Cancer incidence in New York State acquired immunodeficiency syndrome patients.

To identify cancers that occur at higher rates in acquired immunodeficiency syndrome (AIDS) patients, the cancer experience of New York State (NYS) AIDS patients aged 15-69 years who were diagnosed between 1981 and 1994 was compared with that of the NYS general population. Sex and HIV risk group-specific standardized incidence ratios (SIRs), post-AIDS relative risks, and trends of relative risks were calculated to determine cancer risk. Among non-AIDS-related cancers, elevated SIRs were found for Hodgkin's disease (male, 8.0; female, 6.4; heterosexually infected males, 31.3); cancer of the rectum, rectosigmoid, and anus (male, 3.3; female, 3.0); trachea, bronchus, and lung (male, 3.3; female, 7.5); and brain and central nervous system (male, 3.1; female, 3.4; heterosexually infected females, 23.8) cancers. Moreover, significant trends of increasing relative risks from the pre-AIDS to the post-AIDS period were found for cancers of the rectum, rectosigmoid, and anus; trachea, bronchus, and lung; skin; and connective tissues (all sites, p < 0.05) among males. For AIDS-related cancers in women, invasive cervical cancer had an overall SIR of 9.1 (95% confidence interval: 6.9, 10.8) and a post-AIDS relative risk of 6.5 (95% confidence interval: 4.1, 9.7). This population-based registry linkage analysis evaluates cancer risk in AIDS patients by sex and risk factors and adds evidence that HIV-associated immunosuppression increases the risks of specific types of cancer.

Risk of cancer among women with AIDS in New York City.

To evaluate the risk of cancer among women with AIDS in New York City (NYC), we compared the cancer experience of AIDS-infected women in NYC with that of the general population of women in NYC by matching the population-based New York State Cancer Registry with the New York City AIDS Registry. A probabilistic algorithm was used to match names, birth dates, and, where available, Social Security numbers between 15,146 women with AIDS and 232,902 women with cancer. Standardized incidence ratios (SIR) were calculated as the ratio of observed to expected cancer cases in the population of NYC women matched for age, race, and calendar period of cancer diagnosis. Period-specific relative risks (RR) of cancer prevalence prior to AIDS, and incidence at or after AIDS were calculated to determine which cancers increased in proximity to an AIDS diagnosis, a surrogate marker of increasing immunodeficiency. Analysis was limited to women between the ages of 15 to 69 who were diagnosed with AIDS between 1981 and 1994. Among 15,146 women diagnosed with AIDS, we found 1,194 matches with the Cancer Registry. For cancers included in the 1993 AIDS case definition, the SIR was 178.49 for Kaposi's sarcoma, 48.97 for non-Hodgkin's lymphoma, and 9.20 for invasive cervical cancer. The overall SIR for all non-AIDS-defining cancers was 2.20. Among non-AIDS-defining cancers, elevated SIRs were found for cancers of the lung (7.95), esophagus (7.69), multiple myeloma (7.37), oral cavity and pharynx (6.55), Hodgkin's disease (5.65), leukemias (4.52), and rectal/anal cancers (3.23). Statistically significant increases in period-specific risks were found for all non-AIDS-defining cancers combined, but not for individual cancers. Dual screening by two registries and unknown behavioral factors complicate the ascertainment of cancer risk. Our results show significantly elevated risks for several non-AIDS-defining cancers; these results are consistent with other studies of cancers among persons with AIDS. Extension of the time period of analysis is required to test for the effects of new anti-viral treatments and their association with cancer development among HIV-infected women.

Effect of HIV/AIDS versus other causes of death on premature mortality in New York City, 1983-1994.

