Mark Steinwandel

Comparing Diabetes Prevalence Between African Americans and Whites of Similar Socioeconomic Status

OBJECTIVES We investigated whether racial disparities in the prevalence of type 2 diabetes exist beyond what may be attributable to differences in socioeconomic status (SES) and other modifiable risk factors. METHODS We analyzed data from 34331 African American and 9491 White adults aged 40 to 79 years recruited into the ongoing Southern Community Cohort Study. Participants were enrolled at community health centers and had similar socioeconomic circumstances and risk factor profiles. We used logistic regression to estimate the association between race and prevalence of self-reported diabetes after taking into account age, SES, health insurance coverage, body mass index, physical activity, and hypertension. RESULTS Multivariate analyses accounting for several diabetes risk factors did not provide strong support for higher diabetes prevalence rates among African Americans than among Whites (men: odds ratio [OR]=1.07; 95% confidence interval [CI]=0.95, 1.20); women: OR=1.13, 95% CI=1.04, 1.22). CONCLUSIONS Our findings suggest that major differences in diabetes prevalence between African Americans and Whites may simply reflect differences in established risk factors for the disease, such as SES, that typically vary according to race.

Adherence to Cancer Prevention Guidelines and Cancer Risk in Low-Income and African American Populations

Background: The American Cancer Society (ACS) publishes behavioral guidelines for cancer prevention, including standards on body weight, physical activity, nutrition, alcohol, and tobacco use. The impact of these guidelines has been rarely studied in low-income and African American populations. Methods: The study included 61,098 racially diverse, mainly low-income adults who participated in the Southern Community Cohort Study and were followed for a median of 6 years. Cox models were used to estimate HRs for cancer incidence associated with behaviors and with an ACS physical activity/nutrition 0-to-4 compliance score indicating the number of body weight, physical activity, healthy eating, and alcohol guidelines met. Results: During the study period, 2,240 incident cancers were identified. Significantly lower cancer incidence was found among never smokers and non/moderate alcohol drinkers, but not among those meeting guidelines for obesity, physical activity, and diet. The ACS compliance score was inversely associated with cancer risk among the 25,509 participants without baseline chronic disease. HRs for cancer incidence among those without baseline chronic diseases and who met one, two, three, or four guidelines versus zero guidelines were 0.93 (95% confidence intervals, 0.71–1.21), 0.85 (0.65–1.12), 0.70 (0.51–0.97), and 0.55 (0.31–0.99), respectively. Associations were consistent in analyses stratified by sex, race, household income, and smoking status. Conclusions: Meeting the ACS smoking and body weight/physical activity/dietary/alcohol guidelines for cancer prevention is associated with reductions in cancer incidence in low-income and African American populations. Impact: This study provides strong evidence supporting lifestyle modification to lower cancer incidence in these underserved populations. Cancer Epidemiol Biomarkers Prev; 25(5); 846–53. ©2016 AACR.

Association of oral microbiome with type 2 diabetes risk

BACKGROUND AND OBJECTIVE The oral microbiome may help to maintain systemic health, including how it affects blood glucose levels; however, direct evidence linking the oral microbiome with diabetes is lacking. MATERIAL AND METHODS We compared the oral microbiome profiles of 98 participants with incident diabetes, 99 obese non-diabetics and 97 normal weight non-diabetics, via deep sequencing of the 16S rRNA gene. RESULTS We found that the phylum Actinobacteria was present significantly less abundant among patients with diabetes than among the controls (p = 3.9 × 10-3 ); the odds ratio (OR) and 95% confidence interval (CI) was 0.27 (0.11-0.66) for those individuals who had relative abundance higher than the median value. Within this phylum, five families and seven genera were observed, and most of them were less abundant among patients with diabetes. Notably, genera Actinomyces and Atopobium were associated with 66% and 72% decreased risk of diabetes with p-values of 8.9 × 10-3 and 7.4 × 10-3 , respectively. Stratified analyses by race showed that most taxa in this phylum were associated with diabetes in both black and white participants. This phylum was also less abundant among non-diabetic obese subjects compared to normal weight individuals, particularly genera Mobiluncus, Corynebacterium and Bifidobacterium, which showed p < 0.05. CONCLUSION Our study revealed that multiple bacteria taxa in the phylum Actinobacteria are associated with the risk of type 2 diabetes. Some are also associated with the prevalence of obesity, suggesting that the oral microbiome may play an important role in diabetes etiology.

Urinary Metabolite Risk Biomarkers of Lung Cancer: A Prospective Cohort Study

Background: Lung cancer is a major health burden causing 160,000 and 1.6 million deaths annually in the United States and worldwide, respectively. Methods: While seeking to identify stable and reproducible biomarkers in noninvasively collected biofluids, we assessed whether previously identified metabolite urinary lung cancer biomarkers, creatine riboside (CR), N-acetylneuraminic acid (NANA), cortisol sulfate, and indeterminate metabolite 561+, were elevated in the urines of subjects prior to lung cancer diagnosis in a well-characterized prospective Southern Community Cohort Study (SCCS). Urine was examined from 178 patients and 351 nondiseased controls, confirming that one of four metabolites was associated with lung cancer risk in the overall case–control set, whereas two metabolites were associated with lung cancer risk in European-Americans. Results: OR of lung cancer associated with elevated CR levels, and adjusted for smoking and other potential confounders, was 2.0 [95% confidence interval (CI), 1.2–3.4; P= 0.01]. In European-Americans, both CR and NANA were significantly associated with lung cancer risk (OR = 5.3; 95% CI, 1.6–17.6; P= 0.006 and OR=3.5; 95% CI, 1.5–8.4; P= 0.004, respectively). However, race itself did not significantly modify the associations. ROC analysis showed that adding CR and NANA to a model containing previously established lung cancer risk factors led to a significantly improved classifier (P= 0.01). Increasing urinary levels of CR and NANA displayed a positive association with increasing tumor size, strengthening a previously established link to altered tumor metabolism. Conclusion and Impact: These replicated results provide evidence that identified urinary metabolite biomarkers have a potential utility as noninvasive, clinical screening tools for early diagnosis of lung cancer. Cancer Epidemiol Biomarkers Prev; 25(6); 978–86. ©2016 AACR.

