Asthma-related mortality in the United States, 1999 to 2015: A multiple causes of death analysis.

BACKGROUND: Asthma mortality based on the underlying cause of death (UCOD) underestimates disease burden. OBJECTIVE: To analyze asthma mortality in the United States from 1999 to 2015 and the pattern of reporting of asthma and its comorbidities in death certificates, using multiple cause of death (MCOD) records. METHODS: All 156,517 death certificates with any mention of asthma were analyzed for 1999 to 2015. Asthma was defined by International Classification of Diseases, 10th Revision code J45 based on the UCOD or MCOD. Annual age-adjusted asthma death rates were computed according to age, sex, and race/ethnicity. The 6,304 MCOD coded status asthmaticus cases (J46) were also examined. RESULTS: From 1999 to 2015 a total of 59,067 deaths with a UCOD of asthma occurred; 37,832 deaths occurred in females and 21,235 in males (female-male ratio = 1.78). A total of 156,517 deaths with MCOD of asthma occurred; 101,371 deaths occurred in females and 55,146 in males (female-male ratio = 1.83). Hence, 37.7% of deaths with any mention of asthma had asthma as the UCOD (37.3% in females and 38.45% in males). Of these deaths, 41.7% occurred in non-Hispanic blacks and 36% in non-Hispanic whites. Between 1999 and 2015, age-adjusted MCOD death rates changed as follows: 38.1% in Hispanic white females, 34.1% in non-Hispanic black females, 15.1% in non-Hispanic white females, 28.5% in Hispanic white males, 21.3% in non-Hispanic black males, and 25.0% in non-Hispanic white males. Non-Hispanic black females and males had the highest MCOD and UCOD rates throughout the period. CONCLUSION: Among deaths with any mention of asthma, asthma was chosen as the UCOD most often in non-Hispanic black males and least often in non-Hispanic white females. Age-adjusted MCOD rates decreased most in non-Hispanic white males and least in non-Hispanic white females.

Smokeless tobacco use and fractional exhaled nitric oxide in men in a national survey.

BACKGROUND: Tobacco use is an important risk for asthma and increases asthma severity. Fractional exhaled nitric oxide (FeNO) is used as a noninvasive biomarker of eosinophilic airway inflammation. Substantial numbers of men use smokeless tobacco. The effect of use of smokeless tobacco on FeNO is not known. OBJECTIVE: To estimate the association between use of smokeless tobacco and FeNO among US men. METHODS: The National Health and Nutrition Examination Survey 2007-2012 was analyzed to assess association of use of smokeless tobacco and FeNO levels in parts per billion in US men. Participants were categorized by smoking status and use of snuff or chewing tobacco in the previous 5 days. FeNO was measured using a device that relies on an electrochemical sensor. RESULTS: In 3,791 male nonsmokers without asthma, weighted mean natural logarithm FeNO by exposure to smokeless tobacco was 2.81 (geometric mean FeNO, 16.59 ppb; 95% CI, 2.77-2.85) in unexposed and 2.66 (geometric mean, 14.30 ppb; 95% CI, 2.55-2.77) in the exposed. In weighted linear regression analyses, use of smokeless tobacco was associated with significantly lower natural logarithm FeNO after controlling for age and race (black vs nonblack) (coefficient, -0.124; SE, 0.056; P = .03; 95% CI, -0.237 to -0.011). Results were unchanged after additionally controlling for recent nitric oxide-rich vegetable consumption and upper respiratory tract infection (coefficient, -0.118; SE, 0.055; P = .04; 95% CI, -0.228 to -0.007). CONCLUSIONS: Use of smokeless tobacco was associated with lower mean natural logarithm FeNO levels in nonsmokers with no history of asthma. Interpretation of FeNO should consider all forms of tobacco use.

Associations between religious involvement and behavioral risk factors for HIV/AIDS in American women and men in a national health survey.

