Lester Breslow

Relationship of physical health status and health practices

Abstract This paper continues the analysis previously reported of physical health status in an adult population and its relationship to various independent variables. Data for the study were gathered by questionnaires completed by a probability-based sample of adult residents of Alameda County, California, in 1965. Physical health is measured along a spectrum ranging from severe disability to high energy level with absence of chronic conditions or symptoms. The “ridit” which places each individual along the spectrum can be averaged for comparison of groups, and can be adjusted for differences due to age and sex. This paper examines the relation between common health practices, including hours of sleep, regularity of meals, physical activity, smoking and drinking, and physical health status. Good practices are shown to be associated with positive health, and the relationship of these activities was cumulative; those who followed all of the good practices being in better health, even though older, than those who failed to do so. This association was found to be independent of age, sex, and economic status.

Mortality from coronary heart disease and physical activity of work in California

Abstract A gradient of decreasing mortality rates from coronary heart disease with increasing physical activity of work in middle-aged men, reported from England, is confirmed under special conditions in California data for 1949 to 1951. The California gradient is clearly revealed only in contrasts between occupational groups of similar general mortality risk. The evidence for a social class gradient of coronary mortality in California is revealed in the same way, although it too is readily apparent in British studies without controlling general mortality risk. Earlier studies in the United States, which failed to confirm British results, have not included an analysis of general mortality. The apparently greater risk of coronary mortality in sedentary workers compared to heavy workers is of moderate degree, about 40 per cent for occupations at average general mortality risk in the California data. Factors which increase the general mortality risk, and which had obscured the physical activity association, seem to account for as much coronary mortality as that possibly attributed to a limitation of physical activity in work.

Mortality from coronary heart disease in California men who work long hours

Abstract The registered mortality of men in California, 1949 to 1951, is used to test the hypothesis that occupational stress, insofar as it can be measured by the length of the work week, is associated with coronary heart disease. That measure has been used by Russek and Zohman, 1 who reported that a high proportion of persons with coronary heart disease had worked long hours for some time preceding attack. The registered mortality data, together with some Census occupational data on work hours, allows an independent check of that finding. Farmers and farm laborers show relative protection from mortality attributed to coronary heart disease, even though many of them work long hours. On the other hand, evidence from nonfarm occupations shows an excess of coronary mortality among light workers who are on the job more than 48 hours a week, especially before age 45. The evidence for men at ages 45 to 64 is weaker and perhaps questionable; but, it should be noted, Russek and Zohman also report evidence only for young adults. The difference in the evidence for younger and older middle-aged men is open to several interpretations: perhaps the most useful to research is that stress, as defined, may be associated with thrombotic complications but not necessarily with progressive atherosclerosis of the coronary arteries.

Report of a ten-year follow-up study of the San Francisco Longshoremen: Mortality from coronary heart disease and from all causes

Abstract 1. 1. The results of a ten-year follow-up on mortality from coronary heart disease and from all causes, in a previously-examined population are presented. 2. 2. The association between cigarette smoking and mortality from coronary heart disease and from all causes among those men who, in 1951, revealed no abnormalities related to cardiopulmonary diseases, was ascertained. It was found that over the age of 45, those men who smoked more than a pack of cigarettes a day experienced a much higher death rate than did the ‘nonsmokers’. 3. 3. Grouping the individuals according to their 1951 systolic and diastolic blood pressure readings, and associating it with mortality from coronary heart disease and from all causes, it was found that the higher the systolic or diastolic blood pressure in 1951, the greater was the risk of mortality during the ensuing ten years. However, the gradient for diastolic blood pressure was not as steep as for systolic blood pressure. Throughout the age range 45–64, the mortality among hypertensive smokers was approximately 9–10 times as high as that of ‘nonhypertensive nonsmokers’. 4. 4. Both for smokers and ‘nonsmokers’, and in each age group, the men who had abnormal electrocardiograms in 1951 had a death rate approximately three times as high as those who did not have abnormal electrocardiograms. 5. 5. Using the Metropolitan tables of weight for height, the examined men were grouped into four classes referred to as ‘not overweight’, ‘slightly overweight’, ‘moderately overweight’ and ‘markedly overweight’. The mortality rates, both among smokers and ‘nonsmokers’ and in each age group, varied only slightly with the above-mentioned weight classification. We found no indication of a steady gradient between mortality and degree of overweight in this population. 6. 6. The value of multiphasic screening examination as an effective case-finding tool for early detection of chronic diseases has been indicated.