This study examined years of potential life lost (YPLL) before age 65 years to assess the relative impact of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) versus other leading causes of death on premature mortality in New York City, New York, between 1983 and 1994. Most causes of death showed substantial year-to-year variation in YPLL, with the exception of HIV/AIDS. The YPLL attributed to HIV/AIDS increased monotonically from 11,866 in 1983 to 167,317 in 1994, a nearly 15-fold increase. The rank order of the relative contribution of HIV/AIDS to total YPLL changed from the eighth leading cause of death to the leading cause. YPLL from heart disease, which ranked second in 1983, declined to fourth in 1994, homicide was unchanged, and chronic liver disease declined from fifth to ninth rank. The annual YPLL attributed to malignant neoplasms was similar to that for heart disease, but peaked in 1984, and the reduction over the subsequent decade was about 13%. Total YPLL was 78% greater among males than among females in 1983 and was nearly twice as high in 1994. Premature mortality decreased steadily for non-Hispanic whites, from 150,967 to 135,027 years for the years 1983-1994, while increasing 20% among blacks (from 179,176 to 215,826 years) and 48% among Hispanics (from 89,869 to 132,869 years). Among blacks and Hispanics, homicide contributed more years of YPLL than did either heart disease or malignant neoplasms in every year of observation. The HIV/AIDS epidemic and mortality associated with violence have become important public health challenges to the health and well-being of New Yorkers.

Evidence of an increasing AIDS burden in rural America.

As the AIDS epidemic has matured in the United States, the characteristics of affected populations have shifted from a predominantly white homosexual/bisexual population to one now including increasingly more minorities, injecting drug users and women. Concomitant with the changing nature of persons diagnosed with AIDS there has been an increasing proportion of AIDS cases diagnosed in non-metropolitan areas. Both AIDS incidence and mortality data suggest a possible shift in AIDS from urban to rural areas, and from coastal to interior parts of the country. Migration of persons with AIDS may be contributing to this shift. National strategies for prevention and treatment of AIDS should consider taking into account the geographic behavior of this epidemic. The analysis addresses this issue by summarizing current knowledge regarding the spread of AIDS in rural areas, describing the urban-rural migration patterns from a major U.S. urban epicenter and presenting new NYC data on migration of people with AIDS and previously unpublished AIDS mortality data by state.

Urban mortality--race or place?

Several concomitant trends have occurred in American society in the 20th century. First, life expectancy has improved overall, and the gap between blacks and whites has narrowed. Second, as the nature of the economy has changed from rural agrarian to urban postindustrial, there have been fundamental changes in population residential patterns, with most Americans now living in metropolitan areas. Within metropolitan areas, blacks have become concentrated in poor inner cities as whites have moved to the more affluent suburbs. Black mortality rates are higher in big cities than elsewhere, and appear to be directly related to the proportion of blacks in those cities. Black-white mortality ratios, however, are lower in cities of medium size than in either very large or small cities. At the national level age-adjusted mortality ratios between blacks and whites are associated with different causes of death; but only limited cause-specific mortality data are available for large cities. Understanding and ameliorating social conditions that lead to elevated black mortality in U.S. cities will require more information at the municipal level than is currently available.

The changing AIDS epidemic in New York City: a descriptive birth cohort analysis of AIDS incidence and age at diagnosis.

OBJECTIVE: To describe and quantify changing AIDS incidence trends in New York City. METHODS: Data on 44,400 AIDS cases diagnosed and reported between 1981 and 1992 were analyzed among demographic and HIV transmission categories. Data were grouped into 10-year birth cohorts by sex, race/ethnicity, and mode of HIV transmission. AIDS incidence and rates of change, as well as changes in median age at diagnosis, were analyzed for persons born between 1920 and 1969. RESULTS: Declining AIDS incidence between 1989 and 1992 was only observed among white men who have sex with men (MSM) born prior to 1960 and among minority MSM born prior to 1940. Between 1989 and 1992 the highest rate of increase in AIDS incidence was observed among female injecting drug users (IDU) and persons born after 1960. Median age at diagnosis increased during the study period by 1 year among white MSM, by 2 years among minority MSM, by 7 and 6 years among male and female IDU, respectively, and by 5 years among women infected through heterosexual contact. CONCLUSIONS: These findings suggest that early HIV infection dynamics of the AIDS epidemic were differentially related to age, sex, and transmission category, which resulted in the diffusion of infection from older to younger cohorts and from men to women. The continuing increase in AIDS incidence among the 1960s cohort suggests that the future growth of the epidemic will be dependent upon infection patterns of younger birth cohorts.

Trends in the AIDS epidemic among men who reported sex with men in New York City: 1981-1993.

