Prevalence of diabetes in Mexican Americans, Cubans, and Puerto Ricans from the Hispanic Health and Nutrition Examination Survey, 1982-1984.

The purpose of this study was to estimate the prevalence of diagnosed and undiagnosed diabetes among Mexican Americans, Cubans, and Puerto Ricans in the United States and compare these estimates to data from prior surveys for U.S. non-Hispanic whites and blacks. Data for this study are from the Hispanic Health and Nutrition Examination Survey, a multipurpose cross-sectional survey of three U.S. Hispanic populations conducted in 1982-1984. The interviewed sample of people aged 20-74 yr included 3935 Mexican Americans in the southwest, 1134 Cubans in Florida, and 1519 Puerto Ricans in the New York City area. The diabetes component consisted of interview questions on diabetes diagnosis and treatment and an oral glucose tolerance test administered to a subsample. The prevalence of diabetes was two to three times greater for Mexican Americans and Puerto Ricans than for non-Hispanic whites surveyed in 1976-1980. In Cubans, the prevalence was similar to that for non-Hispanic whites. In men and women 45-74 yr of age, the prevalence of diabetes was extremely high for both Mexican Americans (23.9%) and Puerto Ricans (26.1%) compared with Cubans (15.8%) or non-Hispanic whites (12%). The total prevalence of diabetes was not significantly different for Mexican Americans and Puerto Ricans but was significantly lower for Cubans. The relatively lower prevalence of diabetes among Cubans and the high prevalence in both Mexican Americans and Puerto Ricans may be related to socioeconomic, genetic, behavioral, or environmental factors.

Progress in the battle against hypertension. Changes in blood pressure levels in the United States from 1960 to 1980.

Intensive efforts by practicing physicians and public health workers to identify and treat persons with hypertension have been underway for many years. In this report, changes in blood pressure levels in the United States are assessed based on nationally representative health (and nutrition) examination surveys conducted by the National Center for Health Statistics in 1960 to 1962, 1971 to 1974, and 1976 to 1980. Analysis of age-adjusted data for adults aged 18 to 74 years (including those on antihypertensive medication) indicates that between the first and third surveys for whites and blacks, respectively, mean systolic blood pressure declined 5 and 10 mm Hg; the proportion of persons with systolic blood pressure of 140 mm Hg or higher fell 18 and 31%; the proportion with undiagnosed hypertension decreased 17 and 59%; and the proportion taking antihypertensive medications rose 71 and 31%. These differences between the first and third surveys were all statistically significant (p less than 0.05 or better). Changes in diastolic blood pressure levels were generally not significant among race-sex groups. The proportion of persons with definite hypertension (i.e., systolic blood pressure greater than or equal to 160 mm Hg, and/or diastolic blood pressure greater than or equal to 95 mm Hg, and/or taking antihypertensive medication) declined among blacks but rose slightly among whites. Study results are consistent with the recent decline in cardiovascular disease mortality.

Nutrient intakes among selected North American populations in the Lipid Research Clinics Prevalence Study: composition of fat intake.

Components of fat and their relationship to total energy are described for 2,368 white male and 2,200 white female adults, aged 20-59 years, for whom 24-hour dietary recalls were completed between 1972 and 1975 in nine North American populations as a part of the Lipid Research Clinics (LRC) Program Prevalence Study. Men had higher absolute intakes of total fat and cholesterol than women, although both sexes consumed diets similar in relative composition of polyunsaturated, saturated, and monounsaturated fatty acids. Marked geographical differences in intakes of energy, total fat, and dietary cholesterol were observed. Compared with data from dietary surveys conducted in the 1960's the LRC data showed that consumption of cholesterol had decreased by the early 1970's, whereas consumption of polyunsaturated fatty acids appears to have increased, resulting in a higher ratio of polyunsaturated to saturated fatty acids. However, comparison of current dietary guidelines with these data, which are based on a single dietary recall, showed that few LRC participants met the recommendations of the Senate Select Committee on Nutrition and Human needs for dietary fat intake.

