Platelet counts differ by sex, ethnicity, and age in the United States

PURPOSE: The aim of the study is to show that differences in platelet counts by ethnicity, sex, and age are not explained by environmental factors. METHODS: This is a cross-sectional population-based study of participants in the Third National Health and Nutrition Examination Survey. Our analytic sample included 12,142 participants, of whom 65% were women, 27% were non-Hispanic blacks, and 27% were Mexican Americans. We report weighted geometric mean platelet counts stratified by ethnicity, sex, and age and controlled for indicators of nutritional deficiencies and inflammation. RESULTS: The lowest mean platelet counts were in whites (260x10(3)/microL; 95% confidence interval [CI], 256-264), and the highest were in non-Hispanic blacks (281x10(3)/microL [95% CI, 276-286]). Older men and women of each ethnicity consistently had lower platelet counts than young adults; 60- to 69-year-olds had mean counts 7x10(3)/microL lower (p<0.001) and 70- to 90-year-olds had counts 18x10(3)/microL lower (p<0.001). Even controlling for iron deficiency, women had higher platelet counts than men (275x10(3)/microL; 95% CI, 271-279) versus 256x10(3)/microL (95% CI, 251-260; p<0.001). CONCLUSIONS: Platelet count differences by sex, ethnicity, and age are not explained by environmental covariates known to influence platelet count.     

Vitamin D intakes of children differ by race/ethnicity,sex, age,and income in the United States, 2007 to 2010

The 2007-2010 National Health and Nutrition Examination Survey was used to estimate vitamin D intakes of children 1 to 18 years old in the United States by race/ethnicity, sex, age, and family using 24-hour dietary intake recalls and dietary supplement use questionnaires. We hypothesized that total, dietary, and supplemental vitamin D intakes of children would differ by race/ethnicity, sex, age, and income. Statistical analyses of weighted data were performed using Statistical Analysis Software (V 9.2) to estimate means ± SE. Race and ethnic intake differences controlling for poverty income ratio (PIR), sex, and age were assessed by analysis of covariance. Total (dietary and supplement) vitamin D intake was greater in the high (7.9 ± 0.3 μg/d) vs the medium (6.5 ± 0.3 μg/d) income group, but not the low (7.2 ± 0.2 μg/d) PIR group. Total vitamin D intake of non-Hispanic (NH) white children (8.1 ± 0.2 μg/d) was greater than Hispanic (7.0 ± 0.2 μg/d) and NH black (5.9 ± 0.2 μg/d) children. Total vitamin D intake declined with age, and intake by boys was higher than girls. Only 17.4% of the children consumed supplements containing vitamin D. Overall, mean intake of vitamin D by all children in each age and ethnic group was lower than the estimated average requirement for vitamin D. Public health efforts should encourage consumption of foods high in vitamin D, expand the number of foods fortified, and target health messages to parents to increase use of vitamin D supplements by children.     

Vitamin D intakes by children and adults in the United States differ among ethnic groups

Concerns about vitamin D status in the United States have resurfaced due to increasing reports of insufficiency and deficiency. Few foods contain vitamin D naturally, and currently few foods are fortified in the United States. Intakes of vitamin D in the United States from food and food plus supplements by age, sex, and race/ethnicity group were estimated. Individuals > or = 1 y old who participated in the 1999-2000 National Health and Nutrition Examination Survey (NHANES 1999-2000) were included in the analysis. Vitamin D intake by non-Hispanic (NH) white, NH black, Mexican American, and all individuals in the United States was estimated and compared with recommended levels. Vitamin D intakes were highest among children and teenagers, and lowest in the oldest age categories. Among children age 1-8 y, adequate intake (AI) levels for vitamin D from food were met or exceeded by 69% of Mexican American, 59% of NH white, and 48% of NH black subpopulations. Among adults > or = 51 y old, only 4% met or exceeded the AI from food alone. Few women 19-50 y old or men and women > or = 51 y old were estimated to consume recommended vitamin D levels from food. Mean dietary intakes of vitamin D from food plus supplements were consistently highest among NH white populations, although only small proportions of all those > or = 51 y old had intakes above the recommended levels. The large discrepancy between vitamin D intake by older individuals from food plus supplements and recommended levels, especially for NH black and Mexican American adults, warrants intervention.     

Trends in preterm-related infant mortality by race and ethnicity, United States, 1999-2004.

