Michael Wolz

Trends in Hypertension Prevalence, Awareness, Treatment, and Control Rates in United States Adults Between 1988–1994 and 1999–2004

This study assesses trends in hypertension prevalence, blood pressure distributions and mean levels, and hypertension awareness, treatment, and control among US adults, age ≥18 years, between the third National Health and Nutrition Examination Survey (1988–1994) and the 1999–2004 National Health and Nutrition Examination Survey, a period of ≈10 years. The age-standardized prevalence rate increased from 24.4% to 28.9% (P<0.001), with the largest increases among non-Hispanic women. Depending on gender and race/ethnicity, from one fifth to four fifths of the increase could be accounted for by increasing body mass index. Among hypertensive persons, there were modest increases in awareness (P=0.04), from 68.5% to 71.8%. The rate for men increased from 61.6% to 69.3% (P=0.001), whereas the rate for women did not change significantly. Rates remained higher for women than for men, although the difference narrowed considerably. Improvements in treatment and control rates were larger: 53.1% to 61.4% and 26.1% to 35.1%, respectively (both P<0.001). The greatest increases occurred among non-Hispanic white men and non-Hispanic black persons, especially men. Mexican American persons showed improvement in treatment and control rates, but these rates remained the lowest among race/ethnic subgroups (47.4% and 24.3%, respectively). Among all of the race/ethnic groups, women continued to have somewhat better awareness, treatment, and control, except for control rates among non-Hispanic white persons, which became higher in men. Differences between non-Hispanic black and white persons in awareness, treatment, and control were small. These divergent trends may translate into disparate trends in cardiovascular disease morbidity and mortality.

Methodological issues in screening for dementia: The problem of education adjustment

The methodological problems of developing efficient and unbiased screening methods for population-based studies of dementia have received scant attention. The potential advantages of education-adjusted screening methods are discussed. The implications for adjustment techniques of a negative correlation of educational attainment with age are emphasized. Two education adjustment methods, a stratified regression method and a nonparametric method, which take the age-education correlation into account are described, compared, and illustrated.

Sex roles and alcohol consumption: a research note

Inconsistencies in the role sets of women in modern societies are believed by some to account for the difference in rates of mental illness between men and women. In an analysis of rates of neurotic disorders and functional psychoses, Gove (1972) found that the higher rates of mental illness for women, compared to those of men, were due to disproportionately high rates among married women. Gove and Tudor (1973) maintain that the reason for this is that married women are more likely to occupy conflicting role sets. They contend that the role of the housewife involves unskilled labor and low status, both of which are often not consonant with a womans intellectual attainment. In addition, they argue that the married woman who works outside the home occupies a conflicting role set when her employment involves discrimination in the job market and assignment to positions that are not commensurate with her educational background. Gove and Tudor constructed their roleconflict model to explain mental health differences between women and men, but others have questioned this application. A persistent criticism has been that such between-gender

Assessing the Validity of the Omron HEM‐907XL Oscillometric Blood Pressure Measurement Device in a National Survey Environment

J Clin Hypertens (Greenwich). 2010;12:22–28. ©2009 Wiley Periodicals, Inc.

Prevalence of Airflow Obstruction in U.S. Adults Aged 40–79 Years: NHANES Data 1988–1994 and 2007–2010

