetes explained a significant proportion of the mortality differential (HRs relative to NHW were 1.31 (95% CI: 0.87, 1.98) in U.S.-born MA and 1.38 (95% CI: 0.89, 2.12) in MCR).
This study provides evidence that diabetes is more lethal in U.S.-born MA and MCR than in NHW.
Common polymorphisms in the N-acetyltransferase-2 (NAT2) metabolic enzyme determine slow or rapid acetylator phenotypes. We investigated the effects of alcohol, smoking, and caffeine on fecundability, and determined whether the effects were modified by NAT2.
Three NAT2 polymorphisms were genotyped in 319 women office workers participating in a prospective pregnancy study (1990–1994). Women were ages 20–41 and at risk for pregnancy. Discrete-time survival analysis was used to determine the effects of alcohol, smoking, and caffeine on fecundability and evaluate effect modification by NAT2.
319 women (161 slow acetylators, 158 rapid) were followed for an average of 8 menstrual cycles, resulting in 124 pregnancies. There was no effect of caffeine on fecundability. Drinking 1+ alcoholic drink/day and current smoking were significantly associated with reduced fecundability, but only among slow acetylators (adjusted fecundability odds ratio (FOR) for smoking= 0.34: 95% CI, 0.22, 0.90; adjusted FOR for 1+ drink/day = 0.20: 0.05, 0.92). There was no effect among rapid acetylators.
NAT2 status significantly modified the effects of alcohol and smoking on fecundability, emphasizing the importance of incorporating genetic and metabolic information in studies of reproductive health. Replication of this study is warranted.
NAT2; Fertility; Smoking; Alcohol Drinking; Caffeine; Pregnancy; Genetic Polymorphism
Short and long sleep duration and sleep quality are associated with health including all-cause mortality, cardiovascular disease, diabetes, and obesity. Inflammation may play a role in mediating these associations.
We examined associations between inflammation and self-reported sleep characteristics in 1020 respondents of the 2000 and 2006 Social Environment and Biomarkers of Aging Study (SEBAS), a nationally representative survey of Taiwanese adults ages 53 and over. Regression models were used to estimate cross-sectional relationships between inflammation (IL-6, CRP, fibrinogen, e-selectin, sICAM-1, albumin, and WBC) and a modified Pittsburgh Sleep Quality Index (PSQI), index subcomponents, and self-reported sleep duration. Change in inflammatory markers between 2000 and 2006 was also used to predict long or short sleep duration in 2006.
Inflammation was not related to the overall index of sleep quality. However, longer sleep (> 8 hours) was associated with higher levels of inflammation. These associations remained after adjustment for waist circumference, self-reported health decline, diabetes, arthritis/rheumatism, heart disease, and depressive symptoms. Increases in inflammation between 2000 and 2006 were associated with long but not short sleep duration in 2006 for several markers.
Long sleep duration may be a marker of underlying inflammatory illness in older populations. Future studies should explore whether inflammation explains observed relationships between long sleep and mortality.
sleep; inflammation; aging; Taiwan; CRP; IL-6
We aimed to examine the relationship of birthweight to cognitive performance in middle aged participants of the Atherosclerosis Risk in Communities Study (ARIC).
Cognitive function, assessed by means of three neuropsychological tests - the Delayed Word Recall Test (DWR), the Digit Symbol Subtest of the Wechsler Adult Intelligence Scale-Revised (DSS/WAIS-R) and the Word Fluency (WF) Test, was evaluated in relation to birthweight, as recalled through standardized interviews, using data from the second and fourth follow-up visits of the ARIC study cohort (1990 to 1992 and 1996 to 1998, respectively). Overall, 6785 participants satisfied the inclusion criteria and were included in the analysis.
After adjusting for adult socio-demographic factors, childhood socio-economic environment and parental risk factors, and adult anthropometric, health status related and behavioral variables, linear trends were observed for the relationship of birthweight to WF scores, although the trend was statistically significant only for those reporting exact birthweights (p for trend= 0.004). For the other cognitive test results, results were either null or inconsistent with the a priori hypotheses.
