Depression and anxiety among US adults: associations with body mass index.

BACKGROUND: Obesity is associated with an increased risk of developing a variety of chronic diseases, most of which are associated with psychiatric disorders. We examined the associations of depression and anxiety with body mass index (BMI) after taking into consideration the obesity-related comorbidities (ORCs) and other psychosocial or lifestyle factors. METHODS: We analyzed the data collected from 177,047 participants (aged>or=18 years) in the 2006 Behavioral Risk Factor Surveillance System. Current depression was assessed by the Patient Health Questionnaire-8 diagnostic algorithm. Lifetime diagnoses of depression, anxiety and ORCs were self-reported. The prevalence of the three psychiatric disorders was age standardized to the 2000 US population. Multivariate-adjusted prevalence ratios were computed to test associations of depression and anxiety with BMI using SUDAAN software. RESULTS: The age-adjusted prevalence of current depression, lifetime diagnosed depression and anxiety varied significantly by gender. Within each gender, the prevalence of the three psychiatric disorders was significantly higher in both men and women who were underweight (BMI<18.5 kg/m(2)), in women who were overweight (BMI: 25-<30 kg/m(2)) or obese (BMI>or=30 kg/m(2)), and in men who had class III obesity (BMI>or=40 kg/m(2)) than in those with a normal BMI (18.5-<25 kg/m(2)). After adjusting for demographics, ORCs, lifestyle or psychosocial factors, compared with men with a normal BMI, men with a BMI>or=40 kg/m(2) were significantly more likely to have current depression or lifetime diagnosed depression and anxiety; men with a BMI<18.5 kg/m(2) were also significantly more likely to have lifetime diagnosed depression. Women who were either overweight or obese were significantly more likely than women with a normal BMI to have all the three psychiatric disorders. CONCLUSIONS: Our results demonstrate that disparities in the prevalence of depression and anxiety exist among people with different BMI levels independent of their disease status or other psychosocial or lifestyle factors.

Body mass index and headaches: findings from a national sample of US adults.

The objective was to study the cross-sectional association between body mass index (BMI) and the prevalence of severe headaches or migraines in a national sample of US adults. We used data from 7601 men and women aged > or = 20 years who participated in the National Health and Nutrition Examination Survey 1999-2002. The age-adjusted prevalence of severe headaches or migraines during the previous 3 months was 34.0, 18.9, 20.7 and 25.9% among participants with a BMI < 18.5, 18.5 to < 25, 25 to < 30 and > or = 30 kg/m(2), respectively. After adjusting for a variety of covariates in a logistic regression model, those with a BMI < 18.5 kg/m(2)[odds ratio (OR) 2.01; 95% confidence interval (CI) 1.34, 3.02] or > or = 30 kg/m(2 )(OR 1.37; 95% CI 1.09, 1.72) had a significantly elevated OR for having a headache compared with participants with a BMI of 18.5-< 25 kg/m(2). BMI is associated with the prevalence of severe headaches or migraines in a non-linear manner.

Diabetes and anxiety in US adults: findings from the 2006 Behavioral Risk Factor Surveillance System.

AIMS: Anxiety disorders may cause substantial impairment in patient functioning and well-being. Little is known about the relationship between diabetes and anxiety. We estimated the prevalence of lifetime diagnosis of anxiety in adults aged > or = 18 years with and without diabetes in the USA. METHODS: We analysed data from the 2006 Behavioral Risk Factor Surveillance System (total, N = 201 575; 20 142 with diabetes; 39.4% men, 77.9% non-Hispanic Whites, 8.1% non-Hispanic Blacks and 7.7% Hispanics; mean age 52.4 years). Diabetes and lifetime diagnosis of anxiety were self-reported. A multivariable log-binomial model was used to estimate prevalence ratios (PR) and associated 95% confidence intervals (CI) of anxiety based on diabetes status. RESULTS: The overall age-adjusted prevalence of lifetime diagnosis of anxiety was 19.5 and 10.9% in people with and without diabetes, respectively. After adjustment for educational level, marital status, employment status, current smoking, leisure-time physical activity and body mass index, people with diabetes had a 20% higher prevalence of lifetime diagnosis of anxiety than those without (PR 1.20; 95% CI 1.12, 1.30). There were no significant differences in the PR by gender (P = 0.06). However, the ratios differed significantly by age (P = 0.04) and by race/ethnicity (P < 0.01), indicating that people aged 18-29 years (PR 1.70; 95% CI 1.19, 2.43) and Hispanics (PR 1.69; 95% CI 1.33, 2.15) had a higher ratio than their counterparts. CONCLUSION: Diabetes was significantly associated with anxiety in adults in this large population-based sample, particularly in Hispanics and young adults.

