Black-white differences in stroke incidence in a national sample. The contribution of hypertension and diabetes mellitus

Although national data have consistently shown an increased risk of death from stroke among blacks, few studies have addressed the reasons for this excess mortality. We compared the incidence of stroke among 1298 blacks and 7814 whites, aged 35 to 74 years, in the 10-year follow-up of the respondents from the First National Health and Nutrition Survey. Blacks had a higher estimated incidence of stroke than whites even after adjustment for age, hypertension, and diabetes mellitus; the relative risk was 1.4 (95% confidence interval, 1.0 to 2.0) for black women and 1.1 (95% confidence interval, 0.8 to 1.6) for black men. The relative risks for stroke associated with hypertension and diabetes mellitus were unrelated to race. Although efforts to treat hypertension and diabetes are among the most important public health measures for reducing stroke, a more complete understanding of the determinants of stroke may be required to account for the excess stroke risk experienced by blacks.     

Left ventricular hypertrophy in black and white hypertensives. Standard electrocardiographic criteria overestimate racial differences in prevalence.

OBJECTIVE--To assess racial differences in the accuracy of standard electrocardiographic (ECG) criteria in the diagnosis of left ventricular hypertrophy (LVH). DESIGN--The sensitivity and specificity of standard ECG criteria were compared in blacks and whites using echocardiographic LVH as the reference standard. SETTING--Eight worksite-based hypertension clinics in New York, NY. PATIENTS--A sample of 122 black and 148 white hypertensive patients. RESULTS--The prevalence of ECG-LVH was two to six times higher in blacks than in whites, depending on the criteria used (range, 6% to 24% in blacks vs 1% to 7% in whites; P = .0005 to .19 for black-white comparisons). The difference in prevalence of echocardiographic LVH [corrected], however, was less striking and did not attain statistical significance (26% in blacks and 20% in whites; P greater than .2). The sensitivity of the ECG was low (range, 3% to 17%) and did not differ significantly between the two races for any of the conventional criteria; specificity, however, was lower in blacks for all criteria (range, 73% to 94% vs 95% to 100% for whites; P = .0001 to .09). The predictive value of a positive ECG was consistently, although not significantly, lower in the black subjects. Black race was the strongest independent predictor of decreased ECG specificity in multiple logistic regression analysis that also considered age, gender, body mass index, left ventricular mass index, and smoking. CONCLUSIONS--Commonly used ECG criteria for the detection of LVH have a poor sensitivity in both black and white hypertensives and a lower specificity in blacks than in whites; this may lead to a greater number of false-positive diagnoses in black patients, as well as to an overestimation of black-white difference in LVH prevalence.     

Birth defects in the infants of aboriginal and non-aboriginal mothers with diabetes in Western Australia.

OBJECTIVE: Because of the high prevalence of non-insulin-dependent diabetes in Australian Aborigines, and a suggestion that the prevalence of birth defects was high in the infants of Aboriginal mothers with gestational diabetes, this study was undertaken to determine the prevalence of birth defects in infants of Aboriginal and non-Aboriginal mothers with insulin-dependent, non-insulin-dependent, and gestational diabetes mellitus. DESIGN: A retrospective cohort study of all births to diabetic and non-diabetic mothers in Western Australia, 1980-1984. MAIN OUTCOME MEASURE: Birth defects diagnosed at any time up to the age of six years. RESULTS: Compared with infants of non-diabetic, non-Aboriginal mothers, the prevalence ratio for birth defects in infants of non-Aboriginal insulin-dependent mothers was 2.08 (95% confidence interval, 1.2-3.7), and for infants of mothers with non-insulin-dependent diabetes the ratio was 3.64 (95% CI, 1.5-8.6). The corresponding ratios for infants of Aboriginal mothers were 4.85 (95% CI, 0.8-28.2) and 3.64 (95% CI, 1.3-10.4). For birth defects in infants of gestational diabetic mothers, the prevalence ratio was 1.07 (95% CI, 0.6-1.9) for the non-Aboriginal group and 3.65 (95% CI, 2.3-6.0) for the Aboriginal group. Diabetes could have accounted for 0.14% of birth defects in infants of non-Aboriginal mothers and for 4.62% in infants of Aboriginal mothers. CONCLUSIONS: The excess of birth defects in infants of Aboriginal women with gestational diabetes may be due to non-insulin-dependent diabetes that predates the pregnancy but is only diagnosed during pregnancy. For Aboriginal infants, maternal diabetes may be the single most common known cause of birth defects that is amenable to change.     