BACKGROUND: Acquired immunodeficiency syndrome (AIDS), caused by human immunodeficiency virus (HIV), is a leading cause of death. PURPOSE: We tested the hypothesis that religious variables would be inversely associated with prevalence of HIV/AIDS risk factors. METHODS: A 2002 national survey included 9,837 individuals aged 15-44 years with complete data on religious involvement, sexual, and drug use behaviors. RESULTS: Women who never attended services had over two times greater odds of reporting HIV risk factors than those attending weekly or more after adjusting for age and race/ethnicity (p < 0.0001) and over 60% greater after adjusting for multiple confounders, but no significant association was seen in men. Mainline Protestants had lower odds of reporting risk factors than those with no affiliation. No significant independent associations were found with importance of religion. CONCLUSIONS: Women with public religious involvement had lower prevalence of any HIV risk factors while only affiliation was so associated in men.

Religious involvement and seroprevalence of six infectious diseases in US adults.

OBJECTIVE: In the United States, religious practice is inversely associated with several chronic conditions, but no reports show whether it is inversely associated with prevalence of positive serology for infections. METHODS: Data on a multiethnic, national sample included 11,507 persons aged 17 years and over with complete data on frequency of attendance at religious services (FARS) and serologic testing for six pathogens. RESULTS: Even after controlling for multiple confounders, persons attending religious services weekly (19.8%) or more (19.6%) were less likely to be seropositive for herpes simplex type 2 (HSV-2) than those attending less frequently (23.7%) or never (25.1%, P = 0.001). Analyses revealed the association to be partially accounted for by reduced risky sexual behavior and illegal drug use among frequent attenders. No associations were found with three enteric pathogens. CONCLUSION: Infection with HSV-2 and hepatitis C virus (HCV) was inversely associated with FARS, independent of multiple confounders.

Cognitive function, social integration and mortality in a U.S. national cohort study of older adults.

BACKGROUND: Prior research suggests an interaction between social networks and Alzheimer's disease pathology and cognitive function, all predictors of survival in the elderly. We test the hypotheses that both social integration and cognitive function are independently associated with subsequent mortality and there is an interaction between social integration and cognitive function as related to mortality in a national cohort of older persons. METHODS: Data were analyzed from a longitudinal follow-up study of 5,908 American men and women aged 60 years and over examined in 1988-1994 followed an average 8.5 yr. Measurements at baseline included self-reported social integration, socio-demographics, health, body mass index, C-reactive protein and a short index of cognitive function (SICF). RESULTS: Death during follow-up occurred in 2,431. In bivariate analyses indicators of greater social integration were associated with higher cognitive function. Among persons with SICF score of 17, 22% died compared to 54% of those with SICF score of 0-11 (p < 0.0001). After adjusting for confounding by baseline socio-demographics and health status, the hazards ratio (HR) (95% confidence limits) for low SICF score was 1.43 (1.13-1.80, p < 0.001). After controlling for health behaviors, blood pressure and body mass, C-reactive protein and social integration, the HR was 1.36 (1.06-1.76, p = 0.02). Further low compared to high social integration was also independently associated with increased risk of mortality: HR 1.24 (1.02-1.52, p = 0.02). CONCLUSION: In a cohort of older Americans, analyses demonstrated a higher risk of death independent of confounders among those with low cognitive function and low social integration with no significant interaction between them.

Associations of prayer, mind-body therapy, and smoking cessation in a national survey.

Smoking is the leading preventable cause of death. Many people use mind-body therapies and/or prayer to assist them in smoking cessation, but more information on their effectiveness is needed. In the 2002 National Health Interview Survey, 5,864 persons aged 18 or older reported smoking in the prior 12 mo.; among these, users of any of 10 mind-body therapies or prayer were compared to nonusers to assess smoking cessation attempts and smoking cessation over a 1-yr. period. Weighted logistic regression showed that the adjusted odds of reporting quit attempts during the year prior to interview or of reporting no longer smoking at interview were significantly higher in those using prayer alone, any mind-body therapy alone, or both, compared with those who used neither. In the subset of 2,839 persons who reported smoking 12 mo. prior to interview and attempting to quit during the year prior to interview, the odds of reporting no longer smoking at interview were no greater for those who used prayer, any mind-body therapy, or both, than in those using neither.

Frequency of attendance at religious services and mortality in a U.S. national cohort.

