Myocardial infarction occurrence in Jerusalem: a Mediterranean anomaly

BACKGROUND: The Jewish population of Israel consumes a diet rich in polyunsaturated fatty acids with a relatively low proportion of saturated fat, has a small alcohol intake and a lipid profile characterized by low HDL-cholesterol and high lipoprotein(a) (Lp(a)). It is therefore of interest to compare occurrence rates of coronary heart disease (CHD) with those elsewhere. METHODS: The community-based event rate of CHD [comprising acute myocardial infarction (AMI) and CHD death] and case-fatality was determined in 1995-1997 by active surveillance among Jewish residents of the Jerusalem District aged 25-64 according to standardized WHO-MONICA criteria. We compared our findings with rates among MONICA populations in 21 countries. Twelve hundred and six events occurred in Jerusalem during approximately 399,000 [correction] person-years (930 non-fatal AMI and 276 CHD deaths). RESULTS: The age-adjusted incidence of CHD ranked high compared with the 21 countries (men third highest, women eighth highest), far exceeding the Mediterranean countries. In contrast, the pre-hospital mortality rate was low, similar to countries in the Mediterranean basin, and the 28-day case fatality was remarkably low, far lower than for any MONICA population in men, and second lowest in women. Correspondingly, the incidence of non-fatal AMI ranked extraordinarily high (men first, women third). The low case-fatality ranking persisted upon adjustment for treatment differences between populations. CONCLUSIONS: We report an unusual combination of a high incidence of CHD among Jewish residents of Jerusalem accompanied by extraordinarily low case fatality, the latter suggesting reduced susceptibility to lethal arrhythmias. Determinants of this anomaly require clarification.     

Epidemiology of bronchial asthma and chronic rhinitis in schoolchildren of different ethnic origins from two neighboring towns in Israel

Allergic diseases have increased significantly in developed countries for reasons yet to be determined. We studied the epidemiology of bronchial asthma (B.A.) and chronic rhinitis (Ch.R.) among Israeli school children from two neighboring towns, one Jewish (Zichron Yaakov, school population = 585) and the other Arab (Paradis, school population = 658). The children (age range 8-17 years, 567 males, 676 females) shared the same climate and had similar demographic characteristics. They received similar medical care and had the same rates of hospitalization and emergency room visits. The Jewish children had a higher prevalence of B.A. (13.7% vs. 9.4%), Ch.R. (19.7% vs. 9.7%), and stuffy nose (31% vs. 14%) than their Arab counterparts. In addition to ethnicity, parental smoking habits were the major differentiating factor between the two groups: 20% of the mothers and 29% of the fathers from Zichron Yaakov and 2% of the mothers and 60% of the fathers from Paradis were smokers. Smoking fathers increased the rate of B.A. in both towns as well as emergency room visits, but not the rate of Ch.R. or stuffy nose. A familial history of B.A. was the main determinant for having childhood asthma or chronic rhinitis. We conclude that in addition to family history and ethnicity, smoking among mothers was the major contributing factor for the higher prevalence of atopic diseases among Jewish schoolchildren compared to their Arab counterparts.     

The Relation Between NOD2/CARD15 Mutations and the Prevalence and Phenotypic Heterogeneity of Crohn’s Disease: Lessons from the Israeli Arab Crohn’s Disease Cohort

The prevalence of Crohn’s disease depends on geographic location and racial background. Arg702Trp, Gly908Arg, and Leu1007fsinsC mutations in the NOD2/CARD15 gene are associated with Crohn’s disease in Caucasians. The mutation rate among Israeli Jewish patients is 27%–41%. The prevalence of Crohn’s disease is much lower in the Israeli Arab compared to the Israeli Jewish population. We studied the NOD2/CARD15 mutation rate and disease phenotype (according to the Vienna classification) among the Israeli Arabs and compared them with those in an Israeli Jewish cohort. We recruited 66 Israeli Arab patients and 122 ethnically matched controls. Five patients (8.2%) and three controls (2.3%) carried one NOD2/CARD15 mutation. The phenotypic characteristics of the Arab and Jewish patients were very similar. We conclude that NOD2/CARD15 mutations do not contribute to Crohn’s susceptibility in the Israeli Arab population and suggest that NOD2/CARD15 mutations have an important effect on Crohn’s prevalence within a specific population but not on the phenotype. R. Safadi, MD, and R. Eliakim, MD, share senior authorship     

