R. Charon Gwynn

A biomonitoring study of lead, cadmium, and mercury in the blood of New York city adults.

Objectives We assessed the extent of exposure to lead, cadmium, and mercury in the New York City (NYC) adult population. Methods We measured blood metal concentrations in a representative sample of 1,811 NYC residents as part of the NYC Health and Nutrition Examination Survey, 2004. Results The geometric mean blood mercury concentration was 2.73 μg/L [95% confidence interval (CI), 2.58–2.89]; blood lead concentration was 1.79 μg/dL (95% CI, 1.73–1.86); and blood cadmium concentration was 0.77 μg/L (95% CI, 0.75–0.80). Mercury levels were more than three times that of national levels. An estimated 24.8% (95% CI, 22.2–27.7%) of the NYC adult population had blood mercury concentration at or above the 5 μg/L New York State reportable level. Across racial/ethnic groups, the NYC Asian population, and the foreign-born Chinese in particular, had the highest concentrations of all three metals. Mercury levels were elevated 39% in the highest relative to the lowest income group (95% CI, 21–58%). Blood mercury concentrations in adults who reported consuming fish or shellfish 20 times or more in the last 30 days were 3.7 times the levels in those who reported no consumption (95% CI, 3.0–4.6); frequency of consumption explained some of the elevation in Asians and other subgroups. Conclusions Higher than national blood mercury exposure in NYC adults indicates a need to educate New Yorkers about how to choose fish and seafood to maximize health benefits while minimizing potential risks from exposure to mercury. Local biomonitoring can provide valuable information about environmental exposures.

Population prevalence of reported and unreported HIV and related behaviors among the household adult population in New York City, 2004

Background:Surveillance for HIV likely underestimates infection among the general population: 25% of US residents are estimated to be unaware of their HIV infection. Objective:To determine the prevalence of HIV infection and risk behaviors among New York City (NYC) adults and compare these with surveillance findings. Methods:The NYC Health and Nutrition Examination Survey (HANES) provided the first opportunity to estimate population-based HIV prevalence among NYC adults. It was conducted in 2004 among a representative sample of adults > 20 years. Previously reported HIV infection was identified from the NYC HIV/AIDS Surveillance Registry. A blinded HIV serosurvey was conducted on archived blood samples of 1626 NYC HANES participants. Data were used to estimate prevalence for HIV infection, unreported infections, high-risk activities, and self-perceived risk. Results:Overall, 18.1% engaged in one or more risky sexual/needle-use behaviors, of which 92.2% considered themselves at low or no risk of HIV or another sexually transmitted disease. HIV occurred in 21 individuals (prevalence 1.4%; 95% confidence interval (CI), 0.8–2.5]; one infection (5%; 95% CI, 0.7–29.9) was not reported previously and possibly undiagnosed. HIV infection was significantly elevated in those with herpes simplex virus 2 (4%), men who have sex with men (14%), and needle-users (21%) (P < 0.01). Conclusions:Among NYC adults, HIV prevalence was consistent with surveillance findings overall. The proportion of unreported HIV was less than estimated nationally, but findings were limited by sample size. Most adults with risky behaviors perceived themselves to be at minimal risk, highlighting the need for risk reduction and routine HIV screening.

Prevalence of Hepatitis C Infection in New York City, 2004

Hepatitis C virus (HCV) is the leading cause of chronic liver disease in the United States. Accurate hepatitis C prevalence estimates are important to guide local public health programs but are usually unavailable to local health jurisdictions. National surveys may not reflect local variation, a particular challenge for urban settings with disproportionately large numbers of residents in high-risk population groups. In 2004, the New York City Department of Health and Mental Hygiene conducted the NYC Health and Nutrition Examination Survey, a population-based household survey of non-institutionalized NYC residents ages 20 and older. Study participants were interviewed and blood specimens were tested for antibody to HCV (anti-HCV); positive participants were re-contacted to ascertain awareness of infection and to provide service referrals. Of 1,786 participants with valid anti-HCV results, 35 were positive for anti-HCV, for a weighted prevalence of 2.2% (95% confidence interval [CI] 1.5% to 3.3%). Anti-HCV prevalence was high among participants with a lifetime history of injection drug use (64.5%, 95% CI 39.2% to 83.7%) or a lifetime history of incarceration as an adult (8.4%, 95% CI 4.3% to 15.7%). There was a strong correlation with age; among participants born between 1945 and 1954, the anti-HCV prevalence was 5.8% (95% CI 3.3% to 10.0%). Of anti-HCV positive participants contacted (51%), 28% (n = 5) first learned of their HCV status from this survey. Continued efforts to prevent new infections in known risk behavior groups are essential, along with expansion of HCV screening and activities to prevent disease progression in people with chronic HCV.