OBJECTIVE: Few nationally representative cohort studies have appeared on frequency of attendance at religious services and mortality. We test the hypothesis that > weekly attendance compared with nonattendance at religious services is associated with lower probability of future mortality in such a study. METHODS: Data were analyzed from a longitudinal follow-up study of 8450 American men and women age 40 years and older who were examined from 1988 to 1994 and followed an average of 8.5 years. Measurements at baseline included self-reported frequency of attendance at religious services, sociodemographics, and health, physical and biochemical measurements. RESULTS: Death during follow-up occurred in 2058. After adjusting for confounding by baseline sociodemographics and health status, the hazards ratios (95% confidence limits) were never 1.00 (reference); < weekly 0.89 (0.75-1.04), p = 0.15; weekly 0.82 (0.71-0.94) p = 0.005; and > weekly attenders 0.70 (0.59-0.83), p < 0.001. Mediators, including health behaviors and inflammation, explained part of the association. CONCLUSIONS: In a nationwide cohort of Americans, predominantly Christians, analyses demonstrated a lower risk of death independent of confounders among those reporting religious attendance at least weekly compared to never. The association was substantially mediated by health behaviors and other risk factors.

Cigarette smoking during pregnancy: independent associations with religious participation.

OBJECTIVE: Data from a national health survey were used to test the hypothesis of a negative association of smoking in pregnancy and three measures of religious participation and importance. METHODS: The 2002 National Survey of Family Growth included 2395 women aged 15 to 44 years with a history of at least one pregnancy in the five years before interview. An association between religious participation and cigarette smoking during the last pregnancy was assessed in bivariate and multivariate analyses. RESULTS: The rate of smoking during the last pregnancy was 4% (95% confidence limit [CL] 2-7%) among those who attended service more than once weekly and 24% (95% CL 20-30%) among those who never attended (chi-square 68, P < 0.0001). In logistic regression models compared with those who never attended, those attending once a week or more were only one-fifth as likely to smoke during pregnancy among European Americans (adjusted odds ratio with 95% confidence limits of 0.22, 0.12-0.39) and Hispanics (0.28 95% CL, 0.11-0.73), and one-half as likely to smoke among African Americans (0.53 95% CL, 0.16-1.69). Significant associations were also observed for affiliation and importance of religion. CONCLUSION: The frequency of attendance at religious services, affiliation, and importance were independently inversely associated with smoking during pregnancy in American women. The strength of these associations varied among ethnic groups.

Bone mineral density and hypertension prevalence in postmenopausal women: results from the Third National Health and Nutrition Examination Survey.

PURPOSE: We sought to corroborate a reported association of hypertension with bone mineral density (BMD) in postmenopausal women. METHODS: Data are from a nationally representative sample of 2738 women aged 50 years and older from the Third National Health and Nutrition Examination Survey. Total proximal femoral bone mineral density was measured by using dual-energy x-ray absorptiometry. Hypertension is defined as blood pressure of 140/90 mm Hg or greater or recent blood pressure medication use. RESULTS: Compared with the fourth quartile of BMD, age- and race-adjusted relative odds of hypertension were decreased in the first quartile (odds ratio [OR], 0.50; 95% confidence interval [CI], 0.38-0.67; p < 0.01). However, the association was diminished and no longer significant after adjusting for body mass index (OR, 0.96; 95% CI, 0.69-1.36; p = 0.83) and additional risk factors in multivariate models (OR, 0.92; 95% CI, 0.65-1.30; p = 0.62). CONCLUSIONS: No association between hypertension and BMD was observed after controlling for body mass index and other confounders.

Trends in acute myocardial infarction and coronary heart disease death in the United States.

Coronary heart disease accounted for 489,171 deaths in 1990. Age-adjusted death rates decreased faster between 1976 and 1990 for white men than for white women or blacks. Out of hospital death rates for coronary heart disease decreased in the 1980s. Hospital fatality rates for acute myocardial infarction continued a long-term decrease through 1990. Trends in risk factors and invasive procedures support the conclusion that risk factor reduction has resulted in reduced incidence of acute myocardial infarction and sudden coronary death and that improvements in medical care have resulted in a continued decrease in acute myocardial infarction fatalities and overall coronary deaths.

Coronary revascularization and cardiac catheterization in the United States: trends in racial differences.