Behçet's disease in Israel: the influence of ethnic origin on disease expression and severity

OBJECTIVE: To evaluate the relationship between ethnic origin and manifestations of Beh?et's disease (BD) in Israel. METHODS: We studied 100 Israeli patients with BD, 66 Jews and 34 Arabs. The 3 largest ethnic groups of Jewish patients originated from Iran/Iraq (n = 21), Turkey (n = 12), and North African countries (n = 21). Patients were evaluated with respect to the entire spectrum of disease manifestations, and a systemic severity score for BD was calculated for each patient. Disease expression was compared between Jewish and Arab patients and among Jewish ethnic groups. RESULTS: There were no statistically significant differences between Jewish and Arab patients with respect to male:female ratio, prevalence of HLA-B5, age of disease onset, or disease duration. Disease expression and severity score were also similar in the 2 groups, but Arab patients had a higher rate of posterior uveitis (20.6 vs 4.6%; p < 0.03). Among the 3 largest Jewish ethnic groups, patients of North African origin had a significantly higher rate of ocular disease (p < 0.01), mainly in the form of anterior uveitis (p < 0.01). These patients also had higher rates of arthritis, overall vascular disease, deep vein thrombosis, and neuro-Beh?et without reaching statistical significance. The disease severity score in this group was significantly higher compared to the other Jewish ethnic groups (p < 0.02). CONCLUSION: The expression of BD is similar in Israeli Jewish and Arab patients but the latter have more severe eye disease. The disease in Israeli Jewish patients is most severe in those originating from North African countries.     

Identification of a common mutation (Gly194Cys) in both Arab Moslem and Ashkenazi Jewish patients with dihydrolipoamide dehydrogenase (E3) deficiency: Possible beneficial effect of vitamin therapy

Dihydrolipoamide dehydrogenase (E3) deficiency with a clinical phenotype and genotype (Gly194Cys homozygous) previously identified only in Ashkenazi Jewish patients, was diagnosed in two Palestinian Arab siblings and two unrelated Ashkenazi Jewish patients. While three of the four patients died in childhood without specific treatment, the surviving patient at age 18 years may have benefited from long-term daily supplementation with a cocktail of riboflavin, biotin, coenzyme Q and carnitine.     

Coronary heart disease among diabetic and nondiabetic people - socioeconomic differences in incidence, prognosis and mortality

OBJECTIVE: To investigate coronary heart disease (CHD) morbidity and mortality and their patterning by socioeconomic status among diabetic and nondiabetic individuals in Finland. METHODS: All diabetic persons aged 35-74 years entitled to free anti-diabetic medication were drawn from the 1991-1996 national health insurance files along with nondiabetic referents. Outcome events for up to 6 years of follow-up, corresponding to 418,987 and 867,813 person-years in diabetic and nondiabetic people, respectively, were identified from national health insurance, hospital discharge and causes of death registers using personal identification codes. RESULTS: The annual CHD incidence for diabetic women and men was 2.7% and 3.7%, respectively, corresponding to relative risks of 3.55 (95% CI: 3.43-3.67) and 2.64 (95% CI: 2.56-2.72) compared to nondiabetic persons. The impact of diabetes on CHD mortality was greater, with relative death rates of 6.04 and 3.42 for women and men, respectively. CHD mortality and incidence displayed systematic socioeconomic trends with higher rates among worse-off diabetic and nondiabetic people, although gradients were generally steeper for nondiabetics. In the diabetic population, socioeconomic differences were rather similar for sudden CHD deaths and nonfatal CHD incident cases. For both genders, socioeconomic differences in mortality after CHD diagnosis were small in both diabetic and nondiabetic persons, except for the lowest compared to the highest income quintile. CONCLUSIONS: Socioeconomic CHD mortality differences among diabetic people in Finland were mainly explained by higher CHD incidence and particularly sudden deaths without prior CHD diagnosis. No systematic socioeconomic differences were found in long-term prognosis after CHD diagnosis.     

