Ten-year trends (1992 to 2002) in sociodemographic predictors and indicators of alcohol abuse and dependence among whites, blacks, and Hispanics in the United States

Background: The objective of this paper is to examine 10‐year trends (1992 to 2002) in the number and type of indicators of DSM‐IV abuse and dependence among whites, blacks, and Hispanics in the United States. Methods: Data are from the 1991 to 1992 National Longitudinal Alcohol Epidemiologic Survey (NLAES; n = 42,862) and the 2001 to 2002 National Epidemiologic Study on Alcohol and Related Conditions (NESARC; n = 43,093). Both surveys used multistage cluster sample procedures to select respondents 18 years of age and older from the U.S. household population. Results: Increases in the prevalence of alcohol abuse between 1992 and 2002 seem associated with a rise in the prevalence of the indicator for “hazardous use.” which usually means reports of driving after drinking. The decrease in dependence was not associated with changes in a particular indicator. In addition, both in 1992 and 2002, 12.3 to 15.4% of the men and 5.2 to 7.9% of the women were diagnostic “orphans.” These respondents reported 1 or 2 indicators of alcohol dependence as present. Conclusions: The observed trends in number and types of indicators of DSM‐IV alcohol abuse and dependence were probably triggered by a complex interplay between individuals’ volume and pattern of drinking and reactions from the drinkers’ social environment. The close association between hazardous use of alcohol and the prevalence of abuse deserves further discussion. A medical diagnostic category should not be so dependent on a criterion that may be influenced by social situations. It is necessary to understand more about diagnostic “orphans” to better design interventions to address their problems.     

Alcohol and Self-Rated Health in a Mediterranean Country: The Role of Average Volume, Drinking Pattern, and Alcohol Dependence

Background: The association between average alcohol consumption and self‐rated ill‐health is “J‐shaped” in Scandinavian and Anglo‐Saxon countries, but it has shown an inverse linear relationship in the few studies conducted in Mediterranean countries, based on average volume solely. Objective: To examine the relationship between alcohol and self‐rated health in the general population of a Mediterranean country, by simultaneously taking into account average volume, drinking pattern, and alcohol abuse. Methods: From 2000 to 2005, we conducted telephone interviews on 12,037 persons, representative of the population aged 18 to 64 years in Madrid, Spain. The drinking pattern encompassed binge drinking, beverage preference, and drinking at mealtimes. Alcohol abuse was estimated by the CAGE test. The association between each alcohol‐related variable and self‐rated suboptimal (fair, poor, or very poor) health was estimated from logistic regression, with adjustment for the remaining alcohol‐related variables and other potential confounders. Results: In comparison with never‐drinkers, suboptimal health was less frequent among occasional drinkers [odds ratio (OR) 0.72; 95% confidence interval (CI): 0.61 to 0.86], average moderate drinkers (OR 0.57; 95% CI: 0.48 to 0.69), and excessive drinkers (OR 0.51; 95% CI: 0.36 to 0.72), but more frequent among former drinkers with ≥1 year of abstinence (OR 1.30; 95% CI: 1.03 to 1.64). Frequency of suboptimal health was likewise higher in subjects with ≥3 episodes of binge drinking (OR 1.55; 95% CI: 1.12 to 2.14) or alcohol abuse (OR 1.47; 95% CI: 1.22 to 1.76). No differences were observed in suboptimal health according to beverage preference or drinking at mealtimes. Results in each gender were similar to those for total study participants. Conclusions: Occasional, moderate, and excessive consumption of alcohol are associated with better self‐rated health, even after adjustment for drinking pattern and alcohol abuse. In contrast, former‐drinking, frequent binge drinking, and alcohol abuse are all associated with suboptimal self‐rated health.     

Impact of body mass index levels on lipid abnormalities in Chinese Asians, American Blacks and American Whites: the People's Republic of China (PRC) and Atherosclerosis Risk in Communities (ARIC) Studies

Background

Several researchers have reported that Chinese adults may have a greater chronic disease burden than Whites, especially at lower body mass index (BMI) levels.

Objectives

To compare the incidence of lipid abnormalities in Chinese (n = 5303), White (n = 10,752) and Black (n = 3408) middle-aged adults and the effect of BMI on these incidences.

Methods

Data were from the People's Republic of China (PRC) and the Atherosclerosis Risk in Communities (ARIC) studies. In each ethnic group, we calculated the adjusted cumulative incidence for high total cholesterol (≥240 mg/dL), LDL-cholesterol (≥160 mg/dL), and triglycerides (≥200 mg/dL) and low HDL-cholesterol (≤40 in men and ≤50 mg/dL in women) adjusted for age, gender, education, field site, smoking and drinking status. Risk differences associated with BMI (referent = 18.5–22.9 kg/m²) were calculated using weighted linear regression and slopes compared using the Wald test.

Results

Chinese had lower incidence of abnormal total cholesterol, LDL-cholesterol and triglycerides than Whites in most BMI groups and had lower incidence of abnormal HDL-cholesterol and triglycerides than Blacks. Across the range of 18.5 to <30, BMI was more strongly associated with the incidence of having high total cholesterol in Chinese and Whites than in Blacks. Similar trends were seen for LDL-cholesterol and triglycerides, but were not always statistically significant. In contrast, BMI was more highly associated with incidence of low HDL-cholesterol in Whites than in Chinese or Blacks.

Conclusion

Although differences in the incidence of lipid abnormalities and the impact of BMI were identified, results varied by lipid type indicating no consistent ethnic/national pattern.     

Epidemiology of pancreatic cancer in Northeastern Italy: incidence, resectability rate, hospital stay, costs and survival (1990–1992)

BACKGROUND: The incidence of pancreatic cancer and relative hospital stay and costs are not well known. AIMS: To define the incidence, hospital stay and cost of pancreatic cancer in a well-defined area of Italy. PATIENTS AND METHODS: Each new case of pancreatic cancer diagnosed between 1990 and 1992 among 669,703 inhabitants in the Veneto Region of Northern Italy was recorded and followed until death or for 5 years after diagnosis. Four types of hospital stay were defined. Type 1: undiagnosed pancreatic cancer; type 2: first diagnosis of pancreatic cancer, treatment excluded; type 3: main treatment; and type 4: follow-up and disease-related complications. Data were analysed for hospital stay-related procedures, costs and survival. RESULTS: Pancreatic cancer was diagnosed in 253 patients (12.6/100,000 per year), 43 patients (17.7%) underwent surgical resection, and 93 (36.8%) palliative surgery. The mean duration of type 3 hospital stay was similar for resection, palliative and exploratory surgery. The estimated hospital cost was significantly higher for surgical resection, almost the same for palliative and exploratory surgery, and only slightly lower for medical treatment. Each patient spent a mean of 57.7 days in the hospital. The hospital mortality rate was 4.6% for surgical resection, 22.1% for palliative surgery, and 18.7% for exploratory laparotomy. Overall, the 1-, 2-, 3- and 5-year survival rates were 20.9%, 5.1%, 2.9% and 1.2%, respectively. CONCLUSIONS: Pancreatic cancer is an expensive, almost incurable disease. Integrated treatments in specialized Centres should reduce the mortality rate and costs.