Associations Between Neighborhood Environment, Health Behaviors, and Mortality

INTRODUCTION Considering the joint association of neighborhood socioeconomic environment and individual-level health behaviors with health outcomes may help officials design effective disease prevention strategies. This study evaluates the joint influences of neighborhood socioeconomic environment and individual health behaviors on mortality in a cohort primarily comprising people with low individual-level SES. METHODS The prospective Southern Community Cohort Study includes 77,896 white and African American participants recruited in the years 2002-2009; 55% of participants had a household income <

Combined Impact of Health Behaviors on Mortality in Low-Income Americans

15,000 at baseline interview. Mortality from cancer (n=2,471), cardiovascular diseases (n=3,005), and all-causes (n=10,099) was identified from the National Death Index through December 31, 2013 (median follow-up, 8 years). Data were analyzed in 2016 and 2017. Associations were assessed between mortality, a neighborhood deprivation index composed of 11 census tract-level variables, five health behaviors, and a composite healthy lifestyle score. RESULTS Living in a neighborhood with the greatest socioeconomic disadvantage was associated with higher all-cause mortality in both men (hazard ratio=1.41, 95% CI=1.27, 1.57) and women (hazard ratio=1.77, 95% CI=1.57, 2.00). Associations were attenuated after adjustment for individual-level SES and major risk factors (hazard ratio for men=1.09, 95% CI=0.98, 1.22, and hazard ratio for women=1.26, 95% CI=1.12, 1.42). The dose-response association between neighborhood disadvantage and mortality was less apparent among smokers. Nevertheless, individuals who lived in disadvantaged neighborhoods and had the unhealthiest lifestyle scores experienced the highest mortality. CONCLUSIONS Disadvantaged neighborhood socioeconomic environments are associated with increased mortality in a cohort of individuals of low SES. Positive individual-level health behaviors may help negate the adverse effect of disadvantage on mortality.

Retrospective cohort mortality study of workers engaged in motion picture film processing

INTRODUCTION African Americans and low-income whites have higher mortality than the U.S. general population. This study prospectively investigated the combined influence of major lifestyle factors and poverty on mortality in this vulnerable population. METHODS Data were collected in 2002-2009 from 79,101 Southern Community Cohort Study participants, of which 67% were African American and 55% had household incomes <

Total and free circulating vitamin D and vitamin D binding protein in relation to colorectal cancer risk in a prospective study of African Americans

15,000. Mortality outcomes were identified from the National Death Index though December 31, 2011 (data analyzed in 2014-2015). Healthy behavior scores were created based on tobacco smoking, alcohol intake, diet, physical activity, and sedentary time. The primary analysis was performed based on the score created by counting each participant as having met/not met public health guidelines for each behavior. RESULTS Healthy behavior scores were associated with reduced cancer, cardiovascular disease, and all-cause mortality. Associations were stronger for whites than African Americans: hazard ratios for all-cause mortality comparing participants meeting four or five guidelines versus participants meeting zero were 0.41 (95% CI=0.30, 0.55) for African American men; 0.36 (95% CI=0.24, 0.55) for white men; 0.46 (95% CI=0.36, 0.59) for African American women; and 0.27 (95% CI=0.18, 0.43) for white women. The association between healthy lifestyle and all-cause mortality was weaker among those with incomes <

Prospective Study of Oral Microbiome and Colorectal Cancer Risk in Low-income and African American Populations: Oral Microbiome and Colorectal Cancer

15,000 than those with higher income, particularly in men (p<0.05 for interaction). CONCLUSIONS This study demonstrates the importance of health behaviors on mortality among all groups, but highlights the need for additional research to identify factors contributing to high risk of mortality among low-income and African American populations.

Baseline Prostate-specific Antigen Level in Midlife and Aggressive Prostate Cancer in Black Men

Objective: To assess potential health risks associated with work in a large motion picture film-processing facility. Methods: A retrospective cohort mortality study was conducted during 1960–2000 among 2646 film workers. Job family categories, created from detailed employee work history information, were used to evaluate chemical exposure patterns. Results: Overall mortality was as expected (standardized mortality ratio [SMR] = 1.1; 95% confidence interval [CI] = 1.0–1.2). Statistically significant associations were found for suicides (SMR = 2.0; 95% CI = 1.2–3.0) among the hourly workers and AIDS (SMR = 5.3; 95% CI = 1.7–12.3) among the administrative workers. Film developers had increases of respiratory cancer (SMR = 1.9; 95% CI = 1.1–3.0) and suicides (SMR = 2.4; 95% CI = 1.0–4.7), whereas film assemblers had an increase in suicides (SMR = 2.4; 95% CI = 1.2–4.4) only. Conclusions: Excess deaths resulting from suicides and AIDS among the workforce suggest that nonoccupational influences may be involved in the mortality of this cohort and warrant further investigations.