Coronary heart disease mortality trends and related factors in Australia

Coronary heart disease (CHD) has been the greatest single cause of mortality in Australia over the past 30 years. For most age and sex groups CHD mortality rates peaked in 1965-67. Since that time, rates have decreased by nearly 40% and are currently the lowest for 30 years. CHD mortality rates are highest in the eastern areas of Australia, among those who were born in Australia, and among lower socio-economic groups. Changes in CHD mortality have been accompanied by changes in life-style (particularly recent decreases in the prevalence of cigarette smoking, large reductions in tar content of cigarettes and a large change in preference for margarine over butter) and changes in treatment (especially in the control of hypertension and surgical interventions). Concurrent studies of the incidence and case fatality rates in two population centres (Perth and Newcastle) coupled with periodic surveys of changes in treatment and population risk factor levels are being undertaken over a 10-year period to try to understand the current and future trends in CHD mortality.     

Cardiovascular risk profiles in UK-born Caribbeans and Irish living in England and Wales

Cardiovascular disease is the leading cause of morbidity and mortality among Caribbean and Irish origin people living in England and Wales. Yet mortality from coronary heart disease (CHD) of migrant Caribbeans is lower than the national average, while stroke mortality is higher. The Irish experience higher than average mortality from both diseases. Little is known about the health of the children of these migrants. The Health Survey for England (HSE) 1999 was used to investigate for the first time cardiovascular risk factors in UK-born Caribbeans aged 35-44 and Irish aged 35-44 and 45-54 years. Caribbean men were more likely to smoke but had higher mean HDL-cholesterol than men in the general population. Caribbean women had greater body mass indices and lower mean triglyceride levels. Irish men in both age groups smoked more than men in the general population, but in the younger group had lower diastolic blood pressure (BP). At age 35-44 only, Irish women were shorter than women in the general population. These findings were independent of differences in socio-economic position. Previously, Caribbean-born migrants to Britain had generally favourable lipid profiles in line with lower CHD rates, despite obesity and diabetes. The nationally representative but small-scale data presented here suggest that UK-born Caribbeans appear to be losing this more favourable lipid pattern and among men smoking rates are now higher compared with general population men, suggesting that an increase in CHD rates can be expected. Further research should examine how improved education and specific intervention programs could be used to reduce smoking among UK-born Irish and Caribbean men, and obesity among UK-born Caribbean women. The next HSE also needs to include adequate numbers of younger people of different ethnic origins to allow time trends in these anthropometric, behavioural and metabolic risk factors to be examined reliably and fully.     

Eating disorders and disordered eating in Israel: An updated review

Israel presents a unique opportunity to study the role of socio‐cultural parameters in the development of mental disturbances because of the exceptional diversity of the Israeli society. In the present review, we aimed to analyse the current state of disordered eating in Israel by means of an extensive literature review. The following are the main findings of our review: The frequency of maladaptive eating among female and male Israeli Jewish adolescents is higher in comparison to many other Westernised countries. Among different Jewish sub‐populations, Kibbutz women have been found until recently to show higher rates of disordered eating in comparison to other Israeli samples. Recent studies show no such difference between Kibbutz members and the general Israeli population. No clear‐cut findings emerge with respect to the influence of immigration and degree of Jewish religious affiliation on the occurrence of disordered eating. In contrast, disordered eating is less prevalent in Israeli‐Arabs compared with Israeli‐Jews. Moreover, diverse Israeli‐Arab groups show different rates of disordered eating. We discuss the high rate of disordered eating in Israeli youth in light of Israel being a culture in transition that is constantly exposed to the risk of terrorism. The changes in the rates of disordered eating in the Kibbutzim are discussed in light of the dramatic societal changes occurring in these communities within a relatively brief period of time. The low rates of disordered eating in Israeli‐Arabs reflect the traditional non‐Westernised characteristics of their society, whereas the differences between diverse Arab sub‐populations depend upon the degree of exposure to Westernised influences and the presence of conflicts between modern and traditional values. Copyright © 2008 John Wiley & Sons, Ltd and Eating Disorders Association.     

