Luis G. Escobedo

Comparison of Sudden and Nonsudden Coronary Deaths in the United States

BACKGROUND The present study was designed to compare risk factor prevalences in coronary heart disease deaths in persons dying within 1 hour of onset of cardiovascular symptoms (sudden coronary death), those dying without such sudden symptoms (nonsudden coronary death), and those with unknown duration of symptoms before death (other coronary death). METHODS AND RESULTS Data from the 1986 National Mortality Followback Survey and the US Bureau of the Census were examined to assess death rates for sudden, nonsudden, and other coronary deaths. Multivariate logistic regression methods were used to calculate the odds ratio (OR), compared with nonsudden and other coronary deaths, for sudden coronary death associated with socioeconomic status variables, the persons location at death, and coronary heart disease risk factors. Mortality rates for all coronary deaths increased with age, were higher for men than women, and increased with decreasing years of schooling. The rate of sudden coronary death was highest for Hispanics. In 1986, an estimated 251,000 sudden coronary deaths (95% CI = 238,000 to 263,000) occurred in the United States. Sudden coronary deaths were less likely than nonsudden coronary deaths to occur at home (OR = 0.5, 95% CI = 0.4 to 0.6), but individuals who died of sudden coronary death were more likely to have been current cigarette smokers (OR = 1.3, 95% CI = 1.0 to 1.8). No other modifiable risk factors for coronary heart disease distinguished sudden coronary deaths from nonsudden coronary deaths. CONCLUSIONS Contrary to the commonly held view, coronary deaths in the home are more likely to be nonsudden than sudden. Cigarette smoking more likely results in sudden than nonsudden coronary death, perhaps because of nicotine-induced ventricular arrhythmias.

Risk factors for Sudden coronary death in the United States

We assessed risk factors for sudden coronary death among persons without a history of coronary heart disease (unexpected sudden coronary death) and persons with a history of coronary heart disease (sudden coronary heart disease death). We analyzed national data to calculate death rates and odds ratios for both types of sudden coronary death. Among modifiable factors that we examined, only cigarette smoking increased risk for unexpected sudden coronary death [odds ratio (OR) = 1.8; 95% confidence interval (CI) = 1.2–2.7]. Diabetes mellitus (OR = 3.8; 95% CI = 2.5 5.8 for women), cigarette smoking (OR = 1.5; 95% CI = 1.0–2.1), and hypertension (OR = 1.4; 95% CI = 1.1–1.9) increased the risk for sudden coronary heart disease death. Etiologic factors for sudden death appear to differ depending on the presence or absence of coronary disease. With preexisting coronary disease, factors associated with chronic coronary disease may elevate sudden death risk; without coronary disease, factors that provoke ventricular arrhythmias may trigger sudden death.

Case-fatality rates for tubal sterilization in U.S. hospitals, 1979 to 1980

To update a 1977 to 1978 case-fatality estimate for tubal sterilization in U.S. hospitals, we reviewed the medical records of women reported by the Commission on Professional and Hospital Activities to have died after tubal sterilization procedures in 1979 or 1980. We project that the most reasonable case-fatality rate estimate is slightly greater than 9 per 100,000 sterilizations if all deaths associated with the procedure are considered. Rate estimates that assume minimum and maximum numbers of all associated deaths in our sample are approximately 6 per 100,000 and 10 per 100,000 sterilizations, respectively. However, when only deaths that can be attributed to sterilization per se are considered, the most reasonable case-fatality rate is estimated at between 1 and 2 per 100,000 procedures, a lower rate than previously reported. Rate estimates that assume minimum and maximum numbers of attributable deaths in our sample are approximately 1 per 100,000 and 5 per 100,000 sterilizations, respectively. These results further indicate that death attributable to tubal sterilization is rare.

Evaluation of smoking on the physical activity and depressive symptoms relationship

Physical activity is inversely associated with depressive symptoms, and cigarette smoking is positively associated with depressive symptoms. Data from the first National Health and Nutrition Examination Survey (NHANES I) and the NHANES I Epidemiologic Follow-up study were analyzed to determine whether the relationship between physical activity and self-reported distress (depressive symptoms as measured by the Center for Epidemiologic Studies Depression Scale) was different for cigarette smokers and nonsmokers. Logistic regression was used to calculate odds ratios (adjusted for age, race, sex, education, alcohol use, and perceived health status) for depressive symptoms (> or = 16) associated with physical activity and smoking status among 2,054 respondents. At baseline, the odds ratio for depressive symptoms was about 2 times higher for moderately active smokers and nonsmokers, and 3 times higher for low active smokers and nonsmokers, compared with highly active nonsmokers. For 1,132 persons with a low number of depressive symptoms (< 16) at baseline, the incidence of depressive symptoms after 7-9 yr of follow-up was about 2 times higher for low/moderately active smokers and nonsmokers than for highly active nonsmokers. The association between physical activity and the prevalence and incidence of depressive symptoms is not significantly modified by smoking status.

Long-term trends in cigarette smoking among young U.S. adults

Retrospective examination of a national probability sample revealed that young women, particularly those who dropped out of high school, have reached smoking rates as high or higher than subgroups of young men. These results suggest that surveillance, research, and public health programs are needed to address the rapid increase in smoking among young women.

Long-term age-specific prevalence of cigarette smoking among Hispanics in the United States.

To investigate trends in the prevalence of cigarette smoking among different age groups of Mexican-Americans, Cuban-Americans, and Puerto Rican-Americans, the smoking histories of 8,286 adults and adolescents from the 1982-83 Hispanic Health and Nutrition Examination Survey (HHANES) were evaluated. Age-specific prevalence rate curves were constructed by using the estimated smoking rates among 8-, 18-, 28-, 38-, 48-, and 58-year-olds from 1923 to 1983. Age-specific rates were higher for men than for women. However, rates declined over time among all age groups of Mexican-American men, and among Cuban-American and Puerto Rican-American men older than 18 years. In contrast, rates for Mexican-American women did not change appreciably over time, but they increased markedly for 28- and 38-year-old Cuban-American women and most age groups of Puerto Rican-American women. These results suggest that rates of cigarette smoking among Hispanic women are beginning to converge with those of Hispanic men, and that rates of smoking initiation among Cuban-American boys and Puerto Rican-American boys and girls have either remained unchanged or increased markedly over time.

Coronary artery disease, left ventricular hypertrophy, and the risk of cocaine overdose death

BackgroundWe assessed the relationship of coronary artery disease and left ventricular hypertrophy to the risk of cocaine overdose death. MethodsWe conducted a case-control study using data collected by medical examiners in Dade County, Florida, using logistic regression to calculate the odds of cocaine overdose death in relation to coronary artery disease and left ventricular hypertrophy. ResultsCompared with decedents without coronary artery disease, the adjusted odds ratio (likelihood) of cocaine overdose death for decedents with coronary artery disease was 2.8 (95% confidence interval, 1.7 to 4.8). This relationship was stronger for decedents with severe coronary artery disease who had used alcohol and cocaine. Compared with decedents without left ventricular hypertrophy, the adjusted odds ratio of cocaine overdose death for decedents with left ventricular hypertrophy was 5.4 (95% confidence interval. 2.4 to 11.9). ConclusionsThese results suggest that persons with coronary artery disease or left ventricular hypertrophy are at an increased risk of cocaine overdose death and that the use of alcohol in combination with cocaine increases this risk even further.