Except for WF in those reporting exact birthweights, our study does not support the notion that birthweight influences cognitive function in adults.
birthweight; cognition disorders; fetal programming; cohort studies
Population rates of acute myocardial infarction (AMI) are changing. Consistent case definitions to evaluate these trends and make comparisons are essential. The World Health Organization (WHO) AMI diagnostic algorithm and clinical judgments were the standards for classification. However, in recent years, five new algorithms, to include diagnostic advances, are advocated by professional organizations. This study compares AMI rates derived from six algorithms and the impact of troponins on those rates.
The authors utilize the population-based Minnesota Heart Survey hospital data in 1995 and 2001 to compare six published diagnostic algorithms and the impact of troponins.
In 1995 differences in AMI rates between algorithms ranged from 281/100,000 to 440/100,000 for men and 98/100,000 to 139/100,000 for women. The use of troponin, a more sensitive biomarker, adds to the differences by increasing eligible cases. Using 2001 data in patients where creatine kinase and troponin were simultaneously measured, a 64% and 95% increase in AMI rates among men and women, respectively, was observed.
Accurate and consistent AMI definitions are crucial for clinical trials, epidemiology and public health research. Demonstrated here is the sensitivity of AMI rates to changing case definitions and the biomarker troponin.
Acute myocardial infarction(AMI); AMI rates; AMI algorithms; registries; creatine kinase; troponins
To investigate the potential interaction between folate intake and the PON1 Q192R polymorphism with the risk of incident CHD and ischemic stroke in the ARIC study – a population-based prospective cohort of cardiovascular disease in 15,792 whites and African Americans.
Race-stratified Cox proportional hazards models were performed to examine the interaction between folate intake and the PON1 Q192R polymorphism.
A significant inverse association between folate intake and risk of incident CHD among whites was found (HRR=1.30, 95% CI: 1.09, 1.56; P=0.004; folate intake ≤155 μg vs. ≥279 μg- reference group). An interaction effect was observed between the dominant genetic model and folate intake with regards to incident ischemic stroke in whites (HRR=0.68, 0.91, 0.99, and 1.24 from 1st-4th quartile, respectively; P-trend=0.05).
There was an interaction between folate intake and PON1 Q192 polymorphism with regard to the risk of ischemic stroke in whites. Future studies should investigate the interaction between additional polymorphisms within the PON1 gene and genetic variants in other folate metabolizing genes with folate intake on the risk of incident CHD and stroke.
Coronary Heart Disease; Folate; Incidence; Genetic Polymorphism; Stroke
To assess the impact of geographic health services factors on the timely diagnosis of autism.
Children residing in central North Carolina were identified by records-based surveillance as meeting a standardized case definition for autism. Individual-level geographic access to health services was measured by the density of providers likely to diagnose autism, distance to early intervention service agencies and medical schools, and residence within a Health Professional Shortage Area. We compared the presence of an autism diagnosis by age 8 and timing of first diagnosis across level of accessibility, using Poisson regression and Cox proportional hazards regression and adjusting for family and neighborhood characteristics.
Of 206 identified cases, 23% had no previous documented diagnosis of autism. Most adjusted estimates had confidence limits including the null. Point estimates across analyses suggested that younger age at diagnosis was found for areas with many neurologists and psychiatrists and proximal to a medical school but not areas with many primary care physicians or proximal to early intervention services agencies.
Further study of the distribution of medical specialists diagnosing autism may suggest interventions to promote the early diagnosis, and initiation of targeted services, for children with autism spectrum disorders.
Autism; Diagnosis; Health Services Accessibility
To describe long-term trends in TB mortality and to compare trends estimated from two different sources of public health surveillance data.
Trends and changes in trend were estimated by joinpoint regression. Comparisons between datasets were made by fitting a Poisson regression model.
Since 1900, TB mortality rates estimated from death certificates have declined steeply, except for a period of no change in the 1980s. This decade had long-term consequences resulting in more TB deaths in later years than would have occurred had there been no flattening of the trend. Recent trends in TB mortality estimated from National Tuberculosis Surveillance System (NTSS) data, which record all-cause mortality, differed from trends based on death certificates. In particular, NTSS data showed TB mortality rates flattening since 2002.
Estimates of trends in TB mortality vary by data source, and therefore interpretation of the success of control efforts will depend upon the surveillance dataset used. The datasets may be subject to different biases that vary with time. One dataset showed a sustained improvement in the control of TB since the early 1990s while the other indicated that the rate of TB mortality was no longer declining.
