Deborah D. Ingram

White blood cell count, coronary heart disease, and death: the NHANES I Epidemiologic Follow-up Study.

To confirm the reported association of elevated WBC count with increased risk of CHD incidence and death in white men and to determine whether such associations exist for CHD incidence and death in women and blacks, data were examined from the NHANES I Epidemiologic Follow-up Study. Over a follow-up period of 7 to 16 years, WBC counts > 8100 cells/mm3 compared with WBC counts < 6600 cells/mm3 were associated with increased risk of CHD incidence in white men (RR = 1.31; 95% CL 1.07, 1.61) and in white women (RR = 1.31; 1.05, 1.63) aged 45 to 74 after adjustment for baseline risk factors. The association was found in white female but not in white male subjects who had never smoked. Increases in risk of death from all causes, cardiovascular diseases, and noncardiovascular diseases were also seen in all white men in the sample. RRs for death for all causes at ages 45 to 74, which compared the upper and lower strata of WBC counts, were 1.43 (95% CL 1.22, 1.68) in all white men and 1.33 (95% CL 1.00, 1.78) in subjects who had never smoked after adjustment for baseline risk factors. Similar increases in risk of death from all causes were seen in blacks aged 45 to 64 despite small sample size. Thus this analysis failed to clearly establish an increased risk of CHD incidence in white men with relatively elevated WBC counts who never smoked cigarettes, although such an association was evident in white women. The increased risk of death from all causes in men appeared to be only partially due to effects of smoking.(ABSTRACT TRUNCATED AT 250 WORDS)

Frequency of Attendance at Religious Services, Hypertension, and Blood Pressure: The Third National Health and Nutrition Examination Survey

Objective: To test the hypothesis that frequency of attendance at religious services is inversely related to prevalence of hypertension and blood pressure level. Methods: In the Third National Health and Nutrition Examination Survey (NHANES III), 14,475 American women and men aged 20 years and over reported frequency of attendance at religious services, history of hypertension treatment, and had blood pressure (BP) measured. Results: The percentage reporting attending religious services weekly (52 times/yr) was 29 and more than weekly (>52 times/yr) was 10. Prevalence of hypertension (systolic BP ≥140 or diastolic BP ≥90 mm Hg or current use of blood pressure medication) was 21% in never at attenders, 19% in those attending less than weekly (1–51 times/yr), 26% in those attending weekly, and 26% in those attending more than weekly (p < .01). After controlling for sociodemographic and health variables, religious attendance was associated with reduced prevalence compared with nonattendance, significantly so for weekly (&bgr; = −0.24; 95% confidence interval [CL], −0.37 to −0.11; p < .01) and more than weekly (&bgr; = −0.33; 95% CL, −0.60 to −0.07; p < .05). No significant effect modification by gender or age was observed. Compared with never attenders, persons attending weekly had a systolic BP 1.46 mm Hg (95% CL 2.33, 0.58 mm Hg, p < .01) lower and persons attending >52 times/yr had systolic BP 3.03 mm Hg (95% CL 4.34, 1.72 mm Hg, p < .01) lower. No significant effect modification by gender was observed; these estimates are adjusted for a significant interaction between age and less than weekly attendance (1–51 times) (p < .05). Conclusions: Compared with never attending, attendance at religious services weekly or more than weekly was associated with somewhat lower adjusted hypertension prevalence and blood pressure in a large national survey. BMI = body mass index; CL = confidence limits; NHANES III = Third National Health and Nutrition Examination Survey; SBP = systolic blood pressure.

Regional and urbanization differentials in coronary heart disease mortality in the United States, 1968–1985

Regional and urbanization differentials in coronary heart disease (CHD) mortality among white males aged 35-74 years have been examined during 1968-78 and 1979-85. Many of the differentials in CHD mortality found during 1968-78 persisted during 1979-85, e.g. the west had the lowest death rates. Fringe metropolitan (suburban) areas had low rates, and CHD death rates continued to decline, albeit at a faster rate. The urbanization pattern observed for the south differed from that for other regions; the core metropolitan area had the lowest CHD death rates in the south, but the highest in the other regions. The removal of arteriosclerotic cardiovascular disease deaths from the CHD rates under ICD-9 resulted in decreases in CHD mortality between 1978 and 1979 with large decreases in the South and in core metropolitan areas. Indeed, decreases in the core metropolitan areas of the midwest and west were so large that the urbanization pattern changed.

Bridging Between Two Standards for Collecting Information on Race and Ethnicity: An Application to Census 2000 and Vital Rates

Objectives. The 2000 Census, which provides denominators used in calculating vital statistics and other rates, allowed multiple-race responses. Many other data systems that provide numerators used in calculating rates collect only single-race data. Bridging is needed to make the numerators and denominators comparable. This report describes and evaluates the method used by the National Center for Health Statistics to bridge multiple-race responses obtained from Census 2000 to single-race categories, creating single-race population estimates that are available to the public. Methods. The authors fitted logistic regression models to multiple-race data from the National Health Interview Survey (NHIS) for 1997–2000. These fitted models, and two bridging methods previously suggested by the Office of Management and Budget, were applied to the public-use Census Modified Race Data Summary file to create single-race population estimates for the U.S. The authors also compared death rates for single-race groups calculated using these three approaches. Results. Parameter estimates differed between the NHIS models for the multiple-race groups. For example, as the percentage of multiple-race respondents in a county increased, the likelihood of stating black as a primary race increased among black/white respondents but decreased among American Indian or Alaska Native/black respondents. The inclusion of county-level contextual variables in the regression models as well as the underlying demographic differences across states led to variation in allocation percentages; for example, the allocation of black/white respondents to single-race white ranged from nearly zero to more than 50% across states. Death rates calculated using bridging via the NHIS models were similar to those calculated using other methods, except for the American Indian/Alaska Native group, which included a large proportion of multiple-race reporters. Conclusion. Many data systems do not currently allow multiple-race reporting. When such data systems are used with Census counts to produce race-specific rates, bridging methods that incorporate geographic and demographic factors may lead to better rates than methods that do not consider such factors.