Yvette C. Cozier

Socioeconomic Status and Incidence of Type 2 Diabetes: Results From the Black Women's Health Study

The authors examined the relation between individual and neighborhood socioeconomic status (SES) and type 2 diabetes incidence among African-American women in the prospective Black Womens Health Study. Participants have completed mailed biennial follow-up questionnaires since 1995. US Census block group characteristics were used to measure neighborhood SES. Incidence rate ratios were estimated in clustered survival regression models. During 12 years of follow-up of 46,382 participants aged 30-69 years, 3,833 new cases of type 2 diabetes occurred. In models that included both individual and neighborhood SES factors, incidence rate ratios were 1.28 (95% confidence interval: 1.15, 1.43) for < or = 12 years of education relative to > or = 17 years, 1.57 (95% confidence interval: 1.30, 1.90) for household income <

General and Abdominal Obesity and Risk of Death among Black Women

15,000 relative to >

Sarcoidosis in Black Women in the United States: Data From the Black Women's Health Study

100,000, and 1.65 (95% confidence interval: 1.46, 1.85) for lowest quintile of neighborhood SES relative to highest. The associations were attenuated after adjustment for body mass index, suggesting it is the key intermediate factor in the pathway between SES and diabetes. The association of neighborhood SES with diabetes incidence was present even among women who were more educated and had a higher family income. Efforts to reduce the alarming rate of diabetes in African-American women must focus on both individual lifestyle changes and structural changes in disadvantaged neighborhoods.

Relation Between Neighborhood Median Housing Value and Hypertension Risk Among Black Women in the United States

BACKGROUND Recent pooled analyses show an increased risk of death with increasing levels of the body-mass index (BMI, the weight in kilograms divided by the square of the height in meters) of 25.0 or higher in populations of European ancestry, a weaker association among East Asians, and no association of an increased BMI with an increased risk of death among South Asians. The limited data available on blacks indicate that the risk of death is increased only at very high levels of BMI (≥35.0). METHODS We prospectively assessed the relation of both BMI and waist circumference to the risk of death among 51,695 black women with no history of cancer or cardiovascular disease who were 21 to 69 years of age at study enrollment. Our analysis was based on follow-up data from 1995 through 2008 in the Black Womens Health Study. Multivariable proportional-hazards models were used to estimate hazard ratios and 95% confidence intervals. RESULTS Of 1773 deaths identified during follow-up, 770 occurred among 33,916 women who had never smoked. Among nonsmokers, the risk of death was lowest for a BMI of 20.0 to 24.9. For a BMI above this range, the risk of death increased as the BMI increased. With a BMI of 22.5 to 24.9 as the reference category, multivariable-adjusted hazard ratios were 1.12 (95% confidence interval [CI], 0.87 to 1.44) for a BMI of 25.0 to 27.4, 1.31 (95% CI, 1.01 to 1.72) for a BMI of 27.5 to 29.9, 1.27 (95% CI, 0.99 to 1.64) for a BMI of 30.0 to 34.9, 1.51 (95% CI, 1.13 to 2.02) for a BMI of 35.0 to 39.9, and 2.19 (95% CI, 1.62 to 2.95) for a BMI of 40.0 to 49.9 (P<0.001 for trend). A large waist circumference was associated with an increased risk of death from any cause among women with a BMI of less than 30.0. CONCLUSIONS The risk of death from any cause among black women increased with an increasing BMI of 25.0 or higher, which is similar to the pattern observed among whites. Waist circumference appeared to be associated with an increased risk of death only among nonobese women. (Funded by the National Cancer Institute.).

