Charles Dillon

Symptomatic Hand Osteoarthritis in the United States: Prevalence and Functional Impairment Estimates from the Third U.s. National Health and Nutrition Examination Survey, 1991–1994

Dillon CF, Hirsch R, Rasch EK, Gu Q: Symptomatic hand osteoarthritis in the United States: prevalence and functional impairment estimates from the third U.S. National Health and Nutrition Examination Survey, 1991–1994. Am J Phys Med Rehabil 2007;86:12–21. Objective:To estimate the United States prevalence of symptomatic hand osteoarthritis using American College of Rheumatology (ACR) physical examination criteria. Design:The Third National Health and Nutrition Examination Survey (NHANES III), a nationally representative cross-sectional health examination survey, performed upper-extremity physical examinations on a sample of United States adults age 60+ yrs. Data for demographics, pain history, analgesic use, and activity limitations were obtained by interview. Results:Among United States adults, 58% had Heberden’s nodes, 29.9% had Bouchard’s nodes, and 18.2% had first carpal–metacarpal deformities. Women had significantly more first carpal–metacarpal deformities (24.3%) than men (10.3%). Symptomatic osteoarthritis prevalence at these sites was 5.4, 4.7, and 1.9%, respectively. Overall, symptomatic hand osteoarthritis prevalence by ACR criteria was 8% (95% CI 6.5–9.5%), or 2.9 million persons. Symptomatic hand osteoarthritis significantly increased with age and was decreased among non-Hispanic blacks, but there were no gender differences. Symptomatic hand osteoarthritis was associated with self-reported difficulty lifting 10 lbs (OR 2.31; 95% CI 1.23–4.33), dressing (OR 3.77; 95% CI 1.99–7.13), and eating (OR 3.44; 95% CI 1.76–6.73). Frequent monthly use was significantly increased for analgesics, especially acetaminophen, but not nonsteroidal antiinflammatory drugs. Conclusion:Symptomatic hand osteoarthritis affects 1 in 12 older United States adults. NHANES III data provide a population-based assessment of the impact and associated functional impairments of symptomatic hand osteoarthritis.

The prevalence of HLA–B27 in the US: Data from the US National Health and Nutrition Examination Survey, 2009†

OBJECTIVE To carry out the first large-scale population study of the prevalence of HLA-B27 in the US, which is needed for public health planning purposes because of recent improvements in medical therapy and diagnostic testing for ankylosing spondylitis (AS). METHODS The national prevalence of HLA-B27 was determined as part of the 2009 US National Health and Nutrition Examination Survey (NHANES), a cross-sectional survey monitoring the health and nutritional status of the US civilian, noninstitutionalized population. DNA polymerase chain reaction analysis was conducted in samples from 2,320 adults ages 20-69 years from this nationally representative sample. RESULTS The age-adjusted US prevalence of B27 was 6.1% (95% confidence interval [95% CI] 4.6-8.2). By race/ethnicity, the prevalence of B27 was 7.5% (95% CI 5.3-10.4) among non-Hispanic whites and 3.5% (95% CI 2.5-4.8) among all other US races/ethnicities combined. In Mexican Americans, the prevalence was 4.6% (95% CI 3.4-6.1). The prevalence of B27 could not be reliably estimated for other US racial/ethnic groups because of the low number of B27-positive individuals in those groups. For adults 50-69 years of age, the prevalence of B27 was 3.6% (95% CI 2.2-5.8), which suggested a decrease in B27 with age. These prevalence estimates took into account the NHANES survey design and are reviewed with respect to data from the medical literature. CONCLUSION Our findings provide the first US national prevalence estimates for HLA-B27. A decline in the prevalence of HLA-B27 with age is suggested by these data but must be confirmed by additional studies.

Skeletal muscle relaxant use in the United States: data from the Third National Health and Nutrition Examination Survey (NHANES III).

Study Design. Population-based cross-sectional prevalence survey. Objectives. To define muscle relaxant use patterns in the United States. Summary of Background Data: Despite a long history of use for back pain and musculoskeletal disorders, national prevalence patterns of prescription muscle relaxant use have not been defined. Methods. NHANES III (1988–1994) is an in-person health examination survey of the U.S. civilian population, based on a complex, multistage probability sample design. Results. An estimated 2 million American adults reported muscle relaxant use (1-month period prevalence 1.0%; 95% confidence interval 0.8–1.3%). While virtually all (94%) used individual muscle relaxants rather than fixed combination muscle relaxant analgesics, two thirds took an additional prescription analgesic. Men and women had similar usage. Median user age was 42 years, but 16% of users were older than 60 years. Eighty-five percent of users took muscle relaxants for back pain or muscle disorders. Two thirds of muscle relaxant users had histories of recent back pain; however, only 4% of all those with a recent history of back pain reported any muscle relaxant use. Mean length of use was 2.1 years (95% confidence interval 1.6–2.6), with 44.5% taking medication longer than a year (95% confidence interval 35.7–53.3). Muscle relaxant use in the elderly, among older persons with ambulatory impairments, and in chronic obstructive pulmonary disease appeared undiminished compared with general population use. Conclusions. Although typically recommended for short-term treatment of back pain, muscle relaxants are often used chronically and are prescribed to subpopulations potentially at risk for adverse effects.