Innovations in Population Health Surveillance: Using Electronic Health Records for Chronic Disease Surveillance

With 87% of providers using electronic health records (EHRs) in the United States, EHRs have the potential to contribute to population health surveillance efforts. However, little is known about using EHR data outside syndromic surveillance and quality improvement. We created an EHR-based population health surveillance system called the New York City (NYC) Macroscope and assessed the validity of diabetes, hyperlipidemia, hypertension, smoking, obesity, depression, and influenza vaccination indicators. The NYC Macroscope uses aggregate data from a network of outpatient practices. We compared 2013 NYC Macroscope prevalence estimates with those from a population-based, in-person examination survey, the 2013-2014 NYC Health and Nutrition Examination Survey. NYC Macroscope diabetes, hypertension, smoking, and obesity prevalence indicators performed well, but depression and influenza vaccination estimates were substantially lower than were survey estimates. Ongoing validation will be important to monitor changes in validity over time as EHR networks mature and to assess new indicators. We discuss NYCs experience and how this project fits into the national context. Sharing lessons learned can help achieve the full potential of EHRs for population health surveillance.

NYC HANES 2013–14 and Reflections on Future Population Health Surveillance

Accurate and reliable population health data are critical to public health and enable evidence-based planning, policy-making, and program evaluation. Public health agencies rely on local data to identify and monitor the burden of disease in a population over time and to answer important health policy questions. The New York City Health and Nutrition Examination Survey (NYC HANES), a local, representative heath examination survey, was conducted twice in NYC, once in 2004 and again in 2013–14 [1, 2]. Data from NYC HANES have served as a strong complement to existing population health surveillance data, especially in the context of New York City’s urban environment. In this special issue, we describe a range of findings from NYC HANES 2013–14 that collectively illustrate the unique contribution of examination surveys to population health surveillance. Yet, few public health agencies implement examination surveys, despite their important contributions, in part because such surveys can be expensive and difficult to conduct. We explore the value and challenges of surveys like NYC HANES, and we also describe emerging population health surveillance approaches that might provide complementary information to improve public health. NYC HANES was modeled on the National Health and Nutrition Examination Survey (NHANES), using a similar sampling design, instruments, protocols, and testing laboratories. Results from NYC HANES 2004 showed for the first time how many New Yorkers suffered from diagnosed and undiagnosed chronic conditions like diabetes, high cholesterol, and depression, and whether their conditions were well controlled. NYC HANES 2004 findings [3] helped identify and support public health policies to improve New Yorkers’ health, such as laws to restrict the use of artificial trans-fat in restaurants and to reduce exposure to secondhand smoke, the creation of a diabetes A1c Registry to improve diabetes diagnosis and control, and an educational campaign to inform the public of high levels of mercury in certain fish. Ten years later, in 2013–14, the NYC Health Department and researchers at the CUNYSchool of Public Health (now at NYU School of Medicine) conducted a second NYC HANES to collect information about the health of New Yorkers, to assess health changes since 2004, and to support evaluation of health policies implemented over the past decade. Unique strengths of a study like NYCHANES include the ability to quantify and characterize the burden of undiagnosed disease by combining self-reported survey data with objective measurements from laboratory testing or physical examination. Also, by remaining consistent with the national HANES design, comparisons can be J Urban Health https://doi.org/10.1007/s11524-018-0284-0