Are racial differences in the prevalence of diabetes in adults explained by differences in obesity?

To determine whether the higher prevalence of diabetes found among blacks in the United States is explained by racial differences in obesity, we examined the prevalence of diabetes adjusted for adiposity, education, and income in a cohort of US Army veterans from the Vietnam era. Among 12,558 white men and 1677 black men, aged 30 to 47 years, blacks were more likely than whites to have diagnosed diabetes (adjusted prevalence ratio, 1.9; 95% confidence interval, 1.3 to 2.7). Within every age, adiposity, and socioeconomic stratum, blacks had a higher prevalence of diagnosed diabetes than whites. In a subgroup of veterans for whom fasting serum glucose values were measured, blacks were more likely than whites to have fasting hyperglycemia (fasting serum glucose value greater than or equal to 7.8 mmol/L) (adjusted prevalence ratio, 5.7; 95% confidence interval, 2.7 to 12.0). These data provide evidence that the higher prevalence of diabetes found among blacks is not explained by differences in obesity.     

Effects of zidovudine therapy in minority and other subpopulations with early HIV infection

OBJECTIVE--The purpose of this study was to determine whether the beneficial effects of zidovudine seen overall in two recently completed placebo-controlled clinical trials are also apparent in blacks, Hispanics, women, and intravenous drug users. DESIGN--Two double-blind placebo-controlled randomized clinical trials, protocols 016 and 019, conducted by the AIDS Clinical Trials Group. SETTING--University-based referral centers. PARTICIPANTS--Two thousand forty-eight persons with asymptomatic or mildly symptomatic human immunodeficiency virus infection were analyzed. Of these, 155 were black, 190 were Hispanic, 144 were women, and 221 were intravenous drug users. All randomized subjects were included in the analysis. INTERVENTION--Participants in the AIDS Clinical Trials Group protocol 016 were assigned to receive a placebo or a 1200-mg daily dose of zidovudine. Participants in the AIDS Clinical Trials Group protocol 019 were assigned to receive a placebo, a 500-mg daily dose of zidovudine, or a 1500-mg daily dose of zidovudine. MAIN OUTCOME MEASURE--Progression to AIDS. RESULTS--The rates of progression to AIDS in subjects receiving zidovudine were significantly lower than those in subjects receiving a placebo among blacks (P = .03), whites (relative risk [RR] = 2.3, 95% confidence interval [CI] = 1.5 to 3.6, P less than .0001), Hispanics (RR = 4.4, CI = 1.2 to 16.8, P = .02), non-Hispanics (RR = 2.3, CI = 1.5 to 3.6, P = .0002), men (RR = 2.5, CI = 1.6 to 3.8, P less than .0001), and non-intravenous drug users (RR = 2.5, CI = 1.6 to 4.0, P less than .0001). The rates of disease progression for subjects receiving zidovudine were not statistically different from those receiving placebo for women (RR = 3.3, CI = 0.3 to 36.3, P = .31) or for intravenous drug users (RR = 2.0, CI = 0.7 to 6.2, P = .21); however, in both instances the estimated RRs were similar to those for men and non-intravenous drug users. CONCLUSIONS.-Although the two studies used for this analysis were not specifically designed to assess the effects of zidovudine in each separate subpopulation, the data suggest that the beneficial effects of zidovudine reported for the entire study population also apply to the subpopulations of blacks, Hispanics, women, and intravenous drug users.     

Prevalence of C282Y and H63D mutations in the hemochromatosis (HFE) gene in the United States

