Helen A. Jonas

Current estrogen-progestin and estrogen replacement therapy in elderly women: Association with carotid atherosclerosis

The cardioprotective effects of combined estrogen/progestin replacement therapy have been questioned. Therefore, we have compared carotid arterial wall thickening and the prevalence of carotid stenosis in elderly women (> or = 65 years old) currently using replacement estrogen/progestins (E + P) with arterial pathology and its prevalence in women using unopposed estrogens (E). This cross-sectional study used baseline data from all 2962 women participating in the Cardiovascular Health Study, a population-based study of coronary heart disease and stroke in elderly adults. Users of hormone replacement therapy (HRT) were categorized as never (n = 1726), past (n = 787), current E (n = 280), or current E + P (n = 73). Maximal intimal-medial thicknesses of the internal and common carotid arteries and stenosis of the internal carotid arteries were measured by ultrasonography. Current E + P users resembled current E users in most respects, although some lifestyle factors were more favorable among E + P users. Current E + P use and current E use (as compared with no use) were associated with smaller internal carotid wall thicknesses (-0.22 mm; P = 0.003; and -0.09 mm; P = 0.05, respectively) and smaller common carotid wall thicknesses (-0.05 mm; P = 0.03; and -0.02 mm; P = 0.1, respectively) and lower odds ratios (OR) for carotid stenosis (> or = 1% vs. 0%); OR = 0.61; 95% confidence interval [CI]: 0.36 to 1.01; and OR = 0.91, 95% CI: 0.67 to 1.24, respectively), after adjustment for current lifestyle and risk factors. When both groups of current HRT users were compared, there were no significant differences in carotid wall thicknesses or prevalence of carotid stenosis. For this sample of elderly women, both current E + P therapy and current E therapy were associated with decreased measures of carotid atherosclerosis. These measures did not differ significantly between the two groups of HRT users.

Associations between alcohol related hospital admissions and alcohol consumption in Victoria: Influence of socio‐demographic factors

Objective: To examine the cross‐sectional ecologic associations between apparent per‐capita alcohol consumption, alcohol‐related hospital admission rates, and the distributions of socio‐demographic factors for people residing in 76 Local Government Areas (LGAs) in Victoria, during the 1995–1996 fiscal year.

Towards a standardised methodology for estimating alcohol‐caused death, injury and illness in Australia

Two key methodological issues underlying different methods for calculating estimates of the number of alcohol‐caused deaths are identified and recommendations suggested for future work.

Patterns and trends in alcohol-related hospitalizations in Victoria, Australia, 1987/88–1995/96

The objective of this study was to examine patterns and yearly trends in alcohol-related hospitalization rates during the period 1987/88-1995/96 for men and women living in metropolitan and rural/remote Victoria. Alcohol-related hospitalizations were extracted from the Victorian Inpatient Minimum Dataset (VMD) for the years 1987/88-1995/96 (public hospitals) and 1993/94-1995/96 (private hospitals), and adjusted by the appropriate aetiological fractions. Sex-specific age-adjusted rates we expressed per 10000 residents/year. During 1993/94-1995/96, alcohol-related hospitalizations comprised 1.0% of all Victorian hospitalizations (about 12000/year), with men accounting for over two-thirds of alcohol-related hospitalizations. Approximately half of the alcohol-related hospitalizations were for disease conditions and the other half for external cause (injury) conditions. About 80% of all alcohol-related hospitalizations were to public hospitals, with the exception of alcohol dependence (63% to private hospitals). Alcohol-related hospitalization rates were generally higher for people living in rural/remote areas compared to urban areas. During 1987/88-1995/96, the age-adjusted alcohol-related hospitalization rates in public hospitals did not change significantly for disease conditions (14.8-14.7 for men and 6.3-6.4 for women) or female external cause conditions (6.7-6.1), but decreased for external cause conditions (18.4-15.5). In private hospitals during 1993/94-1995/96, the age-adjusted alcohol-related hospitalization rates for disease conditions decreased (5.4-4.1 for men and 3.7-3.0 for women) but increased for external cause conditions (1.8-2.4 for men and 1.0-1.2 for women). These patterns and time-trends in Victorian alcohol-related hospitalizations reflect a combination of alcohol-related morbidity levels, hospital admission practices and patterns and levels of service provision. They suggest a potential need to focus on services and programmes in rural/remote Victoria.

