COVID-19 pandemic-associated changes in overall emergency department visits by age group, race, and ethnicity - United States, January 2019-April 2022.

BACKGROUND: ED data are an important source of surveillance data for monitoring many conditions of public health concern and are especially useful in describing trends related to new, or unusual public health events. The COVID-19 pandemic led to significant changes in emergency care seeking behavior. We described the trends in all-cause emergency department (ED) visit volumes by race, ethnicity, and age using ED data from the National Syndromic Surveillance Program (NSSP) during December 30, 2018-April 2, 2022. METHODS: We described total and race, ethnicity, and age group-specific ED visit volumes during the COVID-19 pandemic by comparing quarterly visit volumes during the pandemic period to the relevant quarters in 2019. We quantified the variability of ED visits volumes by calculating the coefficient of variation in mean weekly ED visit volume for each quarter during Q1 2019-Q1 2022. RESULTS: Overall ED visits dropped by 32% during Q2 2020, when the COVID-19 pandemic began, then rebounded to 2019 baseline by Q2 2021. ED visits for all race, ethnicity, and age groups similarly dropped in Q2 2020 and adults of all race and ethnicity groups rebounded to at or above pre-pandemic levels while children remained at or below the pre-pandemic baseline except during Q3 2021. There was larger variation in mean weekly ED visits compared to the respective quarter in 2019 for 6 of 9 quarters during Q1 2020-Q1 2022. CONCLUSIONS: ED utilization fluctuated considerably during the COVID-19 pandemic. Overall ED visits returned to within 5% of 2019 baseline during Q2 2021, however, ED visits among children did not return to the 2019 baseline until Q3 2021, then again dropped below the 2019 baseline in Q4 2021. Trends in ED visit volumes were similar among race and ethnicity groups but differed by age group. Monitoring ED data stratified by race, ethnicity and age can help understand healthcare utilization trends and overall burden on the healthcare system as well as facilitate rapid identification and response to public health threats that may disproportionately affect certain populations.

Mortality Risk Among Patients Hospitalized Primarily for COVID-19 During the Omicron and Delta Variant Pandemic Periods - United States, April 2020-June 2022.

The risk for COVID-19-associated mortality increases with age, disability, and underlying medical conditions (1). Early in the emergence of the Omicron variant of SARS-CoV-2, the virus that causes COVID-19, mortality among hospitalized COVID-19 patients was lower than that during previous pandemic peaks (2-5), and some health authorities reported that a substantial proportion of COVID-19 hospitalizations were not primarily for COVID-19-related illness,* which might account for the lower mortality among hospitalized patients. Using a large hospital administrative database, CDC assessed in-hospital mortality risk overall and by demographic and clinical characteristics during the Delta (July-October 2021), early Omicron (January-March 2022), and later Omicron (April-June 2022) variant periods† among patients hospitalized primarily for COVID-19. Model-estimated adjusted mortality risk differences (aMRDs) (measures of absolute risk) and adjusted mortality risk ratios (aMRRs) (measures of relative risk) for in-hospital death were calculated comparing the early and later Omicron periods with the Delta period. Crude mortality risk (cMR) (deaths per 100 patients hospitalized primarily for COVID-19) was lower during the early Omicron (13.1) and later Omicron (4.9) periods than during the Delta (15.1) period (p<0.001). Adjusted mortality risk was lower during the Omicron periods than during the Delta period for patients aged ≥18 years, males and females, all racial and ethnic groups, persons with and without disabilities, and those with one or more underlying medical conditions, as indicated by significant aMRDs and aMRRs (p<0.05). During the later Omicron period, 81.9% of in-hospital deaths occurred among adults aged ≥65 years and 73.4% occurred among persons with three or more underlying medical conditions. Vaccination, early treatment, and appropriate nonpharmaceutical interventions remain important public health priorities for preventing COVID-19 deaths, especially among persons most at risk.

Cardiac Complications After SARS-CoV-2 Infection and mRNA COVID-19 Vaccination - PCORnet, United States, January 2021-January 2022.

