Diane M. Makuc

Pulse rate, coronary heart disease, and death : the NHANES I epidemiologic follow-up study

To determine whether associations of elevated resting pulse rate with CHD incidence or death in white men are independent of other risk factors and whether such associations exist for women and blacks, data were examined from the NHANES I Epidemiologic Follow-up Study. Over a follow-up period of 6 to 13 years, elevated RR for CHD incidence were found for older white men with baseline pulse greater than 84 beats/min compared with less than 74 beats/min after controlling multiple risk factors (RR = 1.37, 95% CL 1.02, 1.84). Risks of death from all causes, cardiovascular diseases, and noncardiovascular diseases were also elevated for white men with elevated pulse rate independent of other risk factors. CHD incidence was increased in white women with elevated pulse rate. Risks of death from all causes, cardiovascular diseases, and noncardiovascular diseases, were also elevated for white men with elevated pulse rate independent of other risk factors. CHD incidence was increased in white women with elevated pulse rate. Risk of death from all causes and cardiovascular diseases was elevated in black men and women with elevated pulse rate. Risk of death from noncardiovascular disease was elevated in black men with elevated pulse rate. The association with cardiovascular death was particularly striking in black women, even after adjusting for baseline risk factors (RR 3.03, 95% CL 1.46, 6.28). Further studies are needed to assess associations of pulse rate with CHD in blacks and to elucidate mechanisms in all groups.

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)

Use of ambulatory medical care by the poor: another look at equity.

Access to health services by the poor and other disadvantaged groups has improved considerably over the past 15 years. These circumstances have led some to question whether the poor now have equal access to health care. This article presents recent evidence from the 1976-78 National Health Interview Surveys (NHIS) comparing utilization among age, race, and income groups. Without adjustment for health status, the poor have more physician visits than those with higher incomes. After adjusting for age and health status, however, these differences are reversed. Depending on which measure is used, the poor have between 7 per cent and 44 per cent fewer visits than those with income above twice the poverty level. Furthermore, the age- and health-adjusted data show blacks have significantly fewer visits than their white counterparts. In addition, there are large differences among race and income groups in the characteristics of the ambulatory care obtained. Blacks and the poor are much more likely to use hospital clinics and less likely to use private physician offices or telephone consultations. The poor also receive less preventive care. It would appear from the present evidence that still further progress is required to achieve the goal of equity in the distribution of medical care services.

Serum albumin, coronary heart disease, and death☆

To confirm a reported association between elevated serum albumin concentrations and reduced risk of death in middle-aged white men and to determine whether such associations exist for CHD incidence in white men and CHD and death in white women and black men and women, data were examined from the NHANES I Epidemiologic Follow-up Study. Over a follow-up period of 9 to 16 years, serum albumin concentrations of 4.5 gm/dl or more were associated with reduced risk of CHD incidence in white men aged 45 to 64 years (RR = 0.51; 95% CL = 0.36, 0.73) and in white women aged 45 to 74 years (RR = 0.70; 95% CL = 0.55, 0.88), independent of baseline risk factors. Independent reductions in risk of death from all causes, cardiovascular diseases, and noncardiovascular diseases were also seen in white men and women. Relative risk of death from all causes at ages 45 to 74 years in the white population was 0.73 (95% CL = 0.62, 0.85) for men and 0.71 (95% CL = 0.59, 0.85) for women. Similar reductions in risk of death from all causes and cardiovascular diseases were seen in black men and women, despite the small numbers. Further studies are needed to confirm these findings for women and black persons and to elucidate mechanisms for the effect of serum albumin.

Self-Reported Age-Related Eye Diseases and Visual Impairment in the United States: Results of the 2002 National Health Interview Survey

OBJECTIVESnWe sought to establish national data on the prevalence of visual impairment, blindness, and selected eye conditions (cataract, diabetic retinopathy, glaucoma, and macular degeneration) and to characterize these conditions within sociodemographic subgroups.nnnMETHODSnInformation on self-reported visual impairment and diagnosed eye diseases was collected from 31,044 adults. We calculated weighted prevalence estimates and odds ratios with logistic regression using SUDAAN.nnnRESULTSnAmong noninstitutionalized US adults 18 years and older, the estimated prevalence for visual impairment was 9.3% (19.1 million Americans), including 0.3% (0.7 million) with blindness. Lifetime prevalence of diagnosed diseases was as follows: cataract, 8.6% (17 million); glaucoma, 2.0% (4 million); macular degeneration, 1.1% (2 million); and diabetic retinopathy, 0.7% (1.3 million). The prevalence of diabetic retinopathy among persons with diagnosed diabetes was 9.9%.nnnCONCLUSIONSnWe present the most recently available national data on self-reported visual impairment and selected eye diseases in the United States. The results of this study provide a baseline for future public health initiatives relating to visual impairment.