Comparison of methods for collection of DNA samples by mail in the black women's health study

BACKGROUND Sarcoidosis is a systemic granulomatous disorder of unknown cause that occurs among men and women of all races. In the United States, black women are most frequently and most severely affected. There have been few epidemiologic studies of sarcoidosis focusing on black women. METHODS In this article, we present data on incidence, prevalence, and clinical characteristics of sarcoidosis among participants in the Black Womens Health Study, a cohort study of 59,000 black women from across the United States. Data on incident disease and potential risk factors are obtained through biennial questionnaires. Follow-up has been > 80% through six completed cycles. RESULTS There were 685 prevalent cases of sarcoidosis at baseline in 1995 and 435 incident cases reported during 611,585 person-years of follow-up through 2007, for an average annual incidence rate of 71/100,000 and a current prevalence of 2.0%. The sarcoid diagnosis was confirmed in 96% of self-reported cases for whom medical records or physician checklists were obtained. The most frequently affected site was the lung. Most patients also had extrapulmonary involvement, with the most common sites being lymph nodes, skin, and eyes. Prednisone had the highest prevalence of use, followed by inhaled corticosteroids. CONCLUSIONS This study confirms previous reports of high incidence and prevalence of sarcoidosis among black women, as well as the extent of extrapulmonary disease, frequent need for steroid therapy, and comorbid conditions in this population. The prospective identification of sarcoidosis cases from a defined population will enable a valid assessment of risk factors for incident disease as follow-up continues.

Original ResearchDiffuse Lung DiseaseSarcoidosis in Black Women in the United States: Data From the Black Women's Health Study

OBJECTIVES We examined the relation between median housing value and hypertension risk among US Black women. METHODS We gathered data from the Black Womens Health Study, a prospective follow-up of 59000 Black women aged 21 to 69 years in 1995. Median housing value from US census data was used to measure neighborhood socioeconomic status. Cases of hypertension were identified through postal questionnaires mailed in 1997, 1999, and 2001. Clustered survival regression models were used to estimate incidence rate ratios. RESULTS During 180294 person-years of observation, 3780 cases of hypertension were reported. A significant inverse, graded association was found between median housing value and hypertension. The incidence rate ratio for women living in low median housing value neighborhoods relative to high was 1.29 (95% confidence interval=1.14, 1.45) after adjustment for individual risk factors. The association was evident even at higher individual levels of income and education. CONCLUSIONS Median housing value is inversely associated with hypertension in Black women, independent of individual risk factors. Lowering hypertension risk in Black women will require a greater understanding of the underlying social inequalities that adversely affect health.

African Ancestry and Genetic Risk for Uterine Leiomyomata

PURPOSE The authors compared approaches to participants and methods of collecting buccal cell samples by mail in the Black Womens Health Study, a follow-up study of geographically dispersed African-American women. Outcomes of interest were within group participation rates, yield of DNA, and PCR success. METHODS Six hundred fifty six participants were randomized to four groups: Groups 1 and 2 used the cheek swab method and Groups 3 and 4 used the mouthwash swish method. Groups 1 and 3 were mailed collection kits together with consent forms, whereas Groups 2 and 4 were mailed a kit only after returning a signed consent. RESULTS Participation rates were similar regardless of the method used for sample collection or mailing of the kits: samples were returned by 40% of Group 1, 37% of Group 2, 36% of Group 3, and 35% of Group 4. The median DNA yield was 3693 ng/sample for the swab method and 10,077 ng/sample for the mouthwash swish method (p<0.001). PCR analyses were successful in 98% of mouthwash samples and 94% of swab samples. CONCLUSION Because of its higher yield of DNA, the mouthwash swish method is preferable for collection of buccal cell samples by mail.