Cardiac complications, particularly myocarditis and pericarditis, have been associated with SARS-CoV-2 (the virus that causes COVID-19) infection (1-3) and mRNA COVID-19 vaccination (2-5). Multisystem inflammatory syndrome (MIS) is a rare but serious complication of SARS-CoV-2 infection with frequent cardiac involvement (6). Using electronic health record (EHR) data from 40 U.S. health care systems during January 1, 2021-January 31, 2022, investigators calculated incidences of cardiac outcomes (myocarditis; myocarditis or pericarditis; and myocarditis, pericarditis, or MIS) among persons aged ≥5 years who had SARS-CoV-2 infection, stratified by sex (male or female) and age group (5-11, 12-17, 18-29, and ≥30 years). Incidences of myocarditis and myocarditis or pericarditis were calculated after first, second, unspecified, or any (first, second, or unspecified) dose of mRNA COVID-19 (BNT162b2 [Pfizer-BioNTech] or mRNA-1273 [Moderna]) vaccines, stratified by sex and age group. Risk ratios (RR) were calculated to compare risk for cardiac outcomes after SARS-CoV-2 infection to that after mRNA COVID-19 vaccination. The incidence of cardiac outcomes after mRNA COVID-19 vaccination was highest for males aged 12-17 years after the second vaccine dose; however, within this demographic group, the risk for cardiac outcomes was 1.8-5.6 times as high after SARS-CoV-2 infection than after the second vaccine dose. The risk for cardiac outcomes was likewise significantly higher after SARS-CoV-2 infection than after first, second, or unspecified dose of mRNA COVID-19 vaccination for all other groups by sex and age (RR 2.2-115.2). These findings support continued use of mRNA COVID-19 vaccines among all eligible persons aged ≥5 years.

Association of COVID-19 Vaccination With Symptomatic SARS-CoV-2 Infection by Time Since Vaccination and Delta Variant Predominance.

IMPORTANCE: Monitoring COVID-19 vaccine performance over time since vaccination and against emerging variants informs control measures and vaccine policies. OBJECTIVE: To estimate the associations between symptomatic SARS-CoV-2 infection and receipt of BNT162b2, mRNA-1273, and Ad26.COV2.S by day since vaccination before and during Delta variant predominance (pre-Delta period: March 13-May 29, 2021; Delta period: July 18-October 17, 2021). DESIGN, SETTING, AND PARTICIPANTS: Test-negative, case-control design with data from 6884 US COVID-19 testing sites in the pharmacy-based Increasing Community Access to Testing platform. This study included 1 634 271 laboratory-based SARS-CoV-2 nucleic acid amplification tests (NAATs) from adults 20 years and older and 180 112 NAATs from adolescents 12 to 19 years old with COVID-19-like illness from March 13 to October 17, 2021. EXPOSURES: COVID-19 vaccination (1 Ad26.COV2.S dose or 2 mRNA doses) 14 or more days prior. MAIN OUTCOMES AND MEASURES: Association between symptomatic infection and prior vaccination measured using the odds ratio (OR) from spline-based multivariable logistic regression. RESULTS: The analysis included 390 762 test-positive cases (21.5%) and 1 423 621 test-negative controls (78.5%) (59.9% were 20-44 years old; 9.9% were 12-19 years old; 58.9% were female; 71.8% were White). Among adults 20 years and older, the BNT162b2 mean OR for days 14 to 60 after a second dose (initial OR) was lower during the pre-Delta period (0.10 [95% CI, 0.09-0.11]) than during the Delta period (0.16 [95% CI, 0.16-0.17]) and increased with time since vaccination (per-month change in OR, pre-Delta: 0.04 [95% CI, 0.02-0.05]; Delta: 0.03 [95% CI, 0.02-0.03]). The initial mRNA-1273 OR was 0.05 (95% CI, 0.04-0.05) during the pre-Delta period, 0.10 (95% CI, 0.10-0.11) during the Delta period, and increased with time (per-month change in OR, pre-Delta: 0.02 [95% CI, 0.005-0.03]; Delta: 0.03 [95% CI, 0.03-0.04]). The Ad26.COV2.S initial OR was 0.42 (95% CI, 0.37-0.47) during the pre-Delta period and 0.62 (95% CI, 0.58-0.65) during the Delta period and did not significantly increase with time since vaccination. Among adolescents, the BNT162b2 initial OR during the Delta period was 0.06 (95% CI, 0.05-0.06) among 12- to 15-year-olds, increasing by 0.02 (95% CI, 0.01-0.03) per month, and 0.10 (95% CI, 0.09-0.11) among 16- to 19-year-olds, increasing by 0.04 (95% CI, 0.03-0.06) per month. CONCLUSIONS AND RELEVANCE: Among adults, the OR for the association between symptomatic SARS-CoV-2 infection and COVID-19 vaccination (as an estimate of vaccine effectiveness) was higher during Delta variant predominance, suggesting lower protection. For mRNA vaccination, the steady increase in OR by month since vaccination was consistent with attenuation of estimated effectiveness over time; attenuation related to time was greater than that related to variant.

