David I. Gregorio

The effects of occupation-based social position on mortality in a large American cohort.

OBJECTIVES Four occupation-based measures were used to derive estimates of social positions effect on all-cause mortality among men and women in a large national cohort. METHODS The National Longitudinal Mortality Study provided information on principal occupation and 9-year follow-up for 229,851 persons aged 25 through 64 years. Coxs proportional hazards model was used to estimate the age-adjusted risk of death relative to six ordinal categories of social position. The Slope Index of Inequality described average change in death rates across categories. RESULTS Risk of death was consistently elevated among persons at lower positions in the social hierarchy. Estimates comparing lowest with highest categories varied within a narrow range (1.47-1.92 for men and 1.23-1.55 for women). However, several discrepancies among analyses were noted. The analysis by US census groups revealed nonlinear associations, whereas those using other scales found incremental increases in risk. Effect modification by sex was observed for analyses by two of the four measures. Race/ ethnicity did not modify the underlying association between variables. CONCLUSIONS Our analysis complements previous findings and supports, with few qualifications, the interchangeability of occupation-based measures of social position in mortality studies. Explanations for why relative risk estimates were modified by sex are offered.

Delay, stage of disease, and survival among White and Black women with breast cancer.

Delay in obtaining treatment, stage of disease at diagnosis, and five-year survival were compared for 29 Black and 156 White females treated for breast cancer at Roswell Park Memorial Institute between 1957 and 1965. No statistically significant differences were found between Black and White patients in treatment delay although a tendency for longer delay among Blacks was noted. Race had little effect on survival when delay, stage of disease, and age were controlled.

The geographic distribution of breast cancer incidence in Massachusetts 1988 to 1997, adjusted for covariates

BackgroundThe aims of this study were to determine whether observed geographic variations in breast cancer incidence are random or statistically significant, whether statistically significant excesses are temporary or time-persistent, and whether they can be explained by covariates such as socioeconomic status (SES) or urban/rural status?ResultsA purely spatial analysis found fourteen geographic areas that deviated significantly from randomness: ten with higher incidence rates than expected, four lower than expected. After covariate adjustment, three of the ten high areas remained statistically significant and one new high area emerged. The space-time analysis identified eleven geographic areas as statistically significant, seven high and four low. After covariate adjustment, four of the seven high areas remained statistically significant and a fifth high area also identified in the purely spatial analysis emerged.ConclusionsThese analyses identify geographic areas with invasive breast cancer incidence higher or lower than expected, the times of their excess, and whether or not their status is affected when the model is adjusted for risk factors. These surveillance findings can be a sound starting point for the epidemiologist and has the potential of monitoring time trends for cancer control activities.

Factors Associated With Breastfeeding Duration Among Connecticut Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Participants

This retrospective study aimed to identify factors associated with breastfeeding duration among women enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) of Hartford, Connecticut. The authors included mothers whose children were younger than 5 years and had stopped breastfeeding (N = 155). Women who had planned their pregnancies were twice as likely as those who did not plan them to breastfeed for more than 6 months (odds ratio, 2.15; 95% confidence interval, 1.00-4.64). One additional year of maternal age was associated with a 9% increase on the likelihood of breastfeeding for more than 6 months (odds ratio, 1.09; 95% confidence interval, 1.02-1.17). Time in the United States was inversely associated with the likelihood of breastfeeding for more than 6 months (odds ratio, 0.96; 95% confidence interval, 0.92-0.99). Return to work, sore nipples, lack of access to breast pumps, and free formula provided by WIC were identified as breastfeeding barriers. Findings can help WIC improve its breastfeeding promotion efforts. J Hum Lact. 26(3):266-273.

Counseling adolescents for smoking prevention: a survey of primary care physicians and dentists.

Pediatricians, family practitioners, and dentists were questioned in the spring of 1992 about whether they counseled adolescent patients (10 through 18 years old) not to smoke. Of the 674 questionnaires distributed, 443 (66%) were returned and analyzed. Most practitioners could not estimate cigarette use among their adolescent patients. Prevention counseling occurred infrequently, and least often among younger patients. Physicians were more likely than dentists to counsel adolescents. The data highlight the need for continuing training of primary health care practitioners about the importance of counseling adolescents not to smoke.