Race/ethnicity, substance abuse, and mental illness among suicide victims in 13 US states: 2004 data from the National Violent Death Reporting System.

OBJECTIVE: To calculate the prevalence of substance abuse and mental illness among suicide victims of different racial/ethnic groups and to identify race/ethnicity trends in mental health and substance abuse that may be used to improve suicide prevention. METHODS: Data are from the National Violent Death Reporting System (NVDRS), a state-based data integration system that, for 2004, includes data from 13 US states. The NVDRS integrates medical examiner, toxicology, death certificate, and law enforcement data. RESULTS: Within participating states, for data year 2004, 6865 suicide incidents in which race/ethnicity are known were identified. This included 5797 (84.4%) non-Hispanic whites, 501 (7.3%) non-Hispanic blacks, 257 (3.7%) Hispanics, and 310 (4.5%) persons from other racial/ethnic groups. At the time of the suicide event, non-Hispanic blacks had lower blood alcohol contents than other groups. Non-Hispanic whites had less cocaine but more antidepressants and opiates. There were no differences in the levels of amphetamines or marijuana by race/ethnicity. Hispanics were less likely to have been diagnosed with a mental illness or to have received treatment, although family reports of depression were comparable to non-Hispanic whites and other racial/ethnic groups. Non-Hispanic whites were more likely to be diagnosed with depression or bipolar disorder and non-Hispanic blacks with schizophrenia. Comorbid substance abuse and mental health problems were more likely among non-Hispanic whites and non-Hispanic blacks, while Hispanics were more likely to have a substance abuse problem without comorbid mental health problems. CONCLUSION: The results support earlier research documenting differences in race/ethnicity, substance abuse, and mental health problems as they relate to completed suicide. The data suggest that suicide prevention efforts must address not only substance abuse and mental health problems in general, but the unique personal, family, and social characteristics of different racial/ethnic groups.

Rabies surveillance in the United States during 1995.

In 1995, 49 states, the District of Columbia, and Puerto Rico reported 7,877 cases of rabies in nonhuman animals and 4 cases in human beings to the Centers for Disease Control and Prevention. Nearly 92% (7,247 cases) were wild animals, whereas 8% (630 cases) were domestic species. The total number of reported cases decreased 4.2% from that of 1994 (8,230 cases). Most of the decline was the result of 17.1% fewer reported cases of rabies in raccoons in areas of the Northeast, where rabies is now enzootic rather than epizootic. Exceptions to this decline were detected in states where the virus has only recently entered raccoon populations or where ongoing epizootics persist. States experiencing increasing epizootic activity associated with this variant include Maine (3 cases in 1993 to 101 cases in 1995), North Carolina (9 cases in 1990 to 466 cases in 1995), Rhode Island (1 case in 1993 to 324 cases in 1995), and Vermont (45 cases in 1993 to 179 cases in 1995). The raccoon variant of the rabies virus is now present in Alabama, Pennsylvania, Vermont, West Virginia, and all Atlantic Seaboard states from Florida to Maine. In Ohio, this variant, last detected in 1992 as a single case, was again detected in 1996. Epizootics of rabies in foxes in west central Texas and in dogs and coyotes in southern Texas attributable to canine variants continue, with this state reporting 137 rabid foxes, 55 rabid dogs, and 80 of the 83 cases in coyotes during 1995. The number of rabid bats (787) increased by almost 25%, with cases reported by 47 of the 48 contiguous states. Nationally, reported cases of rabies in cattle (136) and cats (288) increased by 22.5 and 7.9%, respectively, whereas cases in dogs (146) decreased by 4.6%. Cats continued to be the domestic animal most frequently reported rabid. The cases of rabies reported in human beings were all caused by viral variants associated with bats. Eighteen states and Puerto Rico reported decreases in rabies in animals in 1995, compared with 28 states and the District of Columbia in 1994. Hawaii was the only state that did not report a case of rabies in 1995.

Rabies surveillance in the United States during 1994.