Abstract Background: The study evaluated the change in the prevalence of airflow obstruction in the U.S. population 40–79 years of age from years 1988–1994 to 2007–2010. Methods: Spirometry data from two representative samples of the U.S. population, the National Health and Nutrition Examination Surveys (NHANES) conducted in 1988–1994 and 2007–2010, were used. The American Thoracic Society/European Respiratory Society (ATS/ERS) criteria were used to define airflow obstruction. Results: Based on ATS/ERS criteria, the overall age-adjusted prevalence of airflow obstruction among adults aged 40–79 years decreased from 16.6% to 14.5% (p < 0.05). Significant decreases were observed for the older age category 60–69 years (20.2% vs. 15.4%; p < 0.01), for males (19.0% vs. 15.4%; p < 0.01), and for Mexican American adults (12.7% vs. 8.4%; p < 0.001). The prevalence of moderate and more severe airflow obstruction decreased also (6.4% vs. 4.4%; p < 0.01). Based on ATS/ERS criteria, during 2007–2010, an estimated 18.3 million U.S. adults 40–79 years had airflow obstruction, 5.6 million had moderate or severe airflow obstruction and 1.4 million had severe airflow obstruction. Conclusions: The overall age-adjusted prevalence of airflow obstruction among U.S. adults aged 40–79 years decreased from 1988–1994 to 2007–2010, especially among older adults, Mexican Americans, and males.

Impact of National Heart, Lung, and Blood Institute–Supported Cardiovascular Epidemiology Research, 1998 to 2012

In a recent article, Alberts et al1 warned that the US-based biomedical science enterprise is flawed in its assumption that the enterprise will constantly expand, and it cannot expect a persistently expanding National Institutes of Health (NIH) biomedical research budget in the future. In fact, as noted by multiple observers, the NIH budget has been declining in constant dollars since 2003, and the pay lines for grants are at historic lows.1–4 Such realizations have led to calls for a reexamination of the policies and programs of the NIH and its individual institutes and centers.1,2 Some have questioned the appropriateness of the allocation of research budgets between discovery science and translational science.1,2,5 Others have argued for better methods to make funding decisions, suggesting that peer review is too conservative and limits innovation,1,2,4,6,7 or simply does not demonstrate the ability to prioritize research proposals on their potential to yield high impact.8,9 Evidence that scientists spend too much time writing and rewriting grant applications, stay too long in training programs, and achieve their first tenure track position or first NIH grant in their late thirties and early forties, respectively, suggest there is a mismatch in the supply and demand for scientists that must be addressed.1,5,7 Editorial see p 1949 Efforts at the NIH to conduct evaluation and self-examination have already begun. Institutes and centers within the NIH have taken multiple approaches. The National Cancer Institute conducted a workshop to make recommendations on how the National Cancer Institute can transform itself for the 21st century to address criticisms of excess expense, repudiated findings, small incremental gains in knowledge, inability to innovate at reasonable cost, and …

Trends in Apolipoprotein B, Non–High-Density Lipoprotein, and Low-Density Lipoprotein for Adults 60 Years and Older by Use of Lipid-Lowering Medications: United States, 2005 to 2006 Through 2013 to 2014

Over the years, guidelines for cholesterol lowering have focused on total cholesterol (TC) or low-density lipoprotein cholesterol (LDL-C). However, in recent years, apolipoprotein B (apo B) and non–high-density lipoprotein cholesterol (HDL-C) have been proposed as better measures of the atherosclerotic burden of lipids and improved measures for risk prediction.1 In this research letter, we examine trends in mean apo B, non–HDL-C, and LDL-C in adults ≥60 years of age by use of lipid-lowering medication from 2005 to 2006 through 2013 to 2014 using five 2-year cross-sectional NHANES (National Health and Nutrition Examination) surveys. NHANES uses a stratified, multistage probability design to produce samples representative of the US noninstitutionalized population. Written informed consent was obtained from adult participants. The survey was approved by the National Center for Health Statistics Research Ethics Review Board. NHANES includes a home interview consisting of health-related questions, including lipid-lowering medication use, and an examination at a mobile examination center that included blood-derived measures. Participants in the examination component were randomly assigned to a morning session (and asked to fast at least 9 hours before examination) or an afternoon/evening session. Each examined participant was eligible for TC and HDL-C; only participants examined in the morning were eligible for apo B and triglycerides. In 2013 to 2014, 57.8% of adults ≥60 years of age eligible for the survey were examined. Comparable response rates for 2011 to 2012, 2009 to 2010, 2007 …