New York City is a major urban epicenter of the AIDS epidemic in the United States, and has reported nearly one fifth of the nation's cases. This paper chronicles trends in the AIDS epidemic among men who have sex with men (MSM) from 1981 through 1993 in New York City. Annual AIDS incidence and cumulative deaths are described, results of survival analysis by race/ethnicity for three time periods are reported, and the effects of the epidemic on premature mortality are shown from the beginning of the epidemic through 1993. Among 25,812 cases reported in MSM, 52% were white, 25% were black and 21% were Hispanic. AIDS incidence among whites has been declining since 1987 and is continuing to increase among minorities. Survival has been improving over time among all groups analyzed, but a persistent differential in survival between different race and ethnic groups is found, with whites surviving longer than minorities. Overall, nearly one half a million person years of life before age 65 were lost among MSM between 1981 and 1993. A rapid increase in AIDS cases among men born 1970-79 who were diagnosed after 1988 suggests a new wave of the epidemic may be occurring, and continued efforts in AIDS education and prevention among MSM entering the age of sexual activity is required.

Trends in survival among persons with acquired immunodeficiency syndrome in New York City. The experience of the first decade of the epidemic.

This study examined survival trends among the 23,324 cases of acquired immunodeficiency syndrome (AIDS) meeting the Centers for Disease Control (CDC) definition that were diagnosed and reported to the New York City Department of Health from the beginning of the epidemic in 1980 through June 1989. The survival patterns of 20,760 individuals who survived for at least 1 calendar month beyond diagnosis were analyzed; all survival analyses were truncated at December 1, 1990, 17 months after the last diagnosis. Persons who died during the same month in which they were diagnosed ("zero" survivors) were excluded. Cases were examined by race/ethnicity, sex, age at diagnosis, calendar period of diagnosis, transmission category, CDC AIDS case definition (prior to and after the 1987 change in the AIDS case definition), and nature of diagnosis. Results of two- and three-way categorical analysis and logistic regression analysis are reported. Overall median survival time was 13.7 months (14.0 for males and 12.0 for females). Survival was better for whites than for blacks and Hispanics and was better for men who had sex with men than for injecting drug users. Each of the seven demographic and risk behavior factors was independently associated with survival. Trends in survival during three time periods indicated that survival is improving among all groups examined.

Insight into the infection dynamics of the AIDS epidemic: a birth cohort analysis of New York City AIDS mortality.

The authors analyzed the secular trends of New York City acquired immunodeficiency syndrome (AIDS) mortality from 1980 through the first quarter of 1991 using birth cohort techniques to provide insight into reasons for temporal changes in growth of the epidemic. By disaggregating AIDS mortality data into composite birth cohorts, the authors determined that the slowing in the growth of the epidemic is a result of a leveling or decline in AIDS deaths in male birth cohorts born before 1950 and a continued growth in younger male and all female birth cohorts. This phenomenon is believed to largely reflect earlier human immunodeficiency virus type 1 (HIV-1) infection patterns associated with age-related risk behaviors; however, to some lesser extent, it could also reflect age-related host factors or therapies that may influence the time from HIV-1 infection to death. The findings support the hypothesis that the early infection dynamics of the epidemic were differentially related to age and sex, which resulted in a diffusion of infection from older to younger cohorts and from males to females over time. The future growth of the epidemic will largely depend upon the infection patterns of younger birth cohorts. This method of analyzing AIDS incidence or mortality data may contribute to a better understanding of earlier patterns of HIV-1 infection within a defined population, which will be useful for targeting prevention efforts and improving AIDS forecasting methods.

Causes of death among persons reported with AIDS.