Completeness of reporting of race and ethnicity data in the nationally notifiable diseases surveillance system, United States, 2006-2010.

CONTEXT: During 1994-1997, approximately 70% and 60% of the cases of conditions reported to the National Notifiable Diseases Surveillance System included persons of known race and ethnicity, respectively. A major goal of the Healthy People 2020 initiative is to eliminate health disparities. OBJECTIVE: To describe trends in the completeness of race and ethnicity in case reports of the National Notifiable Diseases Surveillance System during 2006-2010. METHODS: The National Notifiable Diseases Surveillance System is a public health surveillance system that aggregates case reports of infectious diseases and conditions that are designated nationally notifiable and are collected by US states and territories. The Centers for Disease Control and Prevention (Atlanta, Georgia) maintains this surveillance system in collaboration with the Council of State and Territorial Epidemiologists. We used Cochran-Armitage Trend Test (SAS, version 9.2) to test the hypothesis that the percentage of case reports with the completeness of race and ethnicity data increased or decreased linearly during 2006-2010. MAIN OUTCOME MEASURE: Completeness of race and ethnicity variables. RESULTS: The 32 conditions reviewed included 1 030 804 case records. Seventy percent of records included a known value for race, and 49% of records included ethnicity during 2006-2010. During 2006-2010, race was known in 70% or more of records in 24 of 32 conditions and in 23 of 51 jurisdictions. During 2006-2010, the systemwide reporting of race remained at the same level of completeness (70%) but the reporting of ethnicity increased slightly from 48% in 2006 to 53% in 2010. In comparison with race, the proportions of records coded to ethnicity were less among all conditions. CONCLUSIONS: Significant change has occurred in the completeness of reporting of ethnicity but not race during 2006-2010. However, the reporting of ethnicity still lags substantially behind the reporting of race. Jurisdictions that identify conditions with lower rates of completeness of race and ethnicity can assess the net benefits of efforts to improve the completeness of race and ethnicity data.

Prostate cancer deaths and incident cases among American Indian/Alaska Native men, 1999-2009.

OBJECTIVES: We linked databases to improve identification of American Indians/Alaska Natives (AI/ANs) in determining prostate cancer death and incidence rates. METHODS: We linked prostate cancer mortality and incidence data with Indian Health Service (IHS) patient records; analyses focused on residents of IHS Contract Health Service Delivery Area (CHSDA) counties. We calculated age-adjusted incidence and death rates for AI/AN and White men for 1999 to 2009; men of Hispanic origin were excluded. RESULTS: Prostate cancer death rates were higher for AI/AN men than for White men. Death rates declined for White men (-3.0% per year) but not for AI/AN men. AI/AN men had lower prostate cancer incidence rates than White men. Incidence rates declined among Whites (-2.2% per year) and AI/ANs (-1.9% per year). CONCLUSIONS: AI/AN men had higher prostate cancer death rates and lower prostate cancer incidence rates than White men. Disparities in accessing health care could contribute to mortality differences, and incidence differences could be related to lower prostate-specific antigen testing rates among AI/AN men.

Descriptive epidemiology of malignant and nonmalignant primary spinal cord, spinal meninges, and cauda equina tumors, United States, 2004-2007.