The low cholesterol-mortality association in a national cohort

The relationship of low serum cholesterol and mortality was examined in data from the NHANES I Epidemiologic Followup Study (NHEFS) for 10,295 persons aged 35-74, 5833 women with 1281 deaths and 4462 men with 1748 deaths (mean (followup = 14.1 years). Serum cholesterol below 4.1 mmol/l was associated with increased risk of death in comparison with serum cholesterol of 4.1-5.1 mmol/l (relative risk (RR) for women = 1.7, 95% confidence interval (CI) = (1.2, 2.3); for men RR = 1.4, CI = (1.1, 1.7)). However, the low serum cholesterol-mortality relationship was modified by time, age, and among older persons, activity level. The low serum cholesterol-mortality association was strongest in the first 10 years of followup. Moreover, this relationship occurred primarily among older persons (RR for low serum cholesterol for women 35-59 = 1.0 (0.6, 1.8), for women 70-74, RR = 2.1 (1.2, 3.7); RR for low serum cholesterol for men 35-59 = 1.2 (0.8, 2.0), for men 70-74, RR = 1.9 (1.3, 2.7)). Among older persons, however, the low serum cholesterol-mortality association was confined only to those with low activity at baseline. Factors related to underlying health status, rather than a mortality-enhancing effect of low cholesterol, likely accounts for the excess risk of death among persons with low cholesterol. The observed low cholesterol-mortality association therefore should not discourage public health programs directed at lowering serum cholesterol.

Travel for ambulatory medical care.

This article describes travel patterns for ambulatory care based on the 1978 National Health Interview Survey. The county where a physician visit occurs has been compared with the county of patients residence. Nearly 20 per cent of physician visits occur outside the county of residence, with substantial variation according to metropolitan status and proximity to an SMSA. Visits by nonmetropolitan residents are twice as likely to occur in another county as visits by metropolitan residents. The proportion of visits that occur outside the county of residence increases with decreasing population density, both among metropolitan and nonmetropolitan areas. Travel patterns for the usual source of care are similar to those for primary care physician visits. The results are used to estimate adjusted physician-population ratios by allocating physicians to each county type in proportion to their use by residents. These adjusted ratios exhibit substantially less variation than the unadjusted ratios.

National and state trends in use of prenatal care, 1970-83.

Using birth certificate data, national trends in prenatal care use are examined for White and Black mothers overall, as well as for 10 separate subgroups defined by marital status, maternal age, and educational attainment. The per cent of Black mothers with early prenatal care increased each year during the 1970s but the average annual percentage point increase for 1976-80 (1.2) was smaller than that for 1970-75 (2.3). Furthermore, the per cent of Black mothers with early care declined from 62.6 in 1980 to 61.4 in 1982 and remained at this lower level in 1983. Similar changes in trends were observed for all of the 10 Black subgroups despite substantial variation among the subgroups in the level of early prenatal care use. Analyses of state trends provide further evidence of a change in trend for Black mothers. For White mothers, average annual increases in the per cent with early care were similar for 1970-75 and 1976-80 (0.8 and 0.6 percentage points). In addition, the per cent with early care has remained stable since 1980.

Changing Practice in the Surgical Treatment of Breast Cancer: The National Perspective

This study documents changes in surgical treatment of breast cancer using data from the National Hospital Discharge Survey. All discharge records for women aged 25 years and older who received a mastectomy and had a diagnosis of breast cancer were selected for analysis. The proportion of such women discharged who received a radical mastectomy declined precipitously from 49% in 1972-1974 to 14% in 1978-1980. The proportion of women discharged who received modified radical mastectomies increased concomitantly from 29% in 1972-1974 to 64% in 1979-1980. Further, these changes in surgical practice were observed in all regions of the United States and for both small and large hospitals. The average length of hospital stay for discharged women treated surgically for breast cancer declined from 11.8 to 10.3 days between 1972-1974 and 1978-1980. About one third of this decline can be attributed to the shift toward less extensive operations.

Methodologic implications of allocating multiple-race data to single-race categories.

OBJECTIVEnTo illustrate methods for comparing race data collected under the 1977 Federal Office of Management and Budget (OMB) directive, known as OMB-15, with race data collected under the revised 1997 OMB standard.nnnDATA SOURCES/STUDY SETTINGnSecondary data from the 1993-95 National Health Interview Surveys. Multiple-race responses, available on in-house files, were analyzed.nnnSTUDY DESIGNnRace-specific estimates of employer-sponsored health insurance were calculated using proposed allocation methods from the OMB. Estimates were calculated overall and for three population subgroups: children, those in households below poverty, and Hispanics.nnnPRINCIPAL FINDINGSnAlthough race distributions varied between the different methods, estimates of employer-sponsored health insurance were similar. Health insurance estimates for the American Indian/Alaska Native group varied the most.nnnCONCLUSIONSnEmployer-sponsored health insurance estimates for American Indian/Alaska Natives from data collected under the 1977 OMB directive will not be comparable with estimates from data collected under the 1997 standard. The selection of a method to distribute to the race categories used prior to the 1997 revision will likely have little impact on estimates of employer-sponsored health insurance for other groups. Additional research is needed to determine the effects of these methods for other health service measures.