In 1994, 48 states, the District of Columbia, and Puerto Rico reported 8,224 cases of rabies in nonhuman animals and 6 cases in human beings to the Centers for Disease Control and Prevention. Nearly 93% (7,632 cases) were wild animals, whereas 7% (592 cases) were domestic species. The total number of reported cases decreased 13.4% from that of 1993 (9,498 cases), with most of the decline resulting from 19.2% fewer cases of rabies in raccoons. Two previously described epizootics of rabies involving the raccoon variant of the rabies virus have converged in North Carolina, and the resulting region is now continuous from Alabama and Florida in the South to Maine in the North. Epizootics of rabies in foxes in west central Texas and in dogs and coyotes in southern Texas continue to expand, with this state reporting 144 rabid foxes, 53 rabid dogs, and 77 of the 85 cases in coyotes during 1994. Maine and New Hampshire reported cases of rabies in foxes (6 and 9, respectively) for the first time in 10 years. Nationally, reported cases of rabies in dogs (153) increased by 17.7%, whereas cases in cattle (111) and cats (267) decreased by 14.6 and 8.3%, respectively. Cats continued to be the domestic animal most frequently reported rabid. Twenty-eight states and the District of Columbia reported decreases in rabies in animals in 1994, compared with 22 states, the District of Columbia, and Puerto Rico in 1993. Hawaii and Nebraska were the only states that did not report cases of rabies in 1994.

Chronic liver disease mortality in the United States, 1979 through 1989.

OBJECTIVES: Rates and trends for chronic liver disease mortality in the United States were examined. METHODS: National Center for Health Statistics data on underlying cause of death for chronic liver disease for the United States from 1979 through 1989 were analyzed. Four groups of diseases and conditions included under the International Classification of Diseases, 9th Revision, code for chronic liver disease were assessed separately. RESULTS: From 1979 through 1989, there were 303,875 deaths from chronic liver disease; 48% were in the cirrhosis without alcohol group, 42% in the alcohol-related liver disease group, 8% in the liver disease without alcohol group, and 1.5% in the biliary cirrhosis group. Chronic liver disease death rates for Blacks were more than 1.5 times greater than those for Whites and for other races. Chronic liver disease mortality declined 22% overall among both sexes. The largest decreases were for liver disease without alcohol (42%) and cirrhosis without alcohol (25%), followed by alcohol-related liver disease (14%) and biliary cirrhosis (12%). CONCLUSION: Although declines in US chronic liver disease deaths have been attributed to declining alcohol consumption, these analyses suggest that greater declines have occurred in deaths not coded as alcohol related.

Multiple false reactions in viral antibody screening assays after influenza vaccination.

In December 1991, US blood centers reported an unusual increase in donations that tested falsely reactive for antibodies to two or more (multiple false positive) of the following viruses: human immunodeficiency virus type 1 (HIV-1), human T-cell lymphotrophic virus type I (HTLV-I), and hepatitis C virus. Many of these donations were from people who had recently received the 1991-1992 influenza vaccine, raising the possibility that this vaccine had somehow specifically caused the problem of multiple false reactivity. A case-control study of 101 affected donors and 191 matched controls found that recent receipt of any brand of influenza vaccine was significantly associated with testing multiple false positive (p < 0.05), as was a history of recent acute illness (p < 0.05) and of allergies (p < 0.05). Surveillance for monthly rates of multiple reactive donations from May 1990 through December 1992 linked the seasonal cluster of multiple false-positive donations to the use of viral screening test kits thought to react nonspecifically to donor immunoglobulin M. There was no similar increase in multiple false-positive donations during the 1992-1993 influenza vaccination season after the HIV-1 and hepatitis C virus tests were replaced; however, the number of donations that were falsely reactive for only HTLV-I almost doubled, indicating that false reactivity was not specifically associated with the 1991-1992 influenza vaccine. Retesting of affected donors found that the duration of HTLV-I and hepatitis C virus false reactivity was 3-6 months. The cluster of multiple false-positive donations in 1991 was most likely caused by the test kits used, rather than by the influenza vaccine.

Epidemiology of Creutzfeldt-Jakob disease in the United States, 1979-1990: analysis of national mortality data.

The trends and current incidence of Creutzfeldt-Jakob disease (CJD) was examined by using a unique and potentially high sensitive source for case ascertainment. We analyzed death certificate information for 1979-1990 from US multiple-cause-of-death mortality data, compiled by the National Center for Health Statistics, Centers for Disease Control and Prevention. We evaluated death certificate data for US residents for whom CJD was listed as one of the multiple causes of death on the death certificate (046.1) from the International Statistical Classification of Diseases, Injuries, and Causes of Death (9th revision). Age-adjusted and age-specific CJD death rates by gender, race, and region were calculated to measure the disease incidence because of the rapidly fatal course of the disease for most patients with CJD. We identified 2,614 deaths with CJD listed on the death certificates. The average annual age-adjusted mortality rate was 0.9 deaths per million persons (range 0.8-1.1). The mean age at death was 67 years. CJD-related deaths were uncommon among persons younger than 50 years of age (4.3% of all deaths). The highest average annual mortality rate was for those persons aged 70-74 years (5.9 deaths per million persons). A slight majority (53.0%) of the deaths was in females, but the age-adjusted mortality rate was 1.2 times higher for males. Most deaths (94.8%) were in whites; the mortality rate for blacks was only 40% of that for whites. The age-adjusted CJD mortality rate in the United States is similar to published estimates of the crude incidence of CJD worldwide.(ABSTRACT TRUNCATED AT 250 WORDS)

Rabies surveillance in the United States during 1993.