BACKGROUND: Primary tumors of the spinal cord, spinal meninges, and cauda equina are relatively rare, and a paucity of population-based data exist on tumors in these sites. This study intends to augment the current literature by examining incidence of these tumors on a national level. METHODS: Data from central cancer registries in the National Program of Cancer Registries (NPCR) and Surveillance, Epidemiology, and End Results (SEER) programs for 2004-2007 (covering 99.2% of US population) and 1999-2007 (covering 89.4% of US population) were analyzed. Analyses for diagnosis years 2004-2007 included cases of malignant and nonmalignant primary spinal cord, spinal meninges, and cauda equina tumors. Descriptive statistics including estimated age-adjusted incidence rates standardized to the 2000 US standard population were conducted for both malignant and nonmalignant primary spinal tumors from cases diagnosed during 2004-2007 as well as trend analyses on malignant cases of primary spinal tumors (n = 5103) for cases diagnosed during 1999-2007 using SEER Stat 6.6.2 software. RESULTS: There were 2576 cases of malignant primary spinal tumors and 9136 cases of nonmalignant primary spinal tumors in 2004-2007. The incidence of malignant and nonmalignant primary spinal tumors combined differed by age, sex, race, and ethnicity. Results of trend analyses indicated that malignant primary spinal tumors have been stable throughout the 1999-2007 period. CONCLUSIONS: This large population-based study adds new insights into the descriptive epidemiology of primary spinal cord, spinal meninges, and cauda equina tumors by providing in-depth analyses of the incidence of these tumors on a national level.

Association of cutaneous melanoma incidence with area-based socioeconomic indicators-United States, 2004-2006.

BACKGROUND: Socioeconomic status (SES) has been associated with melanoma incidence and outcomes. Examination of the relationship between melanoma and SES at the national level in the United States is limited. Expanding knowledge of this association is needed to improve early detection and eliminate disparities. OBJECTIVE: We sought to provide a detailed description of cutaneous melanoma incidence and stage of disease in relationship to area-based socioeconomic measures including poverty level, education, income, and unemployment in the United States. METHODS: Invasive cutaneous melanoma data reported by 44 population-based central cancer registries for 2004 to 2006 were merged with county-level SES estimates from the US Census Bureau. Age-adjusted incidence rates were calculated by gender, race/ethnicity, poverty, education, income, unemployment, and metro/urban/rural status using software. Poisson multilevel mixed models were fitted, and incidence density ratios were calculated by stage for area-based SES measures, controlling for age, gender, and state random effects. RESULTS: Counties with lower poverty, higher education, higher income, and lower unemployment had higher age-adjusted melanoma incidence rates for both early and late stage. In multivariate models, SES effects persisted for early-stage but not late-stage melanoma incidence. LIMITATIONS: Individual-level measures of SES were unavailable, and estimates were based on county-level SES measures. CONCLUSION: Our findings show that melanoma incidence in the United States is associated with aggregate county-level measures of high SES. Analyses using finer-level SES measures, such as individual or census tract level, are needed to provide more precise estimates of these associations.

Association between cutaneous melanoma incidence rates among white US residents and county-level estimates of solar ultraviolet exposure.

BACKGROUND: Recent US studies have raised questions as to whether geographic differences in cutaneous melanoma incidence rates are associated with differences in solar ultraviolet (UV) exposure. OBJECTIVES: We sought to assess the association of solar UV exposure with melanoma incidence rates among US non-Hispanic whites. METHODS: We assessed the association between county-level estimates of average annual solar UV exposure for 1961 to 1990 and county-level melanoma incidence rates during 2004 to 2006. We used Poisson multilevel mixed models to calculate incidence density ratios by cancer stage at diagnosis while controlling for individuals' age and sex and for county-level estimates of solar UV exposure, socioeconomic status, and physician density. RESULTS: Age-adjusted rates of early- and late-stage melanoma were both significantly higher in high solar UV counties than in low solar UV counties. Rates of late-stage melanoma incidence were generally higher among men, but younger women had a higher rate of early-stage melanoma than their male counterparts. Adjusted rates of early-stage melanoma were significantly higher in high solar UV exposure counties among men aged 35 years or older and women aged 65 years or older. LIMITATIONS: The relationship between individual-level UV exposure and risk for melanoma was not evaluated. CONCLUSIONS: County-level solar UV exposure was associated with the incidence of early-stage melanoma among older US adults but not among younger US adults. Additional studies are needed to determine whether exposure to artificial sources of UV exposure or other factors might be mitigating the relationship between solar UV exposure and risk for melanoma.

