Housing Insecurity and the Association With Health Outcomes and Unhealthy Behaviors, Washington State, 2011.

Few studies of associations between housing and health have focused on housing insecurity and health risk behaviors and outcomes. We measured the association between housing insecurity and selected health risk behaviors and outcomes, adjusted for socioeconomic measures, among 8,415 respondents to the 2011 Washington State Behavioral Risk Factor Surveillance System. Housing insecure respondents were about twice as likely as those who were not housing insecure to report poor or fair health status or delay doctor visits because of costs. This analysis supports a call to action among public health practitioners who address disparities to focus on social determinants of health risk behaviors and outcomes.

Associations of self-reported periodontal disease with metabolic syndrome and number of self-reported chronic conditions.

INTRODUCTION: Increasing evidence supports associations between periodontal disease and various chronic conditions. Possible explanations include chronic inflammatory processes, shared pathogens, and shared risk factors, such as smoking and psychosocial stress. The objective of this study was to assess associations of periodontal disease with metabolic syndrome and number of chronic diseases. METHODS: As part of the Washington Adult Health Survey, a household-based cross-sectional study conducted during 2006-2007 among adults aged 25 years or older in Washington State, we collected questionnaire data, blood samples, and anthropometric measures. We used these data to assess associations of periodontal disease with metabolic syndrome and the number of self-reported chronic diseases, controlling for age, sex, annual household income, smoking, and psychosocial stress. We used both complete case and multiple imputation Poisson regression analyses. RESULTS: In the adjusted complete case analysis, 1.4 times as many chronic conditions were found among people with severe compared with no periodontal disease, and people with severe periodontal disease were 1.5 times more likely to have metabolic syndrome than people with no periodontal disease. Arthritis and liver disease were individually associated with severe periodontal disease. Results of the multiple imputation analyses were similar. CONCLUSION: These results suggest that people with severe periodontal disease are likely to have more chronic diseases and are more likely to have metabolic syndrome compared with people without periodontal disease. Research about the effectiveness of periodontal treatment to help prevent or control chronic diseases is needed.

Limited percentages of adults in Washington State meet the Dietary Guidelines for Americans recommended intakes of fruits and vegetables.

Nutritious diets that include sufficient intake of fruits and vegetables promote health and reduce risk for chronic diseases. The 2005 Dietary Guidelines for Americans recommend four to 13 servings of fruits and vegetables daily for energy intake levels of 1,000 to 3,200 kcal, including seven to 13 servings for 1,600 to 3,000 kcal/day as recommended for adults aged ≥25 years. The 2006-2007 Washington Adult Health Survey, a cross-sectional study designed to measure risk factors for cardiovascular disease among a representative sample of Washington State residents aged ≥25 years, included a food frequency questionnaire (FFQ). The FFQ included approximately 120 food items and summary questions for fruits and vegetables that were used to compute energy intake and two measures of fruit and vegetable intake. Measure 1 was computed as the sum of intake of individual FFQ fruit and vegetable items; Measure 2 combined the summary questions with selected individual FFQ fruit and vegetable items. Depending on the measure used, approximately 14% to 22% of 519 participants with complete information met the guidelines for fruits, 11% to 15% for vegetables, and 5% to 6% for both fruits and vegetables. Participants aged ≥65 years and women were more likely to meet recommendations, compared with younger participants and men. Despite decades of public health attention, the vast majority of Washington State residents do not consume the recommended amount of fruits or vegetables daily. These findings underscore the need for developing and evaluating new approaches to promote fruit and vegetable consumption.

Rural/nonrural differences in colorectal cancer incidence in the United States, 1998-2001.

BACKGROUND: Few studies of colorectal cancer incidence by rural, suburban, and metropolitan residence have been published. METHODS: The authors examined colorectal cancer incidence among men and women in U.S. counties classified as rural, suburban, and metropolitan for the period 1998-2001. They examined rural/suburban/metropolitan differences in incidence by age, race, Hispanic ethnicity, stage at diagnosis, histology, and percentage of the total county population below the poverty level, using data from the CDC's National Program of Cancer Registries, the NCI's Surveillance, Epidemiology, and End Results Program, and the 2000 U.S. Census. RESULTS: A total of 495,770 newly diagnosed or incident cases of colorectal cancer were included in this analysis (249,919 among men and 245,851 among women). Over the period 1998-2001, the colorectal cancer incidence rates among men tended to be lower among those who resided in rural areas, for each of the subgroups examined, with the exception of Asians and Pacific Islanders and those living in more affluent counties. Among women aged 75 years and older, the colorectal cancer incidence rates tended to be lower among rural than metropolitan or suburban residents, though the differences were slight. In multivariate analysis, the incidence of colorectal cancer was higher in metropolitan, suburban, and rural areas for blacks than that for whites (incidence rate ratios [RR] = 1.12, 1.07, and 1.06, respectively, all P < 0.015). CONCLUSIONS: This study suggests that black men who reside in metropolitan areas have a higher risk of colorectal cancer than black men who reside in rural areas. This finding suggests the need for diverse approaches for reducing colorectal cancer when targeting rural compared with metropolitan areas.

Socioeconomic and demographic disparities in treatment for carcinomas of the colon and rectum.

BACKGROUND: The current study examined the relationship between socioeconomic and demographic factors and type of treatment for carcinomas of the colon and rectum. The National Institutes of Health and the National Cancer Institute recommend surgery followed by adjuvant chemo- and/or radiotherapy for Stage III colon and Stages II and III rectal carcinomas. METHODS: The authors linked Washington State's cancer registry and hospital discharge records and U.S. census data to assess socioeconomic and demographic factors related to treatment, controlling for clinical factors. RESULTS: Compared to colon carcinoma patients under age 65 years, patients aged 75-84 years and 85 years or older were at higher risk for a treatment plan of surgery without adjuvant therapy (adjusted odds ratio [OR] = 2.5, 95% confidence interval [CI] = 1.3-4.7; OR = 14.1, CI = 6.3-31.4, respectively). Risk of no adjuvant therapy was more than doubled for patients in zip codes in the lowest quartile of per capita income compared to the top three quartiles (OR = 2.3, CI = 1.5-3.4) and for those with Medicare compared to private insurance (OR = 2.2, CI = 1.3-3.8). Older patients with rectal carcinoma were also at higher risk of a treatment plan that did not include adjuvant therapy. CONCLUSIONS: The current findings suggest disparities in the provision of recommended medical procedures related to socioeconomic and demographic factors.