Ischemic heart disease and stroke mortality in African-American, Hispanic, and non-Hispanic white men and women, 1985 to 1991.

We compare recent trends in ischemic heart disease (IHD) and stroke mortality in California among the 6 major sex-racial or -ethnic groups. Rates of age-specific and -adjusted mortality were calculated for persons aged 35 and older during the years 1985 to 1991. Log-linear regression modeling was performed to estimate the average annual percentage change in mortality. During 1985 through 1991, the mortality for IHD and stroke was generally highest for African Americans, intermediate for non-Hispanic whites, and lowest for Hispanics. Age-adjusted mortality for IHD declined significantly in all sex-racial or -ethnic groups except African-American women, and stroke rates declined significantly in all groups except African-American and Hispanic men. African Americans had excess IHD mortality relative to non-Hispanic whites until late in life, after which mortality of non-Hispanic whites was higher. Similarly, African Americans and Hispanics had excess stroke mortality relative to non-Hispanic whites early in life, whereas stroke mortality in non-Hispanic whites was higher at older ages. The lower IHD and stroke mortality among Hispanics was paradoxical, given the generally adverse risk profile and socioeconomic status observed among Hispanics. An alarmingly high prevalence of self-reported cardiovascular disease risk factors in 1994 to 1996, particularly hypertension, leisure-time sedentary lifestyle, and obesity, is a serious public health concern, with implications for future trends in cardiovascular disease mortality. Of particular concern was the growing disparities in stroke and IHD mortality among younger-aged African Americans relative to Hispanics and non-Hispanic whites.

Secular trends in ischemic heart disease mortality in California versus the United States, 1980 to 1991.

We compare the recent trends in ischemic heart disease mortality in California and the United States. Because California was among the first states to have declines in ischemic heart disease mortality, an examination of these recent trends may provide important clues for upcoming national trends. Age-adjusted and -specific ischemic heart disease mortality rates were calculated by sex for persons aged 35 and older during the years 1980 to 1991. Log-linear regression modeling was used to estimate the average annual percentage change in mortality. Between 1980 and 1991, the annual age-adjusted ischemic heart disease mortality declined less in California than in the United States for both women (1.9% versus 3.1%) and men (3.1% versus 3.5%). In California, it increased slightly between 1986 and 1990 for the oldest women and men. The slower rates of decline in mortality of this disease in California compared with the United States and the rising rates among the most elderly Californians suggest that careful attention should be paid to these trends in death rates of and risk factors for this disease in California.

Relationship between diet composition and body fatness, with adjustment for resting energy expenditure and physical activity, in preadolescent children.

We examined the relationship between diet composition and body fatness in 48 children (25 girls, 23 boys) aged 9-11 y. Subjects were identified for two study groups, non-obese [triceps skinfold (TSF) thickness < 85th percentile] and obese (TSF thickness > or = 85th percentile). Measures for dietary intake, physical activity, resting energy expenditure (REE), and body composition were obtained by three 24-h dietary and activity recalls; indirect calorimetry; and anthropometrics, respectively. Percentage of body fat correlated positively with intakes of total (P < 0.0001), saturated (P < 0.01), monounsaturated (P < 0.0001), and polyunsaturated (P < 0.01) fatty acids, and negatively with carbohydrate intake (P < 0.001) and total energy intake adjusted for body weight (P < 0.001). After adjustment for study group, energy intake, REE, and physical activity, the associations remained for total, saturated, and monounsaturated fatty acid and carbohydrate intakes. These data suggest that diet composition, independent of total energy intake, REE, and physical activity may contribute to childhood obesity.

Cancer registry problems in classifying invasive bladder cancer.

A slide review of diagnostic pathologic tissue obtained from 364 bladder cancer cases, identified through the Iowa Surveillance, Epidemiology, and End Results (SEER) Program in 1983, classified 97 (26.6%) of these cases as invasive bladder cancers. These findings contrasted sharply with the Iowa SEER Program classification that coded 289 (79.4%) of these cases as invasive bladder cancers. These results were validated further by the hazard ratio of 4.54 (95% confidence interval, 2.57 to 8.03) among invasive relative to noninvasive bladder cancer cases when the slide review findings were used. In contrast, the hazard ratio was only 1.70 (95% confidence interval, 0.76 to 3.79) when the Iowa SEER Program findings were used. The traditional method used by the National Cancer Institute's SEER Program to deal with this problem is described and its implications are discussed.