Melanoma survival in the United States, 1992 to 2005.

BACKGROUND: Population-based data on melanoma survival are important for understanding the impact of demographic and clinical factors on prognosis. OBJECTIVE: We describe melanoma survival by age, sex, race/ethnicity, stage, depth, histology, and site. METHODS: Using Surveillance, Epidemiology, and End Results data, we calculated unadjusted cause-specific survival up to 10 years from diagnosis for 68,495 first primary cases of melanoma diagnosed from 1992 to 2005. Cox multivariate analysis was performed for 5-year survival. Data from 1992 to 2001 were divided into 3 time periods to compare stage distribution and differences in stage-specific 5-year survival over time. RESULTS: Melanomas that had metastasized (distant stage) or were thicker than 4.00 mm had a poor prognosis (5-year survival: 15.7% and 56.6%). The 5-year survival for men was 86.8% and for persons given the diagnosis at age 65 years or older was 83.2%, varying by stage at diagnosis. Scalp/neck melanoma had lower 5-year survival (82.6%) than other anatomic sites; unspecified/overlapping lesions had the least favorable prognosis (41.5%). Nodular and acral lentiginous melanomas had the poorest 5-year survival among histologic subtypes (69.4% and 81.2%, respectively). Survival differences by race/ethnicity were observed in the unadjusted survival, but nonsignificant in the multivariate analysis. Overall 5-year melanoma survival increased from 87.7% to 90.1% for melanomas diagnosed in 1992 through 1995 compared with 1999 through 2001, and this change was not clearly associated with a shift toward localized diagnosis. LIMITATIONS: Prognostic factors included in revised melanoma staging guidelines were not available for all study years and were not examined. CONCLUSIONS: Poorer survival from melanoma was observed among those given the diagnosis at late stage and older age. Improvements in survival over time have been minimal. Although newly available therapies may impact survival, prevention and early detection are relevant to melanoma-specific survival.

Explaining the decrease in U.S. deaths from coronary disease, 1980-2000.

BACKGROUND: Mortality from coronary heart disease in the United States has decreased substantially in recent decades. We conducted a study to determine how much of this decrease could be explained by the use of medical and surgical treatments as opposed to changes in cardiovascular risk factors. METHODS: We applied a previously validated statistical model, IMPACT, to data on the use and effectiveness of specific cardiac treatments and on changes in risk factors between 1980 and 2000 among U.S. adults 25 to 84 years old. The difference between the observed and expected number of deaths from coronary heart disease in 2000 was distributed among the treatments and risk factors included in the analyses. RESULTS: From 1980 through 2000, the age-adjusted death rate for coronary heart disease fell from 542.9 to 266.8 deaths per 100,000 population among men and from 263.3 to 134.4 deaths per 100,000 population among women, resulting in 341,745 fewer deaths from coronary heart disease in 2000. Approximately 47% of this decrease was attributed to treatments, including secondary preventive therapies after myocardial infarction or revascularization (11%), initial treatments for acute myocardial infarction or unstable angina (10%), treatments for heart failure (9%), revascularization for chronic angina (5%), and other therapies (12%). Approximately 44% was attributed to changes in risk factors, including reductions in total cholesterol (24%), systolic blood pressure (20%), smoking prevalence (12%), and physical inactivity (5%), although these reductions were partially offset by increases in the body-mass index and the prevalence of diabetes, which accounted for an increased number of deaths (8% and 10%, respectively). CONCLUSIONS: Approximately half the decline in U.S. deaths from coronary heart disease from 1980 through 2000 may be attributable to reductions in major risk factors and approximately half to evidence-based medical therapies.

Cognitive functioning in late life: the impact of moderate alcohol consumption.