Nutrient intakes among selected North American populations in the Lipid Research Clinics Prevalence Study: composition of energy intake.

Mean energy intake and its components are presented for 4,568 white adults, 20-59 years, who participated in a population survey at nine North American Lipid Research Clinics (LRC). Nutrient intake was evaluated by a 24-hour dietary recall. Mean energy intakes ranged from 3200 kcal at age 20 to 2400 kcal at age 59 for men (2150-1650 for women). Protein intake, about 15% of energy intake, exceeded 1 g/kg body weight at all ages. Carbohydrate intake was about 40-45% of kcal, starch provided 14-20%, and estimated sucrose intake provided about 6-14%. Sex- and age-related differences varied for each macronutrient. Mean alcohol intake, for those reporting alcohol consumption, contributed 6-18% of energy for women, and 8-15% for men. Comparisons are made with data from the Health and Nutrition Examination Survey I and from the USDA Nationwide Food Consumption Survey, with the Recommended Dietary Dietary Allowances, and with the Dietary Goals.

Electrocardiographic estimate of left ventricular mass versus radiographic cardiac size and the risk of cardiovascular disease mortality in the epidemiologic follow-up study of the First National Health and Nutrition Examination Survey.

The prognostic value of a left ventricular (LV) mass index (g/m2) estimated from an electrocardiographic model and radiographic estimates of the relative heart volume (ml/m2) and cardiothoracic ratio for predicting the risk of cardiovascular disease mortality were investigated using Cox regression analysis to adjust for age, systolic blood pressure and history of heart attack in 1,807 men (1,609 white, 198 black) and 2,143 women (1,884 white, 259 black). The study population (ages 35 to 74 years at baseline) was followed from 5 to 12 years (average 9.5 years) for cardiovascular disease mortality. LV mass index and relative heart volume were independent predictors of cardiovascular disease mortality among white men. All 3 cardiac size estimates were independent predictors for cardiovascular disease mortality among white and black women. When LV mass index was used as a dichotomized variable to indicate the presence or absence of LV hypertrophy, the age-adjusted relative risk of cardiovascular disease mortality was 2.48 (95% confidence interval 1.77 to 3.46) for white men, 3.03 (1.49 to 6.16) for black men, 1.86 (1.21 to 2.87) for white women and 2.05 (0.83 to 5.05) for black women. The corresponding prevalence of LV hypertrophy was 15.4% for white men, 36.6% for black men, 20.1% for white women and 17.4% for black women. It is concluded that the electrocardiographic estimate of LV mass index can identify a substantially larger fraction of persons at increased risk for cardiovascular mortality than conventional electrocardiographic criteria for LV hypertrophy and that LV mass index estimated by electrocardiogram is a valuable supplement to radiographic cardiac size estimates in epidemiologic applications.

Prevalence rates for scoliosis in US adults: results from the first National Health and Nutrition Examination Survey.

National prevalence estimates of scoliosis in adults, based on the reading of 6594 chest X-rays from the first National Health and Nutrition Examination Survey, are presented by age, sex and race. Among US adults aged 25-74 years in 1971-75, the prevalence rate of scoliosis was 8.3%. The prevalence of scoliosis increased across age groups among women (p less than 0.001), but not among men. Women had about twice the prevalence of scoliosis as men; 10.7% versus 5.6% (p less than 0.001). Because scoliosis prevalence rates differed by age and sex, prevalence rates and means for scoliosis status subgroups were adjusted for age and sex. Blacks had a higher rate, although not statistically significant (using alpha = 0.10), of scoliosis than whites: 9.7% versus 8.1%. Bone density of the radius was lower for scoliotics than for non-scoliotics: (287.0 versus 294.0 aluminum equivalency units, p less than 0.001), suggesting a possible association between scoliosis and osteoporosis. The percentage with delayed menarche was higher for scoliotics than non-scoliotics: 37.8 versus 30.8% (p = 0.01). Scoliotic women also had a lower mean age of menstruation termination than non-scoliotic women: 43.4 years versus 44.8 years (p = 0.07). This is the first study to present national prevalence estimates for scoliosis among adults in the US.