Trends in preterm-related causes of death were examined by maternal race and ethnicity. A grouping of preterm-related causes of infant death was created by identifying causes that were a direct cause or consequence of preterm birth. Cause-of-death categories were considered to be preterm-related when 75 percent or more of total infant deaths attributed to that cause were deaths of infants born preterm, and the cause was considered to be a direct consequence of preterm birth based on a clinical evaluation and review of the literature. In 2004, 36.5 percent of all infant deaths in the United States were preterm-related, up from 35.4 percent in 1999. The preterm-related infant mortality rate for non-Hispanic black mothers was 3.5 times higher and the rate for Puerto Rican mothers was 75 percent higher than for non-Hispanic white mothers. The preterm-related infant mortality rate for non-Hispanic black mothers was higher than the total infant mortality rate for non-Hispanic white, Mexican, and Asian or Pacific Islander mothers. The leveling off of the U.S. infant mortality decline since 2000 has been attributed in part to an increase in preterm and low-birthweight births. Continued tracking of preterm-related causes of infant death will improve our understanding of trends in infant mortality in the United States.     

Associations between concentrations of uric acid with concentrations of vitamin A and beta-carotene among adults in the United States

Our objective was to examine the cross-sectional associations between concentrations of vitamin A and beta-carotene, a major source of vitamin A, with concentrations of uric acid in a nationally representative sample of adults from the United States. We conducted a cross-sectional study using data from up to 10893 participants aged ≥20 years of National Health and Nutrition Examination Survey from 2001 to 2006. Concentrations of uric acid adjusted for numerous covariates increased from 305.8 μmol/L in the lowest quintile of vitamin A to 335.3 μmol/L in the highest quintile (p for linear trend <0.001). The prevalence ratio for hyperuricemia also increased progressively across quintiles of serum vitamin A reaching 1.82 (95% confidence interval [CI]: 1.52, 2.16; p for linear trend <0.001) in the top quintile in the maximally adjusted model. Adjusted mean concentrations of uric acid decreased progressively from quintile 1 (333.8 μmol/L) through quintile 4 of concentrations of beta-carotene and were similar for quintiles 4 (313.5 μmol/L) and 5 (313.8 μmol/L). Concentrations of beta-carotene were inversely associated with hyperuricemia (adjusted prevalence ratio comparing highest with lowest quintile = 0.61; 95% CI: 0.52, 0.72; p for linear trend <0.001). Concentrations of uric acid were significantly and positively associated with concentrations of vitamin A and inversely with concentrations of beta-carotene. These cross-sectional findings require confirmation with experimental studies of vitamin A and beta-carotene supplementation.     

Seroprevalence of six infectious diseases among adults in the United States by race/ethnicity: data from the third national health and nutrition examination survey, 1988--94

OBJECTIVE: To provide seroprevalence estimates for six selected infectious agents by various sociodemographic and risk behavior variables stratified by race/ethnicity for adults age 20 years or more. METHODS: Seroprevalence estimates for hepatitis A, B, and C, Toxoplasma gondii, Helicobacter pylori, and Herpes simplex-2 were calculated from data in the third National Health and Nutrition Examination Survey, 1988-94 utilizing weights to account for differential oversampling by race/ethnicity and nonresponse to the interview and examination. Standard errors and 95% confidence intervals were calculated taking into account the complex sample design. RESULTS: Age-adjusted prevalence estimates and 95% confidence intervals are presented for three enteric infectious diseases hepatitis A, Toxoplasma gondii, Helicobacter pylori, as well as three blood-borne/sexually transmitted diseases, hepatitis B, hepatitis C, and Herpes simplex-2 stratified by race/ethnicity and by various demographic factors including gender, poverty index, population size of area of residence, country of birth, household crowding, and years of education. In addition, estimates are presented for the three blood-borne/sexually transmitted diseases by various risk behaviors that include marital status, age at first sexual intercourse, number of lifetime sexual partners, cocaine use, and marijuana use.     

Class,race, and infant mortality in the United States.

As a result of Sweden''s efforts to eliminate poverty and to provide comprehensive health care, there are only small social class differences in infant mortality. The wider social differences in US infant mortality are a consequence of less consistent and thorough attempts at social equity and universal health care. US Black infant mortality continues to be twice that of Whites, and the excess may partially result from racism. Public health research should examine the role of racism in infant mortality and develop interventions to eliminate racism and its effects on the health of Black Americans.     