OBJECTIVES: We sought to determine whether racial differences in rates of coronary artery bypass graft surgery (CABG), percutaneous transluminal coronary angioplasty (PTCA) and cardiac catheterization decreased after 1980. BACKGROUND: Many reports of racial differences in utilization of CABG have been published since 1982. However, changes in the relative utilization of revascularization over time have received little attention. METHODS: Data from the National Hospital Discharge Survey were examined for the years 1980 through 1993. Estimated numbers of procedures performed in nonfederal U.S. hospitals were used to compute age-adjusted rates per 100,000 population by year and race for patients 35 to 84 years old. RESULTS: In patients 35 to 84 years old, the rate of CABG increased in blacks and whites between 1980 and 1993. Between 1986 and 1993, there was little change in the black/white ratio of age-adjusted rates (0.23 in 1980 through 1985 combined, 0.38 in 1986 and 0.43 in 1993). An apparent increase from 0.23 in 1980 through 1985 combined may have been due to sampling variation. Despite rapid increases in rates of PTCA in both races, no increase in the black/white ratio was noted (0.57 in 1993). However, the rate of inpatient cardiac catheterization increased more rapidly in blacks than in whites. This resulted in an increase in the black/white ratio of age-adjusted rates from 0.42 in 1980 to 0.91 in 1993. CONCLUSIONS: Rates of CABG, cardiac catheterization and especially PTCA increased between 1980 and 1993, a period during which racial disparities in the procedures became widely known. Despite apparent increases in the black/white ratio for inpatient cardiac catheterization, large racial disparities in the utilization of CABG and PTCA persist and require further evaluation and possible intervention.

Counts of neutrophils, lymphocytes, and monocytes, cause-specific mortality and coronary heart disease: the NHANES-I epidemiologic follow-up study.

PURPOSE: To examine the association of elevated counts of white blood cell types with increased risk of coronary heart disease (CHD) and death. METHODS: Data were examined from the NHANES-I Epidemiologic Follow-up Study. RESULTS: Relative risks for death at ages 25 to 74 comparing the upper and lower tertiles of neutrophil count were: all causes 1.29 (95% CL, 1.14, 1.47), and cardiovascular causes 1.39 (95% CL, 1.15, 1.67) after adjusting for baseline risk factors. CONCLUSIONS: The increased risk of CHD and death from all causes and cardiovascular diseases appeared to be only partially due to effects of smoking. No association was seen for lymphocytes or monocytes.

Ethnic variation in validity of classification of overweight and obesity using self-reported weight and height in American women and men: the Third National Health and Nutrition Examination Survey.

BACKGROUND: Few data have been published on the validity of classification of overweight and obesity based on self-reported weight in representative samples of Hispanic as compared to other American populations despite the wide use of such data. OBJECTIVE: To test the null hypothesis that ethnicity is unrelated to bias of mean body mass index (BMI) and to sensitivity of overweight or obesity (BMI > or = 25 kg/m2) derived from self-reported (SR) versus measured weight and height using measured BMI as the gold standard. DESIGN: Cross-sectional survey of a large national sample, the Third National Health and Nutrition Examination Survey (NHANES III) conducted in 1988-1994. PARTICIPANTS: American men and women aged 20 years and over (n = 15,025). MEASUREMENTS: SR height, weight, cigarette smoking, health status, and socio-demographic variables from home interview and measured weight and height. RESULTS: In women and Mexican American (MA) men SR BMI underestimated true prevalence rates of overweight or obesity. For other men, no consistent difference was seen. Sensitivity of SR was similar in non-Hispanic European Americans (EA) and non-Hispanic African Americans (AA) but much lower in MA. Prevalence of obesity (BMI > or = 30 kg/m2) is consistently underestimated by self-report, the gap being greater for MA than for other women, but similar for MA and other men. The mean difference between self-reported and measured BMI was greater in MA (men -0.37, women -0.76 kg/m2) than in non-Hispanic EA (men -0.22, women -0.62 kg/m2). In a regression model with the difference between self-reported and measured BMI as the dependent variable, MA ethnicity was a significant (p < 0.01) predictor of the difference in men and in women. The effect of MA ethnicity could not be explained by socio-demographic variables, smoking or health status. CONCLUSION: Under-estimation of the prevalence of overweight or obesity based on height and weight self-reported at interview varied significantly among ethnic groups independent of other variables.