CONTEXT: Population-based estimates of the prevalence of disease-associated mutations, such as hemochromatosis (HFE) gene mutations, are needed to determine the usefulness of genetic screening. OBJECTIVE: To estimate the prevalence of the HFE mutations C282Y and H63D in the US population. DESIGN: Cross-sectional population-based study of samples in the DNA bank from phase 2 of the Third National Health and Nutrition Examination Survey conducted from 1992 to 1994. SETTING AND PARTICIPANTS: Genotyped samples of cells from a total of 5171 participants, cross-classified by sex, age, and race/ethnicity in the analysis. MAIN OUTCOME MEASURES: Estimates of the prevalence of C282Y and H63D mutations. RESULTS: The prevalence of C282Y homozygosity is estimated to be 0.26% (95% confidence interval [CI], 0.12%-0.49%); 1.89% (95% CI, 1.48%-2.43%) for H63D homozygosity; and 1.97% (95% CI, 1.54%-2.49%) for compound heterozygosity. The prevalence estimates for C282Y heterozygosity (C282Y/wild type) are 9.54% among non-Hispanic whites, 2.33% among non-Hispanic blacks, and 2.75% among Mexican-Americans. The prevalence estimates of the C282Y mutation in the US population are 5.4% (95% CI, 4.7%-6.2%) and 13.5% (95% CI, 12.5%-14.8%) for the H63D mutation. CONCLUSIONS: Estimates of prevalence of HFE mutations are within the expected range for non-Hispanic whites and blacks but the estimated prevalence of the C282Y mutation among Mexican-Americans is less than expected. Mutation data now need to be linked to clinically relevant indices, such as transferrin saturation level.     

HIV prevalence and associated risks in young men who have sex with men. Young Men's Survey Study Group

CONTEXT: Studies conducted in the late 1980s on human immunodeficiency virus (HIV) infection among older men who have sex with men (MSM) suggested the epidemic had peaked; however, more recent studies in younger MSM have suggested continued high HIV incidence. OBJECTIVE: To investigate the current state of the HIV epidemic among adolescent and young adult MSM in the United States by assessing the prevalence of HIV infection and associated risks in this population in metropolitan areas. DESIGN: The Young Men's Survey, a cross-sectional, multisite, venue-based survey conducted from 1994 through 1998. SETTING: One hundred ninety-four public venues frequented by young MSM in Baltimore, Md; Dallas, Tex; Los Angeles, Calif; Miami, Fla; New York, NY; the San Francisco (Calif) Bay Area; and Seattle, Wash. SUBJECTS: A total of 3492 15- to 22-year-old MSM who consented to an interview and HIV testing. MAIN OUTCOME MEASURES: Prevalence of HIV infection and associated characteristics and risk behaviors. RESULTS: Prevalence of HIV infection was high (overall, 7.2%; range for the 7 areas, 2.2%-12. 1%) and increased with age, from 0% among 15-year-olds to 9.7% among 22-year-olds. Multivariate-adjusted HIV infection prevalence was higher among blacks (odds ratio [OR], 6.3; 95% confidence interval [CI], 4.1-9.8), young men of mixed or other race (OR, 4.8; 95% CI, 3. 0-7.6), and Hispanics (OR, 2.3; 95% CI, 1.5-3.4), compared with whites (referent) and Asian Americans and Pacific Islanders (OR, 1. 1; 95% CI, 0.5-2.8). Factors most strongly associated with HIV infection were being black, mixed, or other race; having ever had anal sex with a man (OR, 5.0; 95% CI, 1.8-13.8); or having had sex with 20 or more men (OR, 3.0; 95% CI, 2.0-4.7). Only 46 (18%) of the 249 HIV-positive men knew they were infected before this testing; 37 (15%) were receiving medical care for HIV, and 19 (8%) were receiving medical drug therapy for HIV. Prevalence of unprotected anal sex during the past 6 months was high (overall, 41%; range, 33%-49%). CONCLUSIONS: Among these young MSM, HIV prevalence was high, underscoring the need to evaluate and intensify prevention efforts for young MSM, particularly blacks, men of mixed race or ethnicity, Hispanics, and adolescents. JAMA. 2000;284:198-204     

Suicide mortality in the Maryland state prison system, 1979 through 1987

Prisoners are reported to have a higher suicide rate than the community. We studied suicides in the Maryland prison system to determine the level of risk and risk factors for inmate suicide. There were 37 male inmate suicide deaths between 1979 and 1987 (39.6 suicides per 100,000 male inmates), which is significantly higher than the age- and race-adjusted male suicide rate in the general population of Maryland (22.0 per 100,000). Risk of male inmate suicide was increased for the following characteristics: white race (relative risk [RR], 2.0; 95% confidence interval [CI], 1.1 to 3.9), age 25 to 34 years (RR, 1.8; 95% CI, 1.0 to 3.4), major crime committed against person (RR, 3.4; 95% CI, 1.7 to 6.7), life sentence (RR, 4.7; 95% CI, 2.2 to 10.0), and classification to the major maximum security institution in the prison system (RR, 5.1; 95% CI, 2.7 to 9.8). The methods of suicide chosen by inmates were hanging (86%), cutting wound (5%), antidepressant overdose (5%), and fall from height (3%). We conclude that inmate suicide represents a significant correctional health and public health problem. Specific implications for prevention of inmate suicide are examined.     