Health effects of sunlight exposure in the United States. Results from the first National Health and Nutrition Examination Survey, 1971-1974.

The dermatologic component of the first National Health and Nutrition Examination Survey (N = 20,637), conducted from 1971 through 1974, documented the deleterious effect of ultraviolet radiation on selected skin and eye conditions. Actinic skin damage was more frequent in white men with high as compared with low sunlight exposure, 36.7% vs 23.3%, respectively. Among white women, the corresponding figures were 34.1% vs 18.6%, respectively. Actinic damage was found more often in individuals with light eye color. Basal cell epitheliomas were found in 11.3% of white men aged 65 to 74 years who had severely actinic-damaged skin as compared with 1.0% of those with undamaged skin. Sunlight exposure was positively associated with localized hypomelanism, localized hypermelanism, seborrheic keratoses, senile lentigines, freckles, acne rosacea, spider nevi, varicose veins, venus star, dry skin, wrinkled skin, pterygia, arcus senilis, and a variety of minor oral lesions of the tongue, palate, and buccal mucosa. These findings suggest that a large number of dermatologic conditions, which may in part result from overexposure to sunlight, may be preventable.

Lymphangiosarcoma and haemangiosarcoma in a cat.

Ultrastructural findings in a feline ventral abdominal vascular tumour showed lack of basal lamina, few micropinocytotic vesicles and intercellular junctions and a discontinuous endothelial cell layer. A splenic cyst had a continuous basal lamina, numerous micropinocytotic vesicles and intercellular junctions and a continuous endothelial cell layer. These findings were compatible with diagnosis of lymphangiosarcoma (ventral abdomen and metastases) and haemangiosarcoma (splenic cyst).

Breast cancer screening in older women.

BACKGROUND: There is currently an epidemic of breast cancer in women 65 years of age and older. The purposes of this paper are to explore the breast cancer screening behaviors of older women and to identify some of the determinants of screening in these women. METHODS: Data were analyzed from the 1987 National Health Interview Survey, a continuous nationwide household interview survey of the U.S. civilian, noninstitutionalized population. RESULTS: As in other studies, the utilization of breast cancer screening by older women was less in older women than in younger women. This was true for both mammography and clinical breast examination. A number of determinants of screening in older women were identified here. Women with a usual source of care and/or no activity limitation, as well as high school graduates, were the ones most likely to have received a screening mammogram and/or a screening clinical breast exam during the past year. DISCUSSION: The failure of older women to receive adequate breast cancer screening is an important concern which should be reevaluated, given the breast cancer epidemic in this population. This study identified a number of determinants of breast cancer screening in older women. For the most part, these determinants point to the primary care physician as the key to breast cancer screening in these women. Therefore, the primary care physician must be informed of, and encouraged to follow, the recommendations for periodic breast cancer screening in older women.

Women, work and coronary heart disease: prospective findings from the Framingham heart study.

This study examined the relationship of employment status and employment-related behaviors to the incidence of coronary heart disease (CHD) in women. Between 1965 and 1967, a psychosocial questionnaire was administered to 350 housewives, 387 working women (women who had been employed outside the home over one-half their adult years), and 580 men participating in the Framingham Heart Study. The respondents were 45 to 64 years of age and were followed for the development of CHD over the ensuing eight years. Regardless of employment status, women reported significantly more symptoms of emotional distress than men. Working women and men were more likely to report Type A behavior, ambitiousness, and marital disagreements than were housewives; working women experienced more job mobility than men, and more daily stress and marital dissatisfaction than housewives or men. Working women did not have significantly higher incidence rates of CHD than housewives (7.8 vs 5.4 per cent, respectively). However, CHD rates were almost twice as great among women holding clerical jobs (10.6 per cent) as compared to housewives. The most significant predictors of CHD among clerical workers were: suppressed hostility, having a nonsupportive boss, and decreased job mobility. CHD rates were higher among working women who had ever married, especially among those who had raised three or more children. Among working women, clerical workers who had children and were married to blue collar workers were a highest risk of developing CHD (21.3 per cent).