PURPOSE: Sex differences in the association between moderate alcohol consumption and cognitive functioning were examined during 4 years. METHODS: Participants were 2716 US older adults 70 years and older (mean age, = 76.02 years) who were free of cognitive impairment from the Second Longitudinal Study of Aging (1994 to 2000). Multiple logistic regression models were used to predict cognitive functioning (adapted Telephone Interview for Cognitive Status) from average daily alcohol intake (no drink, one drink or less daily, and more than one drink daily) during 4 years after controlling for covariates. RESULTS: Sex differences in the association between alcohol consumption and cognitive functioning were found (p < 0.01). Older adults with alcohol consumption of one drink or less per day had a lower odds of low cognitive functioning compared with abstainers for women (adjusted odds ratio [AOR], 0.67; 95% confidence interval [CI], 0.55-0.83), but not men (AOR, 0.96; 95% CI, 0.69-1.34). CONCLUSIONS: For older adults with a level of cognitive functioning within normal ranges, moderate amounts of alcohol, an average of one drink or less daily, was protective for women, but not men. Caution should be used in suggesting moderate alcohol consumption to maintain cognitive functioning because of the risks of consuming alcohol.

Distribution of serum concentrations of alpha-tocopherol and gamma-tocopherol in the US population.

BACKGROUND: Although the population distribution of serum concentrations of alpha-tocopherol has been described in the United States, little is known about the distribution of gamma-tocopherol or the ratio of alpha-tocopherol to gamma-tocopherol. OBJECTIVE: Our aim was to describe the distribution of serum concentrations of alpha-tocopherol and gamma-tocopherol in a nationally representative sample of US adults. DESIGN: We reviewed data from 4087 adults aged >/=20 y who participated in the National Health and Nutrition Examination Survey (1999-2000). Concentrations of alpha-tocopherol and gamma-tocopherol were measured by using HPLC with ultraviolet-visible wavelength detection. RESULTS: The arithmetic mean (+/-SEM) of serum concentrations of alpha-tocopherol was 30.09 +/- 0.45 micromol/L, the median was 25.94 micromol/L, and the geometric mean (+/-SEM) was 27.39 +/- 0.38 micromol/L. The arithmetic mean of serum concentrations of gamma-tocopherol was 5.74 +/- 0.22 micromol/L, the median was 5.25 micromol/L, and the geometric mean was 4.79 +/- 0.18 micromol/L. The median ratio of alpha-tocopherol to total cholesterol was 4.93 micromol/mmol, that of gamma-tocopherol to total cholesterol was 1.03 micromol/mmol, and that of alpha-tocopherol to gamma-tocopherol was 4.53 micromol/mmol. Concentrations of alpha-tocopherol increased significantly (P for trend < 0.001) with age and were significantly (P = 0.015) lower in men than in women. African Americans and Mexican Americans had significantly (P < 0.001) lower concentrations of alpha-tocopherol than did whites. The median concentrations of gamma-tocopherol showed a trend with respect to age, did not differ significantly between men and women, and were slightly but nonsignificantly lower in white participants than in African American or Mexican American participants. CONCLUSION: Sociodemographic variations in serum concentrations of alpha-tocopherol and gamma-tocopherol exist among US adults.

Two approaches of coronary risk assessment--do they work?

The risk assessment method reported by the National Cholesterol Education Program, Adult Treatment Panel III, is used as a guide to define low-density lipoprotein cholesterol goals and cutpoints for intervention. Two approaches of this method are described by National Cholesterol Education Program, Adult Treatment Panel III and were used to compute coronary heart disease risk among participants in the National Health and Nutrition Examination Survey from 1999 to 2002. In conclusion, the low-density lipoprotein goals were not clear for a sizable proportion of participants, especially using the second approach, and may lead to less intensive intervention.

Aspirin use among U.S. adults: Behavioral Risk Factor Surveillance System.