Efficacy of nonoxynol 9 contraceptive sponge use in preventing heterosexual acquisition of HIV in Nairobi prostitutes.

OBJECTIVE--To determine the efficacy of the nonoxynol 9 contraceptive sponge in preventing sexual acquisition of the human immunodeficiency virus (HIV). DESIGN--Prospective, randomized placebo-controlled trial. SETTING--Research clinic for prostitutes in Nairobi, Kenya. PATIENTS AND INTERVENTIONS--One hundred thirty-eight HIV-seronegative women were enrolled, of whom 74 were assigned to nonoxynol 9 sponge use and 64 to placebo use. These two groups did not significantly differ with respect to demographic characteristics, sexual practices, or prevalence of genital infections at enrollment, except for a lower number of sex partners per week and a higher initial prevalence of genital ulcers among women assigned to nonoxynol 9 sponge use. Among the 116 women who returned for follow-up, the mean durations of follow-up were 14 and 17 months for the two groups, respectively. MAIN OUTCOME MEASURE--HIV seroconversion. RESULTS--Nonoxynol 9 sponge use was associated with an increased frequency of genital ulcers (relative risk [RR], 3.3; P less than .0001) and vulvitis (RR, 3.3; P less than .0001) and a reduced risk of gonococcal cervicitis (RR, 0.4; P less than .0001). Twenty-seven (45%) of 60 women in the nonoxynol 9 sponge group and 20 (36%) of 56 women in the placebo group developed HIV antibodies. The hazard ratio for the association between nonoxynol 9 sponge use and HIV seroconversion was 1.7 (95% confidence interval [CI], 0.9 to 3.0). Using multivariate analysis to control for the presence of genital ulcers at enrollment, the adjusted hazard ratio for the association between nonoxynol 9 sponge use and seroconversion was 1.6 (95% CI, 0.8 to 2.8). CONCLUSIONS--Genital ulcers and vulvitis occurred with increased frequency in nonoxynol 9 sponge users. We were unable to demonstrate that nonoxynol 9 sponge use was effective in reducing the risk of HIV infection among highly exposed women.     

Rates and outcomes of diabetic end-stage renal disease among registered native people in Saskatchewan.

OBJECTIVE: To determine the rates and outcomes of diabetic end-stage renal disease (ESRD) among registered native people and non-native people in Saskatchewan. DESIGN: Retrospective population-based study using data from the Canadian Organ Replacement Registry. SETTING: Saskatchewan. PATIENTS: All patients with diabetic ESRD diagnosed between Jan. 1, 1981, and Dec. 31, 1990. MAIN OUTCOME MEASURES: Incidence rates of diabetic ESRD in the general population, rates of diabetic ESRD among patients with diabetes mellitus, nature of initial dialysis treatment, length of survival from start of dialysis, cause of death and renal transplant rates. RESULTS: The 10-year incidence rates of diabetic ESRD were higher among all age groups among registered native people than among non-native people. The overall relative risk ratio for native people was 16.2. When a higher prevalence of diabetes among native people was taken into account, native diabetic people were still seven times as likely as non-native diabetic people to manifest diabetic ESRD. The median survival from start of dialysis was under 2 years in both groups, but more native people died of stroke and more non-native people died of heart disease. Non-native diabetic people were more likely than native diabetic people to receive renal transplants. CONCLUSIONS: Although the overall incidence of diabetic ESRD in Saskatchewan is increasing, registered native people have a disproportionate risk for this serious complication.     

The epidemiology of end-stage renal disease in Georgia

We have examined the incidence of end-stage renal disease (ESRD) in Georgia in 1986 and 1987. We found high age-sex-race specific and total incidence rates compared to rates reported for other U.S. populations. Cause-specific and total ESRD incidence rates were significantly higher among blacks as compared to whites. In both races, the majority of new cases of ESRD occurring in Georgia during 1986 and 1987 can be attributed to diabetes or hypertension. Total ESRD rates were not uniform throughout the state; counties of the Coastal Plain (South) were significantly more likely to have higher rates than counties in the Piedmont Region (North). These patterns of ESRD in Georgia have implications for possible prevention efforts.     