Ischemic heart disease and risk factors for 40 to 59-year-old men living in the Kabardino-Balkarian ASSR

A study of 379 males selected at random from a population of 40- to 59-years-old male residents of the Lenin district in Nalchik and 320 rural Kabardino-Balkarian male residents of the same age demonstrated that the prevalence of coronary heart disease (CHD) among 40- to 59-years-old males in Nalchik (10.0%) as determined by epidemiologic ECG assessment criteria was similar to that of Moscow (9.6%) and significantly higher than that of rural Kabardino-Balkaria (6.2%, p less than 0.01). A higher prevalence of CHD in male residents of Nalchik is associated with a higher incidence of major CHD risk factors (arterial hypertension, hypercholesterolemia, smoking, excessive body weight) as compared to rural Kabardino-Balkarian population.     

Prevalence and clinical aspects of Behcet’s disease in the north of Israel

Behcet’s disease (BD) has a higher prevalence in countries along the ancient silk route, but the actual prevalence in Israel is unknown. We evaluated the occurrence and clinical expression of BD in the northern region of Israel: in the whole population and by ethnic groups. The sample included all adult patients with BD (International Study Group criteria) treated at three medical centers in northern Israel. Patient data were collected by file review and physician survey. Relevant demographic data for the population served by the medical centers were obtained from the official Israeli authorities. A total of 112 patients were identified. The overall prevalence of BD was 15.2/100,000 and was similar in men and women. The prevalence rates among the Jewish, Arab, and Druze populations were 8.6, 26.2, and 146.4 per 100,000, respectively. Age at disease onset was similar in all ethnic groups and significantly lower in males (28.6±9.7 vs 32.9±11.3, p=0.03). There were no differences in disease manifestations by sex or ethnicity. All Druze patients were HLA-B5 positive, compared to 80.8% of the Arab patients and 72.0% of the Jewish patients. Recurrent oral ulcers in family members were more common in Arab patients (p=0.004). The BD severity index was significantly lower in Druze patients (p=0.05), mainly in males (p=0.03). This study confirms the high prevalence of BD in Israel and the variability in disease rates and expression by ethnic origin. Our findings, particularly regarding the Druze population, call for further field surveys and genetic studies.     

Time trends in the occurrence and outcome of acute myocardial infarction and coronary heart disease death between 1986 and 1996 (a New Jersey statewide study).

Most reports of the decrease in age-adjusted coronary heart disease (CHD) are based on databases with upper age cut-offs that exclude approximately half of the events. We report changes in rates of acute myocardial infarction (AMI) and of out-of-hospital coronary death between 1986 and 1996 among New Jersey residents > or =15 years old. Data on patients discharged with the diagnosis of AMI from nonfederal acute care hospitals in the state (n = 270,091) and all records in the New Jersey death registration files with CHD (n = 172,175) listed as the cause of death from 1986 to 1996 (total study n = 442,266) were analyzed. The rate of hospitalized AMI cases in the state remained essentially unchanged during these 11 years, whereas in-hospital and 30-day case fatality among all age groups and both sexes declined. Age-adjusted CHD rates showed a decrease in fatal events, a smaller decrease in total events, and a slight increase in nonfatal events. The proportion of fatal CHD events occurring out-of-hospital decreased especially among men. The median age at occurrence of events increased by 1 year. Despite a decrease in CHD mortality, the rate of nonfatal events increased, especially among persons > or =75 years old. Thus, the decrease in age-adjusted CHD mortality is not all due to treatment and true prevention of CHD, but the disease simply occurs at an older age.     