Estimated alcohol‐caused deaths in Australia, 1990–97

The purpose of the study was to provide updated estimates of alcohol-caused mortality rates in Australia between 1990 and 1997, making adjustments for changes in the prevalence of high-risk alcohol use estimated on the basis of per capita alcohol consumption (PCAC). Deaths wholly and partially attributable to high-risk alcohol consumption were extracted from the Australian Bureau of Statistics Mortality Datafile (1990-1997) and multiplied by specific aetiological fractions, which in turn were adjusted by changes in the prevalence of high-risk alcohol use estimated on the basis of annual changes in PCAC. The yearly trends in age-standardized rates of estimated alcohol-caused deaths were compared with those using (i) aetiological fractions unadjusted for changes in PCAC, and (ii) wholly alcohol-caused conditions only (thus requiring no application of aetiological fractions). The age-standardized rates of all alcohol-caused deaths among males aged 15+ years declined from 1990 (4.01/10,000) to 1993 (3.19/10,000) and decreased far more slowly up to 1997 (3.15/10,000) - 16% overall. For females, these rates declined steadily from 1990 (1.75/10,000) to 1997 (1.33/10,000) - 19% overall. Similar patterns in time trends were noted for estimated alcohol-caused death rates calculated as in (i) and (ii). However, the proportional decreases in rates (21.6% for males; 24.0% for females) would have been underestimated by 16% (males) and 19% (females) if the alcohol aetiological fractions had not been adjusted to take account of the estimated annual changes in the prevalence of high-risk drinking. The declines in estimated alcohol-caused death rates were more pronounced than the 9% decline in PCAC, and were due mainly to decreasing death rates for stroke (men and women), alcoholic liver cirrhosis and road injuries (men only). When aetiological fractions are used to measure temporal trends in estimated alcohol-caused death rates from official mortality statistics, they should account for annual changes in the prevalence of high-risk drinking. Such changes in prevalence can be deduced from yearly fluctuations in PCAC.

Current estrogen-progestin and estrogen replacement therapy in elderly women: association with carotid atherosclerosis

The cardioprotective effects of combined estrogen/progestin replacement therapy have been questioned. Therefore, we have compared carotid arterial wall thickening and the prevalence of carotid stenosis in elderly women (> or = 65 years old) currently using replacement estrogen/progestins (E + P) with arterial pathology and its prevalence in women using unopposed estrogens (E). This cross-sectional study used baseline data from all 2962 women participating in the Cardiovascular Health Study, a population-based study of coronary heart disease and stroke in elderly adults. Users of hormone replacement therapy (HRT) were categorized as never (n = 1726), past (n = 787), current E (n = 280), or current E + P (n = 73). Maximal intimal-medial thicknesses of the internal and common carotid arteries and stenosis of the internal carotid arteries were measured by ultrasonography. Current E + P users resembled current E users in most respects, although some lifestyle factors were more favorable among E + P users. Current E + P use and current E use (as compared with no use) were associated with smaller internal carotid wall thicknesses (-0.22 mm; P = 0.003; and -0.09 mm; P = 0.05, respectively) and smaller common carotid wall thicknesses (-0.05 mm; P = 0.03; and -0.02 mm; P = 0.1, respectively) and lower odds ratios (OR) for carotid stenosis (> or = 1% vs. 0%); OR = 0.61; 95% confidence interval [CI]: 0.36 to 1.01; and OR = 0.91, 95% CI: 0.67 to 1.24, respectively), after adjustment for current lifestyle and risk factors. When both groups of current HRT users were compared, there were no significant differences in carotid wall thicknesses or prevalence of carotid stenosis. For this sample of elderly women, both current E + P therapy and current E therapy were associated with decreased measures of carotid atherosclerosis. These measures did not differ significantly between the two groups of HRT users.