OBJECTIVES: This study describes causes of death in persons with acquired immunodeficiency syndrome (AIDS) and assesses the completeness of reporting of human immunodeficiency virus (HIV) infection or AIDS on death certificates of persons with AIDS. METHODS: AIDS case reports were linked with death certificates in 11 local/state health departments; underlying and associated causes of death were available for 32,513 persons with AIDS who died. RESULTS: HIV/AIDS was designated as the underlying cause of death for 46% of persons with AIDS who died between 1983 and 1986 and 81% of persons with AIDS who died since 1987 (the year specific coding procedures were implemented for HIV/AIDS). Most other underlying causes of death were conditions within the AIDS case definition (notably Pneumocystis carinii pneumonia), pneumonia, infections outside the AIDS case definition, and drug abuse. Unintentional injuries, suicide, and homicide were less common. HIV/AIDS was listed as underlying or associated on 88% of death certificates from 1987 to 1989; reporting varied primarily by HIV exposure category and time between diagnosis and death. CONCLUSIONS: Physicians and other health care professionals should realize their critical role in accurately documenting HIV-related mortality on death certificates. Such data can ultimately influence the allocation of health care resources for HIV-infected individuals.

Reduction of phytic acid in soybean products improves zinc bioavailability in rats.

The inhibitory effect of phytic acid in soybean products on zinc bioavailability was evaluated in two experiments in rats. In Experiment 1, soybean flours containing different natural phytic acid levels produced by sand culture techniques that limited phosphorus during growth of the soybean plants were formulated into diets. The rats fed a higher phytic acid level diet had lower food intake, depressed weight gain, and lower tibia zinc gain (P < 0.05). A negative, linear relationship between tibia zinc gain and dietary phytic acid level was found. In Experiment 2, two commercially produced soybean isolates containing either normal phytic acid level or a reduced level were formulated into diets. Slope ratio analysis revealed that relative zinc bioavailability from phytic acid-containing soybean isolate-based diets was significantly reduced (P < 0.05) compared with control diets. Reduced phytic acid soybean isolate-containing diets resulted in a significant increase of zinc bioavailability compared with normal phytic acid diets (P < 0.01). These results coupled with other reports indicate that phytic acid is the primary inhibitory factor in soybean products that results in reduced zinc bioavailability and that phytate reduction in soybean protein increases zinc bioavailability.

Acquired immunodeficiency syndrome prevention. Knowledge, attitudes, and practices of primary care physicians.

We conducted a telephone survey of a probability sample of 473 internists, family practitioners, general practitioners, and obstetrician-gynecologists in New York City (NY) in 1988 to assess their knowledge, attitudes, and practices with respect to the prevention of the acquired immunodeficiency syndrome (AIDS). Although 71% of the physicians had cared for a patient with AIDS and 90% had been involved in ordering the human immunodeficiency virus antibody test, only about a third of them took appropriate sexual histories of new patients and only about a quarter (28%) counseled new patients about reducing the risk of contracting AIDS. Multivariate analysis revealed that physician knowledge about AIDS prevention was associated with younger age, more positive attitude toward homosexual males and intravenous drug users, confidence that counseling would result in behavioral change among patients, and specialty other than obstetrics-gynecology. Results indicate a need for increased training and education of primary care physicians about AIDS prevention.

A method for estimating HIV transmission rates among female sex partners of male intravenous drug users.

There are few data available on the dynamics of heterosexual human immunodeficiency virus (HIV) transmission among women whose only risk factor is sexual contact with intravenous drug-using males. Unlike models which rely on unconfirmed estimates regarding sexual partner selectivity and contact rates between infected and uninfected populations, data from a survey conducted between November 1988 and February 1989 of 1,842 women in New York City provide empirical values for these variables which the authors use in a straightforward estimation model. The authors estimate that the number of new infections among women aged 15-44 years in New York City during 1988 was between 876 and 1,668 and that the number of women already infected through heterosexual contact with male intravenous drug users is between 5,390 and 10,230 among the 1,844,285 women in this age group. These conclusions indicate that male-to-female transmission in New York City is of substantial magnitude and that prevention efforts among male intravenous drug users and their female sexual partners must be appropriately directed.

Soy products and the human diet.

This review focuses upon the nutritional significance of soy products in the human diet. The impact of the consumption of soy foods on a range of diet and health issues are discussed, including protein quality and growth promoting effects of soy protein, allergies in children, hypocholesterolemic effects of soy protein and soy fiber, effects of soy products upon glucose tolerance, and the bioavailability of zinc and iron from soy foods. Recent research reports involving humans and relevant animal studies are reviewed.