The effect of hypertension as a predictor of risk for congestive heart failure patients over a 10-year period in a newly developed country

AIMS: Cardiovascular disease is the leading cause of mortality and morbidity in the western world and has reached epidemic proportions. The incidence of congestive heart failure (CHD) and hypertension is also rising rapidly in many of the affluent Arab nations and cardiovascular diseases continue to be a leading cause of morbidity and mortality among adult Qataris and Asians residing in Qatar. OBJECTIVE: The objective of this study is to assess the effect of hypertension among patients admitted to hospital in Qatar with CHD and to identify risk factors that contribute to the development of CHD in hypertensive subjects. DESIGN: This is a retrospective cohort study. SETTING: Hamad General Hospital, Hamad Medical Corporation. SUBJECTS: All patients who were hospitalized with CHD with or without hypertension in the Hamad General Hospital, State of Qatar, from 1991 to 2001. METHODS: The diagnostic classification of definite CHD was made in accordance with criteria based on the International Classification of Disease, ninth revision (ICD-9]. RESULT: A total of 20,856 patients were treated during the 10-year period; 8446 were Qataris. Among them, 60% were males and 40% females. Among the total patients (3713) hospitalized with CHD, 1744 (46.9%) had hypertension. Furthermore, the incidence of hypertension was slightly higher in males than in females (56.4 vs 43.6%). A statistically significant difference was found between hypertensive and non-hypertensive cases with diabetes mellitus and angina. Hypertensive subjects were more likely to have diabetes (p < 0.001) and angina (p < 0.030). The mortality rate of CHD patients with hypertension was higher among Qataris than among non-Qataris (p < 0.038). CONCLUSION: Hypertension was the most common risk factor for CHD; it contributed a large proportion of heart failure cases in this population-based sample. Preventive strategies directed toward earlier detection of elevated blood pressure and its control are likely to offer the greatest promise for reducing the incidence of CHD and its associated mortality.     

Sarcoidosis in residents of northern Israel of Arabic and Jewish origin: a comparative study

BACKGROUND: This study describes the features of sarcoidosis among Arab patients and compares it to Jewish patients residing in northern Israel. METHODS: All new cases of biopsy-confirmed sarcoidosis diagnosed between 1980 and 1996 in northern Israel were divided into two groups according to their ethnic origin: Jewish (n = 72) and Arabic (n = 48). Disease parameters were recorded and compared. RESULTS: Arabs and Jews had similar incidence rates that increased from 0.2/10(5) in 1980 to 2/10(5) per year in 1996. The peak incidence was in the sixth and seventh decades and the female/male ratio was 2 and 1.4 for Arabic and Jewish patients, respectively. Jewish patients had higher proportion stage II-IV pulmonary disease (78% vs. 51.2%) while their Arabic counterparts had higher proportion of stage I disease (70.8% vs. 41.7%). The proportion of extra-thoracic organ involvement was similar. Different disease phenotype indicated differed diagnostic procedures; higher proportion of mediastinoscopy for stage I disease among Arabic patients (47.9% vs. 20.8%, P = 0.015) and trans-bronchial biopsy for stage II-IV pulmonary disease among Jewish patients (25% vs. 8.35%, P = 0.05). Corticosteroids were used in a non-significantly higher proportion of Jewish patients (56.9% vs. 43.8%, P > 0.05). Of six sarcoidosis-related deaths (5%), five occurred in Jewish patients. CONCLUSIONS: This study has documented different forms of presentation, clinical manifestation, severity and prognosis of sarcoidosis present among patients of Arabic and Jewish origin residing in the area of northern Israel.     