The occupational-social class risks of cancer mortality in men

Abstract The social class risks of death from cancer among California men, at ages 20 to 64 in 1949 to 1951, were analyzed and compared with similar mortality experienced in England and Wales. Historical data on social class mortality are available for England but not for California. As recently as 1930 to 1932 the mortality risk due to oral and pharyngeal cancer was greater in lower social classes in England and Wales. By 1950 the over-all death rate for these cancers, regardless of social class, had decreased considerably more in England and Wales than in the United States. The decrease was accompanied by the virtual disappearance of the social class gradient in the former country. California data, however, disclosed a pronounced social class difference in 1950. Cancer of the stomach in England and Wales continued to show the same result from 1921 to 1951, that is, a twofold higher relative risk in lower social classes. In California the relative risk was about threefold in 1950. The over-all death rates for this site of cancer showed little or no change from 1930 to 1950 in the former country, but a 40 per cent decrease in the United States. A similar social class risk for cancer of the esophagus seems to be changing in England and Wales, but was pronounced in California. With the inclusion of cancer of the lung, which reveals a minor social class difference, lower social class is associated with an unfavorable relative risk of cancer at sites comprising 39 per cent of total cancer mortality in California men. Cancers of some other parts of the body show direct associations with higher social class but each requires additional evidence for confirmation.

Cancer of the lung and Los Angeles-type air pollution: Prospective study.

Questionnaires on cigarette smoking status, residence history and other characteristics were mailed to men of the California Division of the American Legion. Subsequent checking of this population against the California mortality records for 1959 through 1962 disclosed the numbers of deaths, including those due to cancer of the lung and provided 336,571 man‐years of observation. The pulmonary cancer gradient by smoking level was less pronounced than that found in other studies. The two major metropolitan areas. Los Angeles and Bay Area plus San Diego, had higher mortality rates for cancer of the lung than remaining mixed rural and urban counties and these differences were relatively greater among nonsmokers. With controls for smoking and length of residence, the risk of pulmonary cancer in Los Angeles, where photochemical air pollution levels are highest, was not greater than in other major metropolitan areas of California.

Relationship of Amount of Cigarette Smoking to Coronary Heart Disease Mortality Rates in Men

Seven out of 8 previous reports indicate a relationship between morbidity or mortality from coronary heart disease and amount of cigarette smoking. Data from 2 California study groups, longshoremen and respondents to a household sample health survey, are presented to show similar relationships. In 4 studies showing mortality, the coronary heart disease death rates for men, in various age groups from 40 to 70 years, who smoked a pack of cigarettes or more per day, generally exceeded the corresponding rates for nonsmokers by from 1 to 7 deaths per thousand per year.

Height, weight, and mortality in a population of longshoremen.

Abstract The 3,992 examined longshoremen, averaging 17 per cent over Metropolitan standard of weight for height, show no excess of mortality from all causes and no excess from coronary heart disease during the first 5 years after examination. They show no gradient of total mortality with weight, even those 40 per cent and more over Metropolitan standard of weight for height showing no excess mortality. The 78 examined longshoremen who died of coronary heart disease in the 5 years after examination did not differ in weight from the total of those examined. Only 12 of the 78 coronary heart deaths occurred among those diagnosed as having coronary heart disease after referral for positive findings at the multiphasic screening examination.