The relationship between fish consumption and stroke incidence. The NHANES I Epidemiologic Follow-up Study (National Health and Nutrition Examination Survey).

OBJECTIVE: To assess the level of fish consumption as a risk factor fo r stroke. METHODS: Participants were members of the National Health and Nutrition Examination Survey I Epidemiologic Follow-up Study, a longitudinal cohort study of a national sample. Included in this analysis were white and black women and men aged 45 to 74 years when examined in 1971 through 1975 who did not report a history of stroke at that time. Average follow-up for survivors was 12 years (maximum, 16 years). The main outcome measure was incident stroke (fatal and nonfatal). Fish consumption at baseline was obtained from a 3-month food frequency questionnaire. RESULTS: White women aged 45 to 74 years who consumed fish more than once a week had an age-adjusted risk of stroke incidence only about half that of women who never consumed fish. This effect persisted after controlling for multiple stroke risk variables (relative risk, 0.55;95% confidence interval [CI], 0.32 to 0.93). Fish consumption more than once a week compared with never was not associated with age-adjusted stroke risk in white men aged 45 to 74 years (relative risk, 0.85;95%CI,0.49 to 1.46). In black women and men combined aged 45 to 74 years, any fish consumption compared with never was significantly associated with reduced adjusted stroke risk (relative risk, 0.51;95%CI,0.30 to 0.88).

Delay in the prehospital phase of acute myocardial infarction. Lack of influence on incidence of sudden death.

Prehospital delay is considered to be an important cause of out-of-hospital coronary mortality. Behavior of patients and physicians in response to the symptoms of myocardial infarction (MI) or impending out-of-hospital death (OHD) was studied for 107 consecutive acute coronary events in Framingham, Mass. Delay due to inappropriate patient behavior was the most important component of total delay. Delay related to patient-physician contact occurred in two thirds of MI cases and was more than 30 minutes in half of these. Office visits and inappropriate triage by nurses and receptionists were important factors in physician delay. However, 60% to 75% of OHDs occur so rapidly that their prevention by reduction of prehospital delay seems impossible. A strategy for reduction of delay that might be of benefit in preventing some of the remaining OHDs is described.

Improving hypertension detection and referral in an ambulatory setting.

A paraprofessional aide working in an urban hospital's ambulatory clinics encouraged nurses to take and record blood pressures; he then contacted patients with elevated pressures who were not referred by clinic staff or who did not return for follow-up of their own accord. Blood pressure recording by clinic staff increased during the intervention from 54% to 68% of patients seen. Appointment keeping increased with intervention from 13% to 73% of those eligible for referral. The yield of hypertensive patients initiating management increased from a control level of 7% to 22% of total patients eligible for referral. Thus, a health aide can be effective in improving detection and referral of hypertensive patients at low cost.

Improving hypertension control in a private medical practice.

Hypertension is one of the most common diseases seen by the practicing physician. Yet, because of noncompliance, conditions of many hypertensive patients are not effectively controlled by treatment. The purpose of this study was to test the efficacy of a patient education program in reducing the blood pressure (BP) of hypertensive patients in a private, solo medical practice. The intervention program focused on three behavioral objectives-pill taking, appointment keeping, and dietary sodium reduction while stressing the need for taking responsibility for one's own care. It was hypothesized that patients receiving an educational intervention stressing self-care would benefit more than those receiving the usual medical care. A substantial reduction in BP was considered to be the measure of successful treatment. Thirty-nine hypertensive patients receiving drug therapy from a private, solo medical practice were randomized into either a treatment group or a control group. A comparison of means disclosed no pretreatment differences between the groups' average BPs. After following up both groups for six months, mean changes in BP were compared for both treatment and control patients using a two-sample t test for independent samples. The BP fell in the treatment group (-13 mm Hg, systolic; -8 mm Hg, diastolic) but rose slightly in the control group (3 mm Hg, systolic 0.5 mm Hg, diastolic). The difference in changes was significant for both the systolic and diastolic BP.