Osteoporosis health-related behavior among healthy peri-menopausal and post-menopausal Israeli Jewish and Arab women

BACKGROUND AND AIMS: Health practices such as calcium-rich diet and exercise, are associated with the prevention of osteoporosis. Since studies showed that ethnic minorities are less involved in preventive practices, the aim of this study was to examine patterns and correlates of osteoporosis health-related behavior in Israeli-Jewish and Arab women. METHODS: Interviews were conducted with 261 women aged 45 and older (70% Jewish). Health behavior included: physical activity, smoking, alcohol consumption, use of hormone replacement therapy, screening behavior, calcium intake, pharmacological prevention, and help-seeking patterns. Correlates included demographic variables, health characteristics (menopausal status, family history of osteoporosis), knowledge about osteoporosis, and beliefs (susceptibility and worries about developing osteoporosis). RESULTS: Compared with Jewish participants, a lower percentage of Arab women engaged in physical activity, were on HRT, and had had bone density examinations. Their overall calcium intake was significantly lower as well. Levels of knowledge were moderate to low for the whole group, but more so among Arab women. Engaging in physical activities was associated with being menopausal and with having more knowledge among Jewish women, and with having more knowledge and lower rates of concern among Arab women. CONCLUSIONS: Expanding knowledge about osteoporosis may prove beneficial for increasing participation in preventive behavior in both groups. Special attention should be paid to different levels of education and to differences in subjects' needs and accessibility to sources of information.     

Decreasing mortality from acute myocardial infarction: effect of incidence and prognosis.

Coronary heart disease (CHD) mortality rates have declined for the past 25 years in most western countries. During the 1970s and early 1980s, a decline in incidence was the main factor in the decline in mortality, but more recently, improvements in treatment and prognosis have played a larger role. Most of the change is a result of improvements in the treatment of risk factors among patients with chronic CHD, while the treatment of acute myocardial infarction has contributed a smaller part. CHD mortality has consistently decreased more than incidence, which may have led to an increased prevalence of CHD. Simultaneously, the treatment practice patterns and possibly also clinical presentation of CHD has changed so that hospitalizations as a result of CHD diagnoses other than myocardial infarction have increased, while definite myocardial infarctions have decreased. Furthermore, the stabilizing rates of incident myocardial infarction combined with the aging population tend to increase the numbers of CHD patients. Therefore, the total burden of CHD to the community has decreased less than one would expect on the basis of age-standardized mortality rates. There is a need to re-emphasize primary prevention, since heavy reliance on expensive treatments for the post-war baby-boom generation presents a major concern for public health resources.     

A population-based study of hairy cell leukemia in Israel

OBJECTIVES: Few population-based data exist on the incidence and prognosis of hairy cell leukemia (HCL). Our objectives were to study the effect of socio-demographic factors on this rare disease and the risk of second malignancies occurring in HCL patients. METHODS: We measured crude and age-adjusted incidence rates of HCL based on reporting to the Israel Cancer Registry (ICR) 1991-2001. Using Kaplan-Meier and multivariate analysis, we assessed survival by gender, ethnicity and geographic region. We ascertained additional primary tumors reported in this population and calculated standardized incidence ratios (SIRs) for tumors reported after the diagnosis of HCL. RESULTS: The ICR registered 147 cases of HCL among males and 34 in females between 1991 and 2001. Age-adjusted incidence rates were 1.62/10(6)/yr for women and 7.97/10(6)/yr for men, with rates 1.5 times higher in Jewish than in non-Jewish (mainly Arab) men. Mean overall survival also differed by ethnicity. In a multivariate model, increasing age at diagnosis (P < 0.001), as well as Arab origin (P = 0.008) were associated with poorer survival but gender did not significantly affect the survival after controlling for age and ethnicity. Other primary malignancies were reported in 20 (11%) individuals, with a predominance of genito-urinary tumors (65%) among males. Secondary genito-urinary tumors were significantly increased above the expected population rates (SIR 3.23, 95% confidence interval: 1.39-6.36, P = 0.008). CONCLUSIONS: In the Israeli population, age and ethnicity were associated with prognosis of HCL. Variations in disease characteristics, stage of disease at diagnosis or differential access to treatment may contribute to these findings. Patients with HCL appear to be at increased risk for genito-urinary malignancies.     