In 1993, 49 states, the District of Columbia, and Puerto Rico reported 9,495 cases of rabies in nonhuman animals and 3 cases in human beings to the Centers for Disease Control and Prevention. Greater than 93% (8,889 cases) were wild animals, whereas 6.4% (606 cases) were domestic species. The total number of reported cases increased 9.9% over that of 1992 (8,645 cases), with most of the increase resulting from continued spread of rabies in raccoons (37.1% increase in reported cases over 1992). The 2 epizootics of rabies in raccoons (Northeastern/mid-Atlantic and Southeastern regions) approach convergence in North Carolina (106 cases of rabies in 1993, compared with 49 in 1992). Maine, Rhode Island, and Vermont remained the only New England states without reported cases associated with the raccoon variant of the rabies virus. New York reported 2,747 cases of rabies, the largest number of cases ever reported during a single year by any state. Increases in reported cases of rabies in Texas and 8 other geographically dispersed states were attributed mainly to larger numbers of reported cases of rabies in bats. Texas reported 71 of the 74 cases in coyotes during 1993 (70 of 75 cases in 1992). Nationally, reported cases of rabies in dogs (130) and cattle (130) each decreased by 29% in 1993, whereas cats (291 cases in 1993, compared with 290 in 1992) continued to be the domestic animal most frequently reported rabid. Twenty-two states and Puerto Rico reported decreases in rabies in animals in 1993, compared with 20 states, the District of Columbia, and Puerto Rico in 1992. Hawaii was the only state that did not report a case of rabies in 1993.

Multiple unconfirmed-reactive screening tests for viral antibodies among blood donors.

BACKGROUND: In December 1991, the United States Food and Drug Administration received reports of blood donations with unconfirmed reactivity on screening tests for antibodies to human immunodeficiency virus, human T-lymphotropic virus type I, and hepatitis C virus (HCV). Of 91 donors with these test results, 57 (63%) reported a recent influenza vaccination. STUDY DESIGN AND METHODS: To determine the extent of unconfirmed reactivity, the time at which it began, and its association or nonassociation with specific manufacturers' tests, a nationwide survey of blood centers was conducted. A case-donation was defined as a blood donation that was repeatedly reactive, but not confirmed positive, on at least two of the three tests from May 1990 through December 1991. RESULTS: Among 14 million donations screened by 110 centers, 582 case-donations were identified. An increase in case-donations was evident in the fall of 1990 (2.8/100,000 donations). In 1991, rates increased from 0.9 per 100,000 donations in the first quarter to 1.3, 3.2, and 19.7 in subsequent quarters. A significantly higher rate of case-donations was observed among donations tested with one of the two available anti-HCV screening tests (8.0 vs. 1.2/100,000 donations; risk ratio = 6.8; 95% CI = 5.4-8.5). CONCLUSION: Although unconfirmed reactivity on multiple screening tests appeared to be seasonal, its documentation prior to the availability of influenza vaccine in 1991 and higher rates among donations tested with one manufacturer's anti-HCV test indicated that test-specific factors were also involved.

Changes in longevity and causes of death among persons with hemophilia A.

To examine recent changes in longevity and the causes of death among persons with hemophilia A, we evaluated death certificate data for persons who died in the United States from 1968 through 1989 and had hemophilia A or congenital Factor VIII disorder (ICD code 286.0) listed on the death certificate as one of the multiple causes of death. Multiple-cause-of-death mortality data for the United States from 1968 to 1989 were examined to compare death rates by year, focusing on death rates and causes of death for 1979-1981, 1983-1985, and 1987-1989. Gender, age group, race, geographic region, and median age at death of persons with hemophilia A and human immunodeficiency virus (HIV)-related disease listed as a cause of death were compared with those with hemophilia A without HIV-related disease. From 1968 through 1989, 2,792 hemophilia A deaths were reported. The death rate increased from 0.5 to 1.3 per 1,000,000 persons. From 1979-1981 through 1987-1989, mortality increased in all age groups above 9 years of age and age at death shifted markedly to lower ages. Median age at death decreased from 57 years in 1979-1981 to 40 years in 1987-1989. The percentage of deaths due to hemorrhage or diseases of the circulatory system decreased markedly as the result of the increase in deaths associated with HIV infection or infections other than HIV infection. Spread of HIV-1 infection in persons with hemophilia A has disrupted the reduction in mortality seen with factor replacement therapy, implementation of home care, and use of comprehensive hemophilia treatment centers. It is hoped that advances in the care of HIV-infected persons will improve survival in the hemophilia community.