Predictors of acute complications in children with type 1 diabetes

CONTEXT: Diabetic ketoacidosis and severe hypoglycemia are acute complications of type 1 diabetes that are related, respectively, to insufficient or excessive insulin treatment. However, little is known about additional modifiable risk factors. OBJECTIVE: To examine the incidence of ketoacidosis and severe hypoglycemia in children with diabetes and to determine the factors that predict these complications. DESIGN, SETTING, AND PARTICIPANTS: A cohort of 1243 children from infancy to age 19 years with type 1 diabetes who resided in the Denver, Colo, metropolitan area were followed up prospectively for 3994 person-years from January 1, 1996, through December 31, 2000. MAIN OUTCOME MEASURES: Incidence of ketoacidosis leading to hospital admission or emergency department visit and severe hypoglycemia (loss of consciousness, seizure, or hospital admission or emergency department visit). RESULTS: The incidence of ketoacidosis was 8 per 100 person-years and increased with age in girls (4 per 100 person-years in < 7; 8 in 7-12; and 12 in > or =13 years; P<.001 for trend). In multivariate analyses, sex-adjusted and stratified by age (<13 vs > or =13 years), the risk of ketoacidosis in younger children increased with higher hemoglobin A(1c) (HbA(1c)) (relative risk [RR], 1.68 per 1% increase; 95% confidence interval [CI], 1.45-1.94) and higher reported insulin dose (RR, 1.40 per 0.2 U/kg per day; 95% CI, 1.20-1.64). In older children, the risk of ketoacidosis increased with higher HbA(1c) (RR, 1.43; 95% CI, 1.30-1.58), higher reported insulin dose (RR, 1.13; 95% CI, 1.02-1.25), underinsurance (RR, 2.18; 95% CI, 1.65-2.95), and presence of psychiatric disorders (for boys, RR, 1.59; 95% CI, 0.96-2.65; for girls, RR, 3.22; 95% CI, 2.25-4.61). The incidence of severe hypoglycemia was 19 per 100 person-years (P<.001 for trend) and decreased with age in girls (24 per 100 patient-years in < 7, 19 in 7-12, and 14 in > or =13 years). In younger children, the risk of severe hypoglycemia increased with diabetes duration (RR, 1.39 per 5 years; 95% CI, 1.16-1.69) and underinsurance (RR, 1.33; 95% CI, 1.08-1.65). In older children, the risk of severe hypoglycemia increased with duration (RR, 1.34; 95% CI, 1.25-1.51), underinsurance (RR, 1.42; 95% CI, 1.11-1.81), lower HbA(1c) (RR, 1.22; 95% CI, 1.12-1.32), and presence of psychiatric disorders (RR, 1.56; 95% CI, 1.23-1.98). Eighty percent of episodes occurred among the 20% of children who had recurrent events. CONCLUSIONS: Some children with diabetes remain at high risk for ketoacidosis and severe hypoglycemia. Age- and sex-specific incidence patterns suggest that ketoacidosis is a challenge in adolescent girls while severe hypoglycemia continues to affect disproportionally the youngest patients and boys of all ages. The pattern of modifiable risk factors indicates that underinsured children and those with psychiatric disorders or at the extremes of the HbA(1c) distribution should be targeted for specific interventions.     

Ethnic disparities in diabetic complications in an insured population

CONTEXT: Higher rates of microvascular complications have been reported for minorities. Disparate access to quality health care is a common explanation for ethnic disparities in diabetic complication rates in the US population. Examining an ethnically diverse population with uniform health care coverage may be useful. OBJECTIVE: To assess ethnic disparities in the incidence of diabetic complications within a nonprofit prepaid health care organization. DESIGN AND SETTING: Longitudinal observational study conducted January 1, 1995, through December 31, 1998, at Kaiser Permanente Medical Care Program in northern California. PARTICIPANTS: A total of 62 432 diabetic patients, including Asians (12%), blacks (14%), Latinos (10%), and whites (64%). MAIN OUTCOME MEASURES: Incident myocardial infarction (MI), stroke, congestive heart failure (CHF), and nontraumatic lower extremity amputation (LEA), defined by primary hospitalization discharge diagnosis, procedures, or underlying cause of death; and end-stage renal disease (ESRD), defined as renal insufficiency requiring renal replacement therapy or transplantation for survival or by underlying cause of death. RESULTS: Patterns of ethnic differences were not consistent across complications and frequently persisted despite adjustment for a wide range of demographic, socioeconomic, behavioral, and clinical factors. Adjusted hazard ratios (relative to that of whites) were 0.56, 0.68, and 0.68 for blacks, Asians, and Latinos, respectively (P<.001), for MI; 0.76 and 0.72 for Asians and Latinos, respectively (P<.01), for stroke; 0.70 and 0.61 for Asians and Latinos, respectively (P<.01), for CHF; 0.40 for Asians (P<.001) for LEA; and 2.03, 1.85, and 1.46 for blacks, Asians, and Latinos, respectively (P<.01), for ESRD. There were no statistically significant black-white differences for stroke, CHF, or LEA and no Latino-white differences for LEA. CONCLUSIONS: This study confirms previous reports of elevated incidence of ESRD among ethnic minorities, despite uniform medical care coverage, and provides new evidence that rates of other complications are similar or lower relative to those of whites. The persistence of ethnic disparities after adjustment suggests a possible genetic origin, the contribution of unmeasured environmental factors, or a combination of these factors.     