Polymorphisms in the TOX3/LOC643714 Locus and Risk of Breast Cancer in African-American Women

BACKGROUND Sarcoidosis is a systemic granulomatous disorder of unknown cause that occurs among men and women of all races. In the United States, black women are most frequently and most severely affected. There have been few epidemiologic studies of sarcoidosis focusing on black women. METHODS In this article, we present data on incidence, prevalence, and clinical characteristics of sarcoidosis among participants in the Black Womens Health Study, a cohort study of 59,000 black women from across the United States. Data on incident disease and potential risk factors are obtained through biennial questionnaires. Follow-up has been > 80% through six completed cycles. RESULTS There were 685 prevalent cases of sarcoidosis at baseline in 1995 and 435 incident cases reported during 611,585 person-years of follow-up through 2007, for an average annual incidence rate of 71/100,000 and a current prevalence of 2.0%. The sarcoid diagnosis was confirmed in 96% of self-reported cases for whom medical records or physician checklists were obtained. The most frequently affected site was the lung. Most patients also had extrapulmonary involvement, with the most common sites being lymph nodes, skin, and eyes. Prednisone had the highest prevalence of use, followed by inhaled corticosteroids. CONCLUSIONS This study confirms previous reports of high incidence and prevalence of sarcoidosis among black women, as well as the extent of extrapulmonary disease, frequent need for steroid therapy, and comorbid conditions in this population. The prospective identification of sarcoidosis cases from a defined population will enable a valid assessment of risk factors for incident disease as follow-up continues.

PERCEIVED RACIAL DISCRIMINATION AND RISK OF UTERINE LEIOMYOMATA

Rates of uterine leiomyomata (UL) are 2-3 times higher in African Americans than in European Americans. It is unclear whether inherited factors explain the ethnic disparity. To investigate the presence of risk alleles for UL that are highly differentiated in frequency between African Americans and European Americans, the authors conducted an admixture-based genome-wide scan of 2,453 UL cases confirmed by ultrasound or surgery in the Black Womens Health Study (1997-2009), a national prospective cohort study. Controls (n = 2,102) were women who did not report a UL diagnosis through 2009. Mean percentage of European ancestry was significantly lower among cases (20.00%) than among controls (21.63%; age-adjusted mean difference = -1.76%, 95% confidence interval: -2.40, -1.12; P < 0.0001), and the association was stronger in younger cases. Admixture analyses showed suggestive evidence of association at chromosomes 2, 4, and 10. The authors also genotyped a dense set of tag single nucleotide polymorphisms at different loci associated with UL in Japanese women but failed to replicate the associations. This suggests that genetic variation for UL differs in populations with and without African ancestry. The admixture findings further indicate that no single highly differentiated locus is responsible for the ethnic disparity in UL, raising the possibility that multiple variants jointly contribute to the higher incidence of UL in African Americans.

Hair Relaxer Use and Risk of Uterine Leiomyomata in African-American Women

Background: The rs3803662 single nucleotide polymorphism (SNP) in the TOX3/LOC643714 region was identified as a breast cancer susceptibility genetic variant in recent genome-wide association studies of women of European ancestry and has been replicated in other populations of European ancestry. The position of the causal variant tagged by the rs3803662 marker is still unknown. In fact, because the rs3803662 polymorphism is located between the TOX3 and the LOC643714 loci, it is unclear which gene is the one causally related to the risk of breast cancer. Because linkage disequilibrium blocks are smaller in populations of African ancestry, fine-mapping in African ancestry samples might be an effective approach to narrowing the position of the causal variant(s) in the TOX3/LOC643714 locus. Methods: We evaluated a total of 60 tagging SNPs throughout the TOX3/LOC643714 region in a nested case-control study of breast cancer within the Black Womens Health Study, which included 906 cases and 1,111 controls. Results: No significant association was found for the rs3803662 SNP. However, four other SNPs (rs3104746, rs3112562, rs3104793, and rs8046994), all of them located in the LOC643714 gene, were associated with risk of breast cancer. The strongest association was observed for rs3104746: each copy of the A-rs3104746 allele was associated with a 23% higher risk of breast cancer (odds ratios, 1.23; 95% confidence intervals, 1.05-1.44; P = 0.009). Conclusions: Our results confirm the association observed in genome-wide association studies of European ancestry populations. Impact: The results narrow the locus to a smaller linkage disequilibrium block in the LOC643714 gene. Cancer Epidemiol Biomarkers Prev; 19(5); 1320–7. ©2010 AACR.