Spouse behavior and coronary heart disease in men: prospective results from the Framingham heart study. I. Concordance of risk factors and the relationship of psychosocial status to coronary incidence.

The relationship of social status and behavior type to the incidence of coronary heart disease was examined among husbands and wives in the Framingham Heart Study. Between 1965 and 1967, 269 spouse pairs, in which the husbands were 45-64 years of age, were administered an extensive psychosocial questionnaire. These pairs were followed over a 10-year period for the development of heart disease. Men married to women with 13 or more years of education were 2.6 times more likely to develop coronary disease than men married to women with a grammar school education (95% CI = 1.0-6.9). Incidence rates among husbands married to women employed outside the home were similar to rates among men married to housewives (15.1 vs. 16.1%, respectively). However, men married to women employed in white-collar jobs were over three times more likely to develop heart disease than those married to clerical workers, blue-collar workers, or to housewives (RR = 4.0, 5.4, and 2.9, respectively; p less than or equal to 0.004). The increased risk in husbands married to women educated beyond the high school level was observed only among men married to women employed outside the home. These effects were apparent regardless of the husband's social status or standard coronary risk factors. Further exploration of these associations revealed that higher-educated working wives whose husbands developed coronary heart disease were significantly more likely to have had a nonsupportive boss and fewer job promotions than wives of noncases.

Spouse behavior and coronary heart disease in men: prospective results from the Framingham heart study. II. Modification of risk in type A husbands according to the social and psychological status of their wives.

Analyses of spouse data from the Framingham Heart Study indicated that the risk of developing coronary heart disease among Type A men, compared with Type B men, was modified by the behavior or social status of their wives. Between 1965 and 1967, 269 spouse pairs, in which the husbands were 45-64 years of age, were administered an extensive psychosocial questionnaire. These pairs were followed over a 10-year period for the development of heart disease. When Type A and Type B men were stratified by the social and personality characteristics of their wives, it was found that the differential rate of heart disease between Type A and Type B men was present only in situations where the wives' characteristics might be deemed stressful. Type A husbands were 2.5 times as likely to develop coronary heart disease as Type B husbands if married to women with 13 or more years of education, and had 3.5 times the coronary risk of Type B husbands if married to a woman employed outside the home. When spouses were stratified by behavior type, employed outside the home. When spouses were stratified by behavior type, the highest rates of coronary heart disease were among Type A men married to Type B wives (25%). This rate was over three times the rate among Type B men married to Type B wives (7.8%). When tests for interaction between the behavior type of husbands and characteristics of wives were calculated, significant effects were found among blue-collar men on all variables except wives' educational level. This indicates that Type A men in white-collar occupations are at higher risk of heart disease regardless of wives' characteristics; whereas, the effect of behavior type among men in blue-collar occupations was interrelated with and modified by wives' characteristics. These results were apparent regardless of the husbands' standard coronary risk factors.

Type A behavior and the ten year incidence of coronary heart disease in the Framingham Heart Study.

This study explored the association between Type A behavior, as measured by a short questionnaire on time urgency and competitiveness, and the development of coronary heart disease (CHD). An assessment of Type A behavior in 750 women and 580 men, aged 45-64 years, participating in the Framingham Heart Study, took place between 1965 and 1969. Type A behavior was associated with a two-fold risk of developing CHD over the ensuing 10 years. Among all women, the relative risk (RR) was 2.0 with confidence limits = 1.2 to 3.3. Among housewives, CHD incidence rates were 2.5 times greater among Type A's compared to Type B's (p = 0.02). Type A working women were more than 1.5 times as likely to develop CHD as Type B's, although this was not significant at the 10 year follow-up. Among men employed in white-collar jobs, the RR was 2.4 with confidence limits = 1.1 to 5.7. Type A behavior was most strongly related to coronary diagnoses in which angina pectoris symptoms were present. Synergism between Type A behavior and other CHD risk factors is demonstrated. The findings suggest that assessment of Type A behavior can improve the prediction of incident coronary cases, independent of the standard coronary risk factors.