Fatal occupational injury rates in southern and non-southern States, by race and Hispanic ethnicity

OBJECTIVES: We investigated fatal occupational injury rates in the United States by race and Hispanic ethnicity during the period 1990-1996. METHODS: Fatalities were identified by means of the national traumatic occupational fatalities surveillance system. Fatal occupational injury rates were calculated by race/ethnicity and region using US-census-based workforce estimates. RESULTS: Non-Hispanic Black men in the South had the highest fatal occupational injury rate (8.5 per 100000 worker-years), followed by Hispanic men in the South (7.9 per 100000 worker-years). Fatal injury rates for Hispanic men increased over the study period, exceeding rates for non-Hispanic Black men in the latter years of observation. CONCLUSIONS: These data suggest a change in the demographics of fatal occupational injuries in the United States. Hispanic men in the South appear to be emerging as the group with the nation's highest unintentional fatal occupational injury rate.     

Seasons but not ethnicity influence urinary iodine concentrations in Belgian adults

Background  

Mild iodine deficiency (MID) is endemic in Belgium. Previous surveys, which assessed iodine nutrition in Belgium, focused on children. The iodine status of adults and the influence of ethnicity or seasonality on urinary iodine concentrations (UIC) have not been investigated. Since the nutritional profile of children differs from that of adults, we may anticipate similar differences in iodine status. Seasonal fluctuations in UIC have also been reported from other MID regions.     

Mental illness surveillance among adults in the United States

Mental illnesses account for a larger proportion of disability in developed countries than any other group of illnesses, including cancer and heart disease. In 2004, an estimated 25% of adults in the United States reported having a mental illness in the previous year. The economic cost of mental illness in the United States is substantial, approximately $300 billion in 2002. Population surveys and surveys of health-care use measure the occurrence of mental illness, associated risk behaviors (e.g., alcohol and drug abuse) and chronic conditions, and use of mental health-related care and clinical services. Population-based surveys and surveillance systems provide much of the evidence needed to guide effective mental health promotion, mental illness prevention, and treatment programs. This report summarizes data from selected CDC surveillance systems that measure the prevalence and impact of mental illness in the U.S. adult population. CDC surveillance systems provide several types of mental health information: estimates of the prevalence of diagnosed mental illness from self-report or recorded diagnosis, estimates of the prevalence of symptoms associated with mental illness, and estimates of the impact of mental illness on health and well-being. Data from the CDC 2005-2008 National Health and Nutrition Examination Survey indicate that 6.8% of adults had moderate to severe depression in the 2 weeks before completing the survey. State-specific data from the CDC 2006 Behavioral Risk Factor Surveillance System (BRFSS), the most recent BRFSS data available, indicate that the prevalence of moderate to severe depression was generally higher in southeastern states compared with other states. Two other CDC surveys on ambulatory care services, the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey, indicate that during 2007-2008, approximately 5% of ambulatory care visits involved patients with a diagnosis of a mental health disorder, and most of these were classified as depression, psychoses, or anxiety disorders. Future surveillance should pay particular attention to changes in the prevalence of depression both nationwide and at the state and county levels. In addition, national and state-level mental illness surveillance should measure a wider range of psychiatric conditions and should include anxiety disorders. Many mental illnesses can be managed successfully, and increasing access to and use of mental health treatment services could substantially reduce the associated morbidity.     

C-reactive protein concentration and concentrations of blood vitamins,carotenoids, and selenium among United States adults

OBJECTIVE: To examine the relationships between circulating concentrations of C-reactive protein and concentrations of retinol, retinyl esters, vitamin C, vitamin E, carotenoids, and selenium. DESIGN: Cross-sectional study using National Health and Nutrition Examination Survey III (1988-1994) data. SETTING: United States population. SUBJECTS: Up to 14 519 US noninstitutionalized civilian men and women aged > or=20 y. RESULTS: C-reactive protein concentration (dichotomized at the sex-specific 85th percentile) was inversely and significantly associated with concentrations of retinol, retinyl esters, vitamin C, alpha-carotene, beta-carotene, cryptoxanthin, lutein/zeaxanthin, lycopene, and selenium after adjustment for age, sex, race or ethnicity, education, cotinine concentration, body mass index, leisure-time physical activity, and aspirin use. CONCLUSIONS: These results suggest that the inflammatory process, through the production of reactive oxygen species, may deplete stores of antioxidants. Whether increased consumption of foods rich in antioxidants or supplementation with antioxidants can provide health benefits to people characterized by elevated C-reactive protein concentrations may be worthy of further study.     

Alcohol and body weight in United States adults.