Prevalence of gestational diabetes mellitus among Swampy Cree women in Moose Factory, James Bay

BACKGROUND: Although high rates of gestational diabetes mellitus have been documented in native populations, few studies have examined rates of the disease among native Indians in Canada. The authors conducted a study to estimate the prevalence of gestational diabetes among Swampy Cree women, to identify factors predictive of the occurrence of gestational diabetes, and to identify delivery and infant outcomes related to the presence of the disease. METHODS: Information on Swampy Cree women who gave birth at Weeneebayko Hospital, Moose Factory, James Bay, Ont., between 1987 and 1995 was obtained from medical charts. Patients with and without gestational diabetes were compared. Logistic regression analysis was used to identify independent predictors of gestational diabetes. Delivery and infant outcomes that occurred secondary to gestational diabetes were also identified by means of logistic regression. RESULTS: A total of 1401 deliveries occurred at Weeneebayko Hospital over the study period, of which 1298 were included in the study. Gestational diabetes was diagnosed in 110 (8.5% [95% confidence interval (CI) 6.9%-9.9%]) of the 1298 pregnancies. Factors predictive of gestational diabetes were age 35 years or more (relative risk [RR] 4.1, 95% CI 1.5-11.7), a history of gestational diabetes in a previous pregnancy (RR 6.4, 95% CI 3.5-11.7), diastolic blood pressure of 80 mm Hg or higher at the first prenatal visit (RR 1.7, 95% CI 1.1-2.8), weight greater than 80 kg at the first prenatal visit (RR 4.9, 95% CI 1.8-12.9) and having a first-degree relative with diabetes (RR 3.0, 95% CI 1.4-6.1). The only delivery outcome independently associated with the presence of gestational diabetes was an increased likelihood of needing assisted delivery (forceps or vacuum extraction) (RR 2.8, 95% CI 1.1-7.0). Shoulder dystocia was indirectly associated with gestational diabetes owing to increased infant birth weight. Infant outcomes associated with the presence of gestational diabetes were birth weight greater than 4500 g (RR 2.4, 95% CI 1.4-3.8), hyperbilirubinemia (RR 2.9, 95% CI 1.4-6.1), hypoglycemia (RR 7.3, 95% CI 3.7-14.4) and hypocalcemia (RR 8.9, 95% CI 2.3-33.7). INTERPRETATION: Gestational diabetes occurred in a significant minority of Swampy Cree women and was associated with a number of adverse outcomes.     

Fruit and vegetable intake in relation to risk of ischemic stroke.