The relationship of psychosocial factors to coronary heart disease in the Framingham Study. III. Eight-year incidence of coronary heart disease.

An extensive psychosocial questionnaire was administered to 1674 coronary free individuals participating in the Framingham Heart Study between 1965 and 1967. The respondents were followed for the development of coronary heart disease (CHD) over an eight-year period. Women (aged 45-64 years) who developed CHD scored significantly higher on the Framingham Type A behavior, suppressed hostility (not showing or discussing anger), tension, and anxiety symptoms scales than women remaining free of CHD. Type A women developed twice as much CHD and three times as much angina as Type B women. In a multivariate analysis, Framingham Type A behavior and not discussing anger were independent predictors of CHD incidence when controlled for the standard coronary risk factors and other psychosocial scales. Men exhibiting Framingham Type A behavior, work overload, suppressed hostility (not showing anger), and frequent job promotions were at increased risk of developing CHD (especially in the age group 55-64 years). Among men aged 45-64 years, Type A behavior was associated with a twofold risk of angina, myocardial infarction, and CHD in general, as compared to Type B behavior. The association was found only among white-collar workers and was also independent of the standard coronary risk factors and other psychosocial scales. This prospective study suggests that Type A behavior and suppressed hostility may be involved in the pathogenesis of CHD in both men and women.

Survival after early and normal retirement.

This paper describes an epidemiological study of the patterns and correlates of survival after early (age 62 to 64) and normal retirement (age 65) among 3,971 U.S. rubber tire workers. For the two companies, death rates were significantly elevated during the first, fourth, and fifth years after early retirement. Among normal retirees, elevations in death rates occurred during the third or fourth years after retirement in Company B and Company A, respectively. When the experiences of both companies were combined, no significant mortality excesses were observed. Comparisons of deaths (cases) within 5 years of retirement with survivors (controls) showed that pre-retirement health status was the only significant predictor of survival after early retirement. Among normal retirees, lower status workers were more likely to die within 3 years of retirement than higher status workers, who were more prominent among deaths 4 to 5 years after retirement. Risks of dying were greater among normal retirees with a history of repeated medical and nonmedical absences.

Nutrient intake, lipids, and lipoprotein cholesterols in black and white children: the Lipid Research Clinics Prevalence Study.

Our specific aim was to assess differences in nutrient intake and in lipids and lipoprotein cholesterols between blacks and whites in 259 black children (129 boys, 130 girls) and in 811 white children (424 boys, 387 girls) ages 5-19. The nutrient intake data were obtained by 24-hr recall from the Houston and Cincinnati Lipid Research Clinics. The fundamental nutrient differences between blacks and whites were in total calories and in calories per kilogram of body weight, both of which were uniformly and significantly lower among black than white boys and generally, but less consistently and significantly, lower among black than white girls. No racial differences in total cholesterol or cholesterol intake per kilogram body weight were observed. After statistically controlling for education of the head of household, there were no consistent significant racial differences in Quetelet index. There was no significant independent effect of education of head of household on the children's caloric intake and racial differences in socioeconomic status did not appear to systematically account for differences in total energy intake. In aggregate, black children had lower triglyceride and very-low-density lipoprotein cholesterol levels, and higher levels of high-density lipoprotein cholesterol than whites; there were no significant differences by race in low-density lipoprotein cholesterol levels. Race was a significant independent explanatory variable for high-density lipoprotein cholesterol levels (higher in blacks) and for very-low-density lipoprotein and triglyceride levels (higher in whites) (P less than 0.005), after covariance adjusting for education of head of household, sex, age, Quetelet index, calories, saturated fat (g/day/kg body wt), and clinic. Lower caloric intake among blacks compared with whites, the major nutrient difference in the current study, did not account for differences in lipoprotein cholesterol levels between the two groups.