Alcohol contributes more than 10 per cent of the total caloric intake of adult drinkers in the United States. However, the effect of alcohol on body weight has not been adequately studied in the general population. The association between weight and frequency of alcohol consumption was examined in two national cross-sectional surveys: the Second National Health and Nutrition Examination Survey (HANESII; n = 10,929) and the Behavioral Risk Factor Surveys (BRFS; n = 18,388). Linear multiple regression was used to estimate the independent effect of alcohol on weight, adjusting for smoking, age, diet practices, physical activity, race, education, and height. Among men, alcohol had only a slight effect on weight in either survey. However, among women, alcohol was associated with a substantial reduction in weight, which was as large as the effect of smoking. Compared with nondrinkers, women who consumed alcohol 7-13 times per week had the greatest reduction in weight: -3.6 kg (95% confidence limits [CL] = -5.6, -1.5 kg) in HANESII and -3.2 kg (95% CL = -4.9, -1.5 kg) in BRFS. Alcohol confounded the association between smoking and weight, and among women it accounted for nearly 45 per cent of the weight-lowering effect of smoking. Alcohol also diminished the weight-lowering effect of smoking in men, while in women the smoking effect was slightly enhanced. Further studies are needed to understand the causal mechanisms by which alcohol is associated with body weight.     

Income and race/ethnicity are associated with adherence to food-based dietary guidance among US adults and children

BackgroundIncome and race/ethnicity are associated with differences in dietary intakes that may contribute to health disparities among members of the US population.ObjectiveTo examine alignment of intakes of food groups and energy from solid fats, added sugars, and alcohol with the 2005 Dietary Guidelines for Americans and MyPyramid, by family income and race/ethnicity.DesignData from the National Health and Nutrition Examination Survey, a cross-sectional, nationally representative survey, for 2001-2004.Participants/settingPersons aged ≥2 years for whom reliable dietary intake data were available (n=16,338) were categorized by income (lowest, middle, and highest) and race/ethnicity (non-Hispanic white, non-Hispanic black, and Mexican American).Statistical analyses performedThe National Cancer Institute method was used to estimate the proportions of adults and children in each income and race/ethnic group whose usual intakes met the recommendations.ResultsHigher income was associated with greater adherence to recommendations for most food groups; the proportions meeting minimum recommendations among adults in the highest income group were double that observed for the lowest income group for total vegetables, milk, and oils. Fewer differences by income were apparent among children. Among the race/ethnic groups, the proportions meeting recommendations were generally lowest among non-Hispanic blacks. Marked differences were observed for milk—15% of non-Hispanic black children met the minimum recommendations compared with 42% of non-Hispanic white children and 35% of Mexican-American children; a similar pattern was evident for adults. One in five Mexican-American adults met the dry beans and peas recommendations compared with approximately 2% of non-Hispanic whites and non-Hispanic blacks. Most adults and children consumed excess energy from solid fats and added sugars irrespective of income and race/ethnicity.ConclusionsThe diets of some subpopulations, particularly individuals in lower-income households and non-Hispanic blacks, are especially poor in relation to dietary recommendations, supporting the need for comprehensive strategies to enable healthier dietary intake patterns.     

Mortality from leading causes by education and race in the United States, 2001

BACKGROUND: Low educational attainment is a marker of socioeconomic status that correlates strongly with higher death rates from many conditions. No previous studies have analyzed national data to measure the number of deaths associated with lower education among working-aged adults (25-64 years) by race or ethnicity. Furthermore, no previous studies have examined comprehensively the relationship of education to cause-specific and all-cause mortality in the three largest racial or ethnic groups in the United States using national data. METHODS: Age-standardized, race/ethnicity-specific death rates from all causes and the 15 leading causes were measured among men and women aged 25-64 years by level of education based on U.S. national mortality data in 2001. The total number of deaths that potentially could be avoided among people aged 25-64 years was estimated by applying the mortality rates among college graduates (within each 5-year category of age, gender, and race/ethnicity) to each of the less-educated subpopulations. All analyses were performed in 2007. RESULTS: Nearly half (48%) of all deaths among men aged 25-64 years (white, black, and Hispanic), and 38% of all deaths in women would not have occurred in this age range if all segments of the population experienced the death rates of college graduates. Black men and women had the highest death rates from all causes combined and from many specific causes at nearly all levels of education, and the largest average life years lost before age 65 years. However, the total number of deaths associated with low education status was not confined to any single racial group. About 161,280 deaths in whites, 40,840 deaths in blacks, and 13,162 deaths in Hispanics in this age range were associated with educational disparity. CONCLUSIONS: Potentially avoidable factors associated with lower educational status account for almost half of all deaths among working-aged adults in the U.S.; these deaths are not confined to any single racial or ethnic group. These findings highlight the need for greater attention to social determinants of health.     

Association between race/ethnicity and disability status and receipt of vaccines among older adults in Florida

Background

Individuals living with a disability or are a member of a certain racial/ethnic group may be at heightened risk for not receiving important vaccinations.