CONTEXT: Few studies have evaluated the relationship between fruit and vegetable intake and cardiovascular disease. OBJECTIVE: To examine the associations between fruit and vegetable intake and ischemic stroke. DESIGN, SETTING, AND SUBJECTS: Prospective cohort studies, including 75 596 women aged 34 to 59 years in the Nurses' Health Study with 14 years of follow-up (1980-1994), and 38683 men aged 40 to 75 years in the Health Professionals' Follow-up Study with 8 years of follow-up (1986-1994). All individuals were free of cardiovascular disease, cancer, and diabetes at baseline. MAIN OUTCOME MEASURE: Incidence of ischemic stroke by quintile of fruit and vegetable intake. RESULTS: A total of 366 women and 204 men had an ischemic stroke. After controlling for standard cardiovascular risk factors, persons in the highest quintile of fruit and vegetable intake (median of 5.1 servings per day among men and 5.8 servings per day among women) had a relative risk (RR) of 0.69 (95% confidence interval [CI], 0.52-0.92) compared with those in the lowest quintile. An increment of 1 serving per day of fruits or vegetables was associated with a 6% lower risk of ischemic stroke (RR, 0.94; 95 % CI, 0.90-0.99; P =.01, test for trend). Cruciferous vegetables (RR, 0.68 for an increment of 1 serving per day; 95% CI, 0.49-0.94), green leafy vegetables (RR, 0.79; 95% CI, 0.62-0.99), citrus fruit including juice (RR, 0.81; 95% CI, 0.68-0.96), and citrus fruit juice (RR, 0.75; 95% CI, 0.61-0.93) contributed most to the apparent protective effect of total fruits and vegetables. Legumes or potatoes were not associated with lower ischemic stroke risk. The multivariate pooled RR for total stroke was 0.96 (95% CI, 0.93-1.00) for each increment of 2 servings per day. CONCLUSIONS: These data support a protective relationship between consumption of fruit and vegetables-particularly cruciferous and green leafy vegetables and citrus fruit and juice-and ischemic stroke risk.     

不同糖代谢状态人群慢性肾脏病的患病率及危险因素

目的探讨不同糖代谢状态人群的慢性肾脏病（CKD）患病率及危险因素。方法本横断面研究纳入2015年1月~2015年 10月于南方医科大学体检中心及内分泌科门诊就诊的患者共934例,其中糖尿病患者425例,糖尿病前期患者243例,血糖正常 人群266例,收集其一般资料及实验室检查等数据。CKD诊断标准采用：估算的肾小球滤过率（eGFR）<60 mL/min/1.73 m2和/ 或尿微量白蛋白与尿肌酐比值（ACR）≥30 mg/g,建立多元Logistic回归模型探讨糖尿病前期与CKD的关系。结果血糖正常 组、糖尿病前期组和糖尿病组的CKD患病率分别为10.2%,26.3%,32.5%。糖尿病前期患者的CKD患病率较血糖正常组升高 （P<0.001,OR=3.17,95% CI 1.94-5.17）,糖尿病患者的CKD患病率较血糖正常组升高（P<0.001,OR=4.27,95% CI 2.72-6.65）, 糖尿病前期患者与糖尿病患者相比,CKD患病率无明显差异（P=0.115,OR=1.35,95% CI 0.95-1.91）。Logistic回归模型分析显 示,校正性别、年龄、血压、高血压病史、血尿酸等混杂因素后,糖尿病前期（OR=2.03,95% CI 1.02-4.03,P=0.044）、糖尿病（OR= 2.22,95% CI 1.16-4.25,P=0.016）分别与CKD独立相关。结论糖尿病前期与CKD独立相关,因此提高糖尿病前期人群的检出 率和管理水平、积极从糖尿病前期就采取干预措施防治CKD是十分有必要的。     

A nine-year prospective study on the incidence of childhood type 1 diabetes mellitus in China

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A prospective study of exercise and incidence of diabetes among US male physicians.

OBJECTIVE--To examine prospectively the association between regular exercise and the subsequent development of non-insulin-dependent diabetes mellitus (NIDDM). DESIGN--Prospective cohort study including 5 years of follow-up. PARTICIPANTS--21,271 US male physicians participating in the Physicians' Health Study, aged 40 to 84 years and free of diagnosed diabetes mellitus, myocardial infarction, cerebrovascular disease, and cancer at baseline. Morbidity follow-up was 99.7% complete. MAIN OUTCOME MEASURE--Incidence of NIDDM. RESULTS--At baseline, information was obtained about frequency of vigorous exercise and other risk indicators. During 105,141 person-years of follow-up, 285 new cases of NIDDM were reported. The age-adjusted incidence of NIDDM ranged from 369 cases per 100,000 person-years in men who engaged in vigorous exercise less than once weekly to 214 cases per 100,000 person-years in those exercising at least five times per week (P, trend, less than .001). Men who exercised at least once per week had an age-adjusted relative risk (RR) of NIDDM of 0.64 (95% Cl, 0.51 to 0.82; P = .0003) compared with those who exercised less frequently. The age-adjusted RR of NIDDM decreased with increasing frequency of exercise: 0.77 for once weekly, 0.62 for two to four times per week, and 0.58 for five or more times per week (P, trend, .0002). A significant reduction in risk of NIDDM persisted after adjustment for both age and body-mass index: RR, 0.71 (95% Cl, 0.56 to 0.91; P = .006) for at least once per week compared with less than once weekly, and P, trend, .009, for increasing frequency of exercise. Further control for smoking, hypertension, and other coronary risk factors did not materially alter these associations. The inverse relation of exercise to risk of NIDDM was particularly pronounced among overweight men. CONCLUSIONS--Exercise appears to reduce the development of NIDDM even after adjusting for body-mass index. Increased physical activity may be a promising approach to the primary prevention of NIDDM.     