BACKGROUND: The role of aspirin in prevention of cardiovascular disease (CVD) and cardiovascular complications among people with diabetes has been examined. A Healthy People 2010 objective calls for increasing the proportion of people with diabetes aged>or=40 years who take aspirin>or=15 times per month. METHODS: Data from 2003 Behavioral Risk Factor Surveillance System were used to examine (1) the prevalence of aspirin intake, (2) aspirin use among those with CVD, (3) aspirin use among those with diabetes, (4) current status with respect to Healthy People objective 5-16, and (5) changes in aspirin intake from 1999. RESULTS: Daily or every-other-day aspirin use was reported by 36.2% of participants in 2003. Aspirin intake among those with CVD and diabetes was 82.8% and 62.6%, respectively. The Healthy People 2010 objective of increasing the proportion of adults with diabetes aged>or=40 years who take aspirin to 30% was achieved. The prevalence of aspirin intake was higher in 2003 compared to 1999 among all participants, those with CVD, and those with diabetes (relative increase of about 20%, 12%, and 36%, respectively). Most participants (74%) reported cardiovascular reasons for aspirin use. Among those without CVD or diabetes, the prevalence of aspirin intake increased with the increasing number of CVD risk factors. CONCLUSIONS: Regular aspirin use increased over a 4-year period. Greater use of inexpensive and easily accessible interventions to prevent cardiovascular events is encouraging. Increased efforts to continue preventive uses of available treatment and reduction in risk by modifying other risk factors will help lower future disease burden.

The impact of cognitive functioning on mortality and the development of functional disability in older adults with diabetes: the second longitudinal study on aging.

BACKGROUND: For older adults without diabetes, cognitive functioning has been implicated as a predictor of death and functional disability for older adults and those with mild to severe cognitive impairment. However, little is known about the relationship between cognition functioning on mortality and the development of functional disability in late life for persons with diabetes. We examined the relative contribution of cognitive functioning to mortality and functional disability over a 2-year period in a sample of nationally representative older US adults with diabetes who were free from cognitive impairment through secondary data analyses of the Second Longitudinal Study of Aging (LSOA II). METHODS: Participants included 559 US adults (232 males and 327 females) >or= 70 years old who had diabetes and who were free from cognitive impairment were examined using an adapted Telephone Interview of Cognitive Status (TICS), Activities of Daily Living (ADL), and Instrumental Activities of Daily Living (IADL). RESULTS: Multivariate logistic regression was conducted to investigate the independent contribution of cognitive functioning to three mutually exclusive outcomes of death and two measures of functional disability status. The covariates included in the model were participants' sex, age, race, marital status, educational level, duration of diabetes, cardiovascular disease (CVD) status, and self-rated health. Persons with diabetes who had the lowest levels of cognitive functioning relative to the highest level of cognitive functioning had a greater odds of dying (AOR = 0.80, 95% CI = 0.67-0.96) or becoming disabled (AOR = 0.87, 95% CI = 0.78-0.97) compared to those people who were disability free. CONCLUSION: Older adults with diabetes and low normal levels of cognition, yet within normal ranges, were approximately 20% more likely to die and 13% more likely to become disabled than those with higher levels of cognitive functioning over a 2-year period. Brief screening measures of cognitive functioning could be used to identify older adults with diabetes who are at increased risk for mortality and functional disability, as well as those who may benefit from interventions to prevent or minimize further disablement and declines in cognitive functioning.

Brief communication: The prevalence of high intake of vitamin E from the use of supplements among U.S. adults.

BACKGROUND: People who consume at least 400 IU of vitamin E per day from supplements may be at slightly increased risk for premature mortality. OBJECTIVE: To estimate the percentage of U.S. adults age 20 years or older who consume at least 400 IU of vitamin E per day through the use of vitamins, minerals, or other dietary supplements. DESIGN: Cross-sectional analysis. SETTING: The 1999-2000 National Health and Nutrition Examination Survey. PATIENTS: Representative sample of the civilian, noninstitutionalized U.S. population. MEASUREMENTS: Participants answered questions about the use of vitamins, minerals, or other dietary supplements. RESULTS: Among 4609 adults, 11.3% (95% CI, 9.7% to 13.1%) consumed at least 400 IU of vitamin E per day from supplements. Such intake increased with age, was about equal for men and women, and was more common among white persons (14.1%; CI, 11.9% to 16.7%) than African-American (3.7% [CI, 2.6% to 5.2%]) or Mexican-American persons (3.9% [CI, 2.8% to 5.4%]). The median dietary intake of vitamin E was 8.8 IU per day. LIMITATIONS: Information about vitamin E intake was self-reported. CONCLUSIONS: The use of vitamin E supplements in dosages of at least 400 IU per day is common among U.S. adults.

The metabolic syndrome and concentrations of C-reactive protein among U.S. youth.