The marked decline in coronary heart disease mortality rates in the United States, 1968-1981; summary of findings and possible explanations

During the years 1940-1967, age-adjusted mortality rates from coronary heart disease (CHD) rose in the USA by 14.1% for all persons aged 35-74. This upward trend was recorded for white men, black men, and black women, but not for white women. From 1968 to 1981 (year of latest record), the trend in the preceding period was reversed, i.e., CHD death rates decreased steadily, at a rate averaging about 3% per year. This downward trend has involved all age-sex-color groups in the adult population and all regions of the country. It has encompassed both main categories of CHD, i.e., acute myocardial infarction (AMI) and chronic ischemic heart disease (CIHD), the former more prominently than the latter, especially among adults aged 35-64. The US decline in CHD mortality rates is greater-absolutely and relatively-than that of any other country. US death rates from stroke have also fallen markedly over these years, so that death rates from the major cardiovascular diseases (CVD) and all causes also fell substantially, with savings of hundreds of thousands of people from premature death since 1968. Responding to vigorous development in the USA over the last 25 years of public policy and strategy for the prevention and control of the coronary epidemic, tens of millions of Americans have made changes in eating habits resulting in lower population mean intake of total fat, saturated fat, cholesterol; increased intake of polyunsaturated fats; decreased mean levels of serum cholesterol and rates of hypercholesterolemia. Prevalence rates of cigarette smoking among adults have also decreased markedly. Tens of millions have taken up leisure time exercise. All these changes have occurred more among the more educated-affluent than among the less educated-affluent. Over the last decade the proportion of persons with hypertension whose hypertension was detected, treated, and controlled has risen from 10 to 15% to embrace a majority of hypertensives. It is a reasonable inference that these mass changes in life-styles and life-style-related major CHD risk factors have contributed importantly to the large sustained declines in CHD, CVD, and all causes death rates in the USA. Concordant with this inference are data sets indicating greater declines in CHD mortality among the more educated-affluent strata than among the general population (matched for age-sex-color), in keeping with the greater changes in life-styles among the more educated-affluent, e.g., as exemplified by findings for physicians.(ABSTRACT TRUNCATED AT 400 WORDS)     

Ethnicity and prevalence of scleroderma-like syndrome. A study of Arab and Jewish Israeli insulin-dependent diabetic children

Scleroderma-like syndrome (SLS) may represent the earliest apparent diabetes complication in insulin-dependent diabetic (IDDM) patients. To evaluate the frequency of SLS and its association with other diabetes-related pathology in our diabetic population, we studied 153 (127 Jewish and 26 Arab) IDDM patients and 45 healthy age-and gender-matched controls (25 Jewish, 20 Arab). The mean age and diabetes duration of the patients were 14.09 ± 5.1 years and 51 ± 45 months, respectively. While no diabetes-related pathology was found in the controls, SLS was detected in 47% of all patients (skin, 31.4%; arthropathy, 37.9%; both, 22%), and nephropathy, neuropathy, and retinopathy were present in 10.5%, 5.2%, and 4.6%, respectively. Independent of age, SLS directly correlated with diabetes duration (p < 0.01) and with the presence of either nephropathy or neuropathy (p < 0.009 and p < 0.005, respectively). One or more features of systemic diabetic involvement were present in 22% of patients with SLS, compared to only 7.2% in patients without SLS (p < 0.009). When patients were analyzed according to ethnicity, the frequency of skin involvement and neuropathy were found to be higher among Arab patients, particularly males (p < 0.002 and p < 0.005, respectively), and detection of one was significantly associated with the presence of the other (p < 0.001). In conclusion, our results suggest that SLS is the most common diabetic complication among Jewish and Arab IDDM patients, and its presence may reflect an inherited tendency to develop other serious diabetic complications. Ethnicity (Arab) by itself, particularly when associated with male gender, seems to accelerate neurological and dermatological diabetic involvement.