An Estimate of Blood Donor Eligibility in the General Population

Abstract. To estimate the number of adults medically eligible to donate blood, the percent of the general population over the age of 16 deferrable by 13 current American Red Cross donor guidelines was calculated using the best available United States data. Categories examined included age, weight, hematocrit, pregnancy, blood pressure, heart disease, diabetes requiring insulin, male homosexual activity since 1977, intravenous drug use, sexual partner of high‐risk group member, recent transfusion, history of cancer, and other (medical, surgical, travel history). Sex‐specific total eligibility rates were estimated by serial multiplication of individual eligibility rates (1.0 minus deferral rates) to account for the proportionate overlap of independent categories, with corrections for expected associations between categories. The resultant eligibility rates for women (57%) and men (70%) indicate fewer eligible donors than commonly stated. Surrogate testing (ALT, anti‐HBc) for non‐A, non‐B hepatitis would further reduce the percent of eligible donors to 55 and 67%, respectively. Based on the actual numbers of women and men in the population, these calculations indicate that an equal number of women and men are medically eligible to donate.

Subject loss in spatial analysis of breast cancer

Possible selection bias from assignment of latitude-longitude coordinates to the place of residence of all Connecticut women diagnosed with breast cancer from 1992 to 1995 (N = 11,470) was evaluated. Exact address-matching was accomplished for 8,121 records (70.8%) and an additional 1,722 records (15.0%) were matched using relaxed criteria. We did not address-match 1,627 records (14.1%) due to missing address information or limitations of the Geographic Information Systems street file. The age-adjusted likelihood of address-matching records was significantly greater for women of color, those born within Connecticut, residents of urban locales or census tracts with low median family incomes and those cases diagnosed nearer to 1992. Few differences in address-matching were attributable to tumor characteristics or therapeutic modality.

Geographic differences in invasive and in situ breast cancer incidence according to precise geographic coordinates, Connecticut, 1991–95

To evaluate geographical variation of invasive and in situ breast cancer incidence rates using precise geographical coordinates for place of residence at diagnosis, latitude‐longitude coordinates pertaining to 10,601 invasive and 1,814 in situ breast cancers for Connecticut women, 1991–95, were linked to US Census information on the 2,905State census block groups. A spatial scan statistic was used to detect geographic excess or deficits in incidence and test the statistical significance of results, without prior assumptions about the size or location of such areas. The age adjusted invasive cancer incidence rate was 165.3/100,000 women/year. The spatial scan statistic identified 3 places with significantly low incidence rates and 4 places where rates were significantly high. The most probable location of low incidence was rural northeastern Connecticut where risk of disease, relative to elsewhere around the state, was 0.70 (p = 0.0001); the most probable place of elevated incidence was north central Connecticut where a relative risk of 1.34 (p = 0.002) was observed. Incidence of in situ disease was estimated to be significantly high for north central Connecticut (RR = 1.84; p = 0.0001). Geographic differences of invasive and in situ breast cancer incidence were observed. Examining cancer events at the lowest available level of data aggregation is beneficial in highlighting localized rate variations. Such information may enable public health officials to target additional resources for promoting breast cancer screening to specific locations.

Geographical Differences in Primary Therapy for Early-Stage Breast Cancer

Background: Breast-conserving surgery may not be uniformly available to all women. We evaluated geographical differences across Connecticut in the proportions of cases with early stage breast cancer treated by partial mastectomy PM. We also looked at geographical variation in PM with axillary lymph node dissection AND and PM with adjuvant radiotherapy RAD.Methods: The Connecticut Tumor Registry identified 9106 cases of early disease for 1991 to 1995. Latitude-longitude coordinates for place of residence at diagnosis and initial form of therapy were available for 8795 records. A spatial scan statistic was used to detect geographical differences in treatment rates across the state.Results: A total of 57.7% of early breast cancer cases were treated by PM. Women living around New Haven were less likely than others to be treated in that manner relative risk [RR] = .86; P = .0001, whereas those living around Norwalk were more likely RR = 1.26; P = .0001. PM with AND, relative to PM alone, was reported less often for cases from a large area of southwestern Connecticut RR = .89; P = .0001, but more often for those in north central Connecticut RR = 1.13; P = .0001. PM with RAD, relative to PM alone, was less common for cases around Danbury RR = .40; P = .0001 but more common among cases around Hartford RR = 1.14; P = .0001.Conclusions: Geographical analysis is a way for physicians and health officials to identify groups of women who may not yet benefit from preferred surgical procedures.

Misclassification of childhood homicide on death certificates.

Suspect classification of homicide deaths of Connecticut residents under 20 years of age was noted for 29 percent of cases examined. Misclassification was attributed to incomplete or erroneous information recorded on the death certificates, rather than errors in the designation of ICD-9 homicide codes. The results have important implications in the interpretation of vital statistics when homicide is listed as the cause of death and underscore the value of record linkage systems.