OBJECTIVE: Adults with the metabolic syndrome show biochemical evidence of low-grade inflammation. We sought to examine whether this is true among U.S. youth with the metabolic syndrome. RESEARCH DESIGN AND METHODS: We used data from 1,366 participants aged 12-17 years from the National Health and Nutrition Examination Survey 1999-2000. A modification of the definition of the metabolic syndrome proposed by the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults was used. C-reactive protein (CRP) was measured by latex-enhanced nephelometry. RESULTS: Mean and median concentrations of CRP were higher among participants who had the metabolic syndrome (mean 3.8 mg/l, geometric mean 1.8 mg/l) than among those who did not (mean 1.4 mg/l, geometric mean 0.4 mg/l). The percentage of participants with a concentration of CRP >3.0 mg/l was 38.4% among those with the metabolic syndrome and 10.3% among those without the syndrome (P = 0.007). Of the five components of the syndrome, only abdominal obesity was significantly and independently associated with log-transformed concentrations of CRP in multiple linear regression analysis. CONCLUSIONS: Our results show that a large percentage of children and adolescents with the metabolic syndrome have elevated concentrations of CRP. Whether the elevated concentrations of CRP among children and adolescents who have the metabolic syndrome predict future adverse health events remains to be determined.

Examining the coverage of influenza vaccination among people with cardiovascular disease in the United States.

BACKGROUND: People with chronic cardiovascular conditions are at increased risk of developing complications from relative common influenza infection. METHODS: We examined the coverage of influenza vaccination during the past 12 months among people with cardiovascular disease (CVD) using data from the National Health Interview Survey 2002. RESULTS: The coverage of influenza vaccination among people with CVD was observed to be less than optimum (32.7%) after adjusting for age. Among separate components studied, the coverage of influenza vaccination was highest among people with congestive heart failure (37.1%) and lowest among people with stroke (31.4%). Hypertension was the most commonly reported condition with influenza vaccination coverage of 32.6%. Only 22% of people with CVD aged <50 years reported receiving influenza vaccine in the past 12 months. For people in higher age groups with CVD, the coverage was 40.5% and 69.9% among people aged 50 to 64 years and > or =65 years, respectively. CONCLUSIONS: People with CVD, especially those <50 years of age, should be encouraged to receive influenza vaccination to prevent influenza-related cardiovascular complications.

Microalbuminuria and concentrations of antioxidants among US adults.

BACKGROUND: Microalbuminuria may increase the risk for cardiovascular disease. Increased oxidative stress, which may be important in the pathophysiological process of cardiovascular disease, occurs frequently in people with microalbuminuria and could depress their antioxidant concentrations, which then could contribute to end-organ damage associated with microalbuminuria. METHODS: We examined associations between microalbuminuria and circulating concentrations of vitamins A, C, and E and carotenoids in 9,575 US adults aged 20 years or older who participated in the Third National Health and Nutrition Examination Survey (1988 to 1994). RESULTS: After adjustment for age, sex, race or ethnicity, education, smoking status, cotinine concentration, physical activity, alcohol use, fruit and vegetable intake, vitamin or mineral use during the past 24 hours, body mass index, systolic blood pressure, and total cholesterol, triglyceride, glucose, insulin, and C-reactive protein concentrations, concentrations of beta-cryptoxanthin (odds ratio for quartile of highest concentration compared with quartile of lowest concentration, 0.56; 95% confidence interval, 0.38 to 0.82), lutein/zeaxanthin (odds ratio, 0.59; 95% confidence interval, 0.37 to 0.94), lycopene (odds ratio, 0.64; 95% confidence interval, 0.46 to 0.89), and total carotenoids (odds ratio, 0.54; 95% confidence interval, 0.38 to 0.75) were associated inversely with microalbuminuria. Vitamin C, vitamin E, and selenium concentrations were not significantly associated with microalbuminuria. CONCLUSION: People with microalbuminuria may have reduced concentrations of selected antioxidants. Additional research is needed to examine the relationships between microalbuminuria and antioxidant status, mechanisms for depletion of antioxidants, and possible benefits from increased intake of antioxidants through dietary change or the use of supplements in people with microalbuminuria.