Invasive group B streptococcal disease in adults. A population-based study in metropolitan Atlanta.

OBJECTIVE: To define the incidence and clinical spectrum of group B streptococcus infection in adults. To characterize groups at increased risk for infection. DESIGN: Retrospective population-based surveillance of group B streptococcus infections occurring in adults. Patients were identified by review of microbiology records at all surveillance area hospital laboratories. Demographic and clinical data were abstracted from patient medical records. SETTING: Metropolitan Atlanta, Ga, 1982 through 1983. PATIENTS: We identified 70 adult patients with invasive group B streptococcus infections; 14 infections occurred in pregnant women and 56 in nonpregnant adults. RESULTS: The annual incidence of group B streptococcus infection in men and nonpregnant women was 2.4 cases per 100,000 population. Incidence increased with age and was higher in blacks than in whites. The case-fatality rate was 32%. Group B streptococcus was most often isolated from blood (71%) and soft tissue (16%). Common clinical presentations included skin and soft-tissue infection (36%), bacteremia without focus (34%), pneumonia (11%), arthritis (9%), and endocarditis (9%). Compared with the general population's risk of infection, the risk of infection in persons with diabetes mellitus was increased 10.5-fold (95% confidence interval [CI], 7.8 to 14.4); in persons with cancer, it was increased 16.4-fold (95% CI, 11.5 to 23.3). CONCLUSIONS: Group B streptococcus infections cause serious disease in adults as well as in neonates, providing an additional rationale for vaccine development. Determining the incidence of adult disease and groups at greatest risk will help in focusing prevention efforts.     

Impact of childhood vaccination on racial disparities in invasive Streptococcus pneumoniae infections

Context  Historically, incidence of pneumococcal disease in the United States has been higher among blacks than among whites. Following recommendation of a new 7-valent pneumococcal conjugate vaccine for children in October 2000, the incidence of invasive pneumococcal disease has declined dramatically, but the impact of vaccination on racial disparities in incidence of pneumococcal disease is unknown. Objective  To assess the effect of conjugate vaccine introduction on rates of pneumococcal disease among whites and blacks in the United States. Design, Setting, and Patients  Analysis of data from the Active Bacterial Core Surveillance (ABCs)/Emerging Infections Program Network, an active, population-based surveillance system in 7 states. Patients were 15 923 persons with invasive pneumococcal disease occurring between January 1, 1998, and December 31, 2002. Main Outcome Measures  Age- and race-specific pneumococcal disease incidence rates (cases per 100 000 persons), rate ratios, and rate differences. Results  Between 1998 and 2002, annual incidence rates for invasive pneumococcal disease decreased from 19.0 to 12.1 cases per 100 000 among whites and from 54.9 to 26.5 among blacks. Due to these declines, 14 730 fewer cases occurred among whites and 8780 fewer cases occurred among blacks in the United States in 2002, compared with 2 prevaccine years, 1998 and 1999. Before vaccine introduction, incidence among blacks was 2.9 times higher than among whites (95% confidence interval [CI], 2.7-3.0); in 2002, the black-white rate ratio had been reduced to 2.2 (95% CI, 2.0-2.4). Incidence among black children younger than 2 years went from being 3.3 times higher (95% CI, 3.0-3.7) than among white children in the prevaccine period to 1.6 times higher (95% CI, 1.1-2.2) in 2002. By 2002, 74% of white children and 68% of black children aged 19 to 35 months in the 7 states had received at least 1 dose of pneumococcal conjugate vaccine; 43% of white and 39% of black children received 3 or more doses. Conclusion  Although blacks remain at higher risk of invasive pneumococcal disease, introduction of childhood pneumococcal vaccination has reduced the racial disparity in incidence of pneumococcal disease.