Rabies surveillance in the United States during 1992.

In 1992, 49 states, the District of Columbia, and Puerto Rico reported 8,644 cases of rabies in nonhuman animals and 1 case in a human being to the Centers for Disease Control and Prevention. Almost 92% (7,912 cases) were wild animals, the largest number of wild animals ever reported, whereas 8.5% (732 cases) were domestic species. The total number of reported cases increased 23.9% over that of 1991 (6,975 cases), with most of the increase resulting from continued spread of rabies in raccoons. The 2 epizootics of rabies in raccoons (Northeastern/mid-Atlantic region and Southeastern region) are now approaching convergence in North Carolina (49 reported cases of rabies in 1992). Massachusetts (57 cases), New York City (41 cases), and New Hampshire (10 cases) became new additions to the epizootic in the Northeast, with Maine, Rhode Island, and Vermont the only states in the region without cases associated with the raccoon strain of rabies. The state of New York (including New York City) reported 1,761 cases (79% in raccoons) of rabies, the largest number ever recorded for any state. Increases attributable to epizootics of rabies in other species were reported by Alaska (25 cases in 1992, compared with 12 in 1991, mainly attributable to rabies in foxes) and Kansas (374 cases in 1992, compared with 63 in 1991, mainly attributable to rabies in skunks). Reported cases of rabies in coyotes (75) increased 50% over those for 1991 (50 cases). In the southern portion of Texas (reporting 70 of the 75 cases in coyotes), there was a similar increase (55%) in reported cases of rabies in dogs, whereas nationally, reported cases of rabies in dogs (182) increased 17%. Twenty states, the District of Columbia, and Puerto Rico reported decreases in rabies in animals in 1992, compared with 16 states in 1991. Hawaii was the only state that did not report a case of rabies in 1992.

Rabies surveillance in the United States during 1991.

In 1991, 49 states, the District of Columbia, and Puerto Rico reported 6,972 cases of rabies in nonhuman animals and 3 cases in human beings to the Centers for Disease Control. Ninety-one percent (6,354 cases) were wild animals, whereas 8.9% (618 cases) were domestic species. The total number of reported cases of rabies increased 42.9% over that of 1990 (4,881 cases), with most of the increase resulting from continued spread of the epizootic of rabies in raccoons in the mid-Atlantic and northeastern states. Large increases in cases of rabies in animals were reported from Connecticut (200 cases in 1991, compared with 3 in 1990, an increase of 6,567%), Delaware (197 cases in 1991, compared with 44 in 1990, an increase of 348%), New York (1,303 cases in 1991, compared with 242 in 1990, an increase of 326%), and New Jersey (994 cases in 1991, compared with 469 in 1990, an increase of 112%). Other noteworthy increases were reported by Wyoming (96.4%), Texas (69.7%), California (41.3%), Oklahoma (33.1%), Minnesota (31.4%), Georgia (26.7%), and Maryland (23.7%). Hawaii reported 1 imported case of rabies in a bat. Only 16 states reported decreases in rabies in animals in 1991, compared with 30 in 1990. Pennsylvania and Iowa reported decreases of 40.6% and 27.4%, respectively. Rhode Island was the only state that did not report a case of rabies in 1991.

Hodgkin disease mortality in the United States: 1979-1988.

Mortality trends for Hodgkin disease in the United States were examined from 1979 to 1988 with the use of mortality data for multiple causes of death, which were obtained from the National Center for Health Statistics. A progressive decrease in the death rate from Hodgkin disease was observed over this period. The decrease in death rate was greatest among white patients. Patients who were 55 years or older had the highest death rate. Analysis by geographic region showed decreases in each of the regions, with no significant difference among groups of states with high and low incidences of acquired immune deficiency syndrome. However, the decrease in the South was approximately 35% greater than that in the North-east. In 1988 the most significant difference in death rates between male and female patients was in the 35-54-year age group, whereas a significant difference in death rates between white and black patients was seen only in patients who were 55 years of age or older. In summary, although there has been a significant reduction in deaths resulting from Hodgkin disease between 1979 and 1988, the decreases observed have varied between sexes and among age groups, racial groups, and geographic regions.