Biomechanical, psychosocial, and organizational risk factors for WRMSD: population-based estimates from the Connecticut upper-extremity surveillance project (CUSP).

In a case-control study of a population-based telephone survey of 3,798 working adults, symptoms of work-related musculoskeletal disorder (WRMSD) were associated with biomechanical, psychosocial, and organizational factors. In several models, biomechanical exposures with strong associations were static postures (odds ratios [ORs] = 2.00-5.45); repeated pushing, pulling, lifting (ORs = 1.86-12.75); and repeated neck bending (ORs = 1.07-12.8). Psychosocial and organizational factors consistently retained in these models were demands (ORs = 1.26-1.59) and organizational support (ORs = 0.53-0.79). Decision latitude entered less frequently (ORs = 0.30-0.49). This research may have implications for intervention strategies. First, reducing both biomechanical and psychosocial risk may be more effective than focusing solely on engineering controls. Second, organizational culture and policy may have strong implications for WRMSD prevalence and control.

US demographic trends in mid-arm circumference and recommended blood pressure cuffs for children and adolescents: data from the National Health and Nutrition Examination Survey 1988-2004.

ObjectiveMid-arm circumference measurement is a prerequisite for the selection of properly sized blood pressure cuffs for accurate blood pressure readings in children and youth. This study examined recent trends in the mid-arm circumference distribution and the distribution of corresponding recommended blood pressure cuff sizes using National Health and Nutrition Examination Survey III (1998–1994) and National Health and Nutrition Examination Survey 1999–2004 data. DesignBoth studies were complex, cross-sectional surveys providing nationally representative samples of the civilian noninstitutionalized US population. ParticipantsChildren of 7–17 years of age were studied. A total of 2515 boys and 2596 girls participated in National Health and Nutrition Examination Survey III, and 3941 boys and 3917 girls in National Health and Nutrition Examination Survey 1999–2004. Statistical AnalysisMean mid-arm circumference and recommended National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents defined blood pressure cuff sizes were assessed by sex, age, and race/ethnicity. US boys aged 7–12 years and girls aged 7–12 and 13–17 years had significant increases in mid-arm circumference (P<0.05) across the two surveys. Moreover, from 1988–1994 to 1999–2004, there were statistically significant increases in the percentage of boys (age 7–12 and 13–17 years) and girls (age 13–17 years) needing large blood pressure adult cuffs (P<0.05). National Health and Nutrition Examination Survey 1999–2004 data show that both boys and girls aged 13–17 years had a mean mid-arm circumference ≥27 cm, which requires an adult blood pressure cuff fit. Furthermore, 52% boys and 42% girls aged 13–17 years, required a standard adult cuff fit. ConclusionMean mid-arm circumference has increased among US children and adolescents, with important implications for the accuracy of blood pressure measurement in clinical practice.

Trends in the Prevalence of Coronary Heart Disease in the U.S.

INTRODUCTION This study evaluated recent trends in the prevalence of coronary heart disease in the U.S. population aged ≥40 years. METHODS A total of 21,472 adults aged ≥40 years from the 2001-2012 National Health and Nutrition Examination Survey were included in the analysis. The analysis was conducted in 2015. Coronary heart disease included myocardial infarction, angina, and any other type of coronary heart disease, which were defined as a history of medical diagnosis of these specific conditions. Angina was also defined as currently taking anti-angina medication or having Rose Angina Questionnaire responses that scored with a Grade ≥1. Trends from 2001 to 2012 were analyzed overall, within demographic subgroups, and by major coronary heart disease risk factors. RESULTS Between 2001 and 2012, the overall prevalence of coronary heart disease significantly decreased from 10.3% to 8.0% (p-trend<0.05). The prevalence of angina significantly decreased from 7.8% to 5.5% and myocardial infarction prevalence decreased from 5.5% to 4.7% (p-trend <0.05 for both groups). Overall coronary heart disease prevalence significantly decreased among women, adults aged >60 years, non-Hispanic whites, non-Hispanic blacks, adults who did not complete high school, adults with more than a high school education, and adults who had health insurance (p-trend <0.05 for all groups). CONCLUSIONS The overall prevalence of coronary heart disease including angina and myocardial infarction decreased significantly over the 12-year survey period. However, this reduction was seen mainly among persons without established coronary heart disease risk factors. There was no change in coronary heart disease prevalence among those with specific coronary heart disease risk factors.