Tuberculosis; Mortality; Trends; United States; Surveillance
Recent evidence suggests early life factors correlate with atrial fibrillation (AF). We hypothesized that AF-related mortality, similar to stroke mortality, is elevated for individuals born in the southeastern US.
We estimated 3-year (1999-2001) average AF-related mortality rates, using US vital statistics for 55-89 year old whites (136,573 AF-related deaths) and blacks (8,288 AF-related deaths). We estimated age- and sex-adjusted odds of AF-related (contributing cause) mortality associated with birth state, and birth within the US stroke belt (SB), stratified by race. SB results were replicated using 1989-1991 data.
Among blacks, four contiguous birth states were associated with statistically significant ORs>=1.25 compared to the national average AF-related mortality. The four highest-risk birth states for blacks also predicted elevated AF-related mortality among whites, but patterns were attenuated. The odds ratio for AF-related mortality associated with SB birth was 1.19 (CI 1.13, 1.25) for blacks and 1.09 (CI 1.07, 1.12) for whites, adjusting for SB adult residence.
Place of birth predicted AF-related mortality, after adjusting for place of adult residence. The association of AF related mortality and SB birth parallels that of other cardiovascular diseases, and may likewise indicate an importance of early life factors in the development of AF.
Atrial Fibrillation; Mortality; Residence; Geographic; Lifecourse
We compared mortality rates among state prisoners and other state residents to identify prisoners’ healthcare needs
We linked North Carolina prison records with state death records for 1995-2005 to estimate all-cause and cause-specific death rates among Black and White male prisoners aged 20-79 years, and used standardized mortality ratios (SMRs) to compare these observed deaths with the expected number based on death rates among state residents
The all-cause SMR of Black prisoners was 0.52 (95%CI: 0.48 0.57), with fewer deaths than expected from accidents, homicides, cardiovascular disease and cancer. The all-cause SMR of White prisoners was 1.12 (95%CI: 1.01, 1.25) with fewer deaths than expected for accidents, but more deaths than expected from viral hepatitis, liver disease, cancer, chronic lower respiratory disease, and HIV.
Mortality of Black prisoners was lower than that of Black state residents for both traumatic and chronic causes of death. Mortality of White prisoners was lower than that of White state residents for accidents, but higher for several chronic causes of death. Future studies should investigate the effect of prisoners’ pre-incarceration and in-prison morbidity, the prison environment, and prison healthcare on prisoners’ patterns of mortality.
Mortality; Prisoners; Minority Health
To testthe hypothesis that inflammation measured by white blood cell count (WBC) and C-reactive protein (CRP) is associated positively with incident heart failure (HF).
Using the Atherosclerosis Risk in Communities (ARIC) Study, we conducted separate Cox proportional hazards regression analyses for WBC (measured 1987 to 1989) and CRP (measured 1996 to 1998) in relation to subsequent heart failure occurrence. A total of 14,485 and 9,978 individuals were included in the WBC and CRP analyses, respectively.
There were 1647 participants that developed HF during follow up after WBC assessment and 613 developed HF after CRP assessment. After adjustment for demographic variables and traditional HF risk factors, the hazard ratio (95% CI)for incident HF across quintiles of WBC was 1.0, 1.10 (0.9-1.34), 1.27(1.05-1.53), 1.44(1.19-1.74), and 1.62(1.34-1.96) (p trend <0.001); hazard ratio across quintiles of CRP was 1.0, 1.03 (0.68-1.55), 0.99 (0.66-1.51), 1.40 (0.94-2.09) and 1.70 (1.14-2.53) (p trend 0.002). Granulocytes appeared to drive the relation between WBCs and heart failure [hazard ratios across quintiles: 1.0, 0.93(0.76-1.15), 1.26 (1.04-1.53), 1.67(1.39-2.01) and 2.19 (1.83-2.61) (p trend <0.0001)], while lymphocytes or monocytes were not related.
Greater levels of WBC (especially granulocytes) and CRP are associated with increased risk of heart failure in middle-aged adults, independent of traditional risk factors.
Prospective Study; Risk Factors; Heart Failure; Inflammation; C-Reactive Protein; Leukocytes; Granulocytes