Respiratory disease mortality patterns among South African iron moulders.

To assess the influence of foundry exposure on malignant and non-malignant respiratory disease, the proportional mortality ratio (PMR) was used to compare the cause of death distributions of the 578 dead members of the Iron Moulders Society of South Africa, recipients of the union's death benefit fund between 1961 and 1983. Comparisons were made with the age and period specific white male deaths. For the 419 members where job information was available, the influence of occupation (journeyman, production moulder) was assessed using different techniques--the relative proportional mortality ratio (RPMR), the mortality odds ratio (MOR), and the proportional cancer mortality ratio (PCMR) for comparison. Excess PMRs were found for cancer of the trachea, bronchus, and lung (1.71, p = 0.03; Poisson one sided test) for those over 65 and for non-malignant respiratory disease (1.58, p = 0.01) and for injuries and poisonings (2.61, p less than 0.0001) in those under 65. Reduced PMRs were found for all cancers (0.75, p = 0.03) and all circulatory disease (0.91, p = 0.12) in those under 65. When comparing job types, raised risks were obtained for journeymen using all methods (RPMR, MOR, PCMR) but the small cell sizes rendered the results non-significant. The raised PMRs due to respiratory disease are unlikely to be due to smoking because of a poor association with other causes of death related to smoking. A more likely explanation is that these excess rates for malignant and non-malignant respiratory disease are due to exposure to the foundry environment. Of additional concern are the high PMRs due to injuries and poisonings, which could be related to the high accident rates in the iron and steel industry.     

Respiratory disease mortality patterns among South African iron moulders

To assess the influence of foundry exposure on malignant and non-malignant respiratory disease, the proportional mortality ratio (PMR) was used to compare the cause of death distributions of the 578 dead members of the Iron Moulders Society of South Africa, recipients of the union's death benefit fund between 1961 and 1983. Comparisons were made with the age and period specific white male deaths. For the 419 members where job information was available, the influence of occupation (journeyman, production moulder) was assessed using different techniques--the relative proportional mortality ratio (RPMR), the mortality odds ratio (MOR), and the proportional cancer mortality ratio (PCMR) for comparison. Excess PMRs were found for cancer of the trachea, bronchus, and lung (1.71, p = 0.03; Poisson one sided test) for those over 65 and for non-malignant respiratory disease (1.58, p = 0.01) and for injuries and poisonings (2.61, p less than 0.0001) in those under 65. Reduced PMRs were found for all cancers (0.75, p = 0.03) and all circulatory disease (0.91, p = 0.12) in those under 65. When comparing job types, raised risks were obtained for journeymen using all methods (RPMR, MOR, PCMR) but the small cell sizes rendered the results non-significant. The raised PMRs due to respiratory disease are unlikely to be due to smoking because of a poor association with other causes of death related to smoking. A more likely explanation is that these excess rates for malignant and non-malignant respiratory disease are due to exposure to the foundry environment. Of additional concern are the high PMRs due to injuries and poisonings, which could be related to the high accident rates in the iron and steel industry.     

Diabetes and coronary heart disease risk in Mexican Americans.

Mexican Americans have a high prevalence of diabetes relative to non-Hispanic whites, but paradoxically experience a lower prevalence of myocardial infarction and lower cardiovascular mortality (at least in men). To determine whether Mexican Americans might be more resistant to the atherogenic effects of diabetes than non-Hispanic whites, we examined the associations between diabetes and myocardial infarction and selected coronary heart disease (CHD) risk factors in these two ethnic groups. The study population consisted of 5149 Mexican Americans and non-Hispanic whites who were 25 to 64 years old and recruited from the San Antonio Heart Study, a population-based study of cardiovascular risk factors and diabetes conducted between 1979 and 1988. Diabetic men were more than twice as likely to have an electrocardiography (ECG)-documented myocardial infarction than were nondiabetic men, while diabetic women were more than three times as likely to have a myocardial infarction than were nondiabetic women. In both sexes the association between myocardial infarction and diabetes was nearly identical between the two ethnic groups. In both ethnic groups diabetes was also more strongly associated with conventional CHD risk factors (e.g., triglycerides, systolic blood pressure, and high-density-lipoprotein cholesterol) in women than in men. Furthermore, these associations were at least as strong, if not stronger, in Mexican Americans as in non-Hispanic whites. Thus, these data provide no evidence to suggest that Mexican Americans are resistant to the lipid-altering effects of diabetes. We conclude that the protective effect against CHD conferred by Mexican American ethnicity may be obscured in part by the high prevalence of diabetes in this ethnic group.     

Serum copper concentration and coronary heart disease among US adults

Copper, a strong prooxidant, may play a role in atherogenesis. The author examined the association between serum copper concentration and mortality from coronary heart disease using data from the Second National Health and Nutrition Examination Survey (1976-1992). Serum copper concentration was determined using atomic absorption spectroscopy. After various exclusions, 151 deaths from coronary heart disease occurred among 4,574 participants aged > or =30 years. At baseline, the age-adjusted serum copper concentration was about 5% higher among participants who died from coronary heart disease than among those who did not (p = 0.072). After adjustment for age, sex, race, education, smoking status, systolic blood pressure, serum cholesterol, serum high density lipoprotein cholesterol, body mass index, recreational activity, nonrecreational activity, history of diabetes, and white blood cell count, the hazard ratios for death from coronary heart disease for serum copper concentrations in the second, third, and fourth quartiles (versus the first quartile) were 1.84 (95% confidence interval (CI): 0.93, 3.66), 2.14 (95% CI: 1.21, 3.77), and 2.87 (95% CI: 1.57, 5.25), respectively. Several prospective studies, including the present analysis, have found elevated serum copper concentrations to be associated with cardiovascular disease. Whether copper directly affects atherogenesis or is a marker of inflammation associated with atherosclerosis remains to be established.     

Metropolitan governance, residential segregation, and mortality among African Americans.

OBJECTIVES: This study tested the hypothesis that the degree to which local government is metropolitanized is associated with mortality rates for African Americans and with residential segregation, which has itself previously been shown to be positively associated with mortality among African Americans. METHODS: One hundred fourteen US standard metropolitan statistical areas were examined. The primary dependent variable was the age-adjusted, race- and sex-specific all-cause mortality rate, averaged for 1990 and 1991. The 2 primary independent variables were residential segregation, as measured by the index of dissimilarity, and metropolitanization of government, as measured by the central city's elasticity score. RESULTS: Mortality rates for male and female African Americans were lower in metropolitan statistical areas with more metropolitanized local governments and lower levels of residential segregation. Mortality for male and female Whites was not associated in either direction with residential segregation. White male mortality showed no association with level of metropolitanization, but lower White female mortality rates were associated with less metropolitanization. CONCLUSIONS: This study suggests the need for further research into whether policy changes in areas not traditionally thought of as "health policy" areas can improve the health of urban minorities.     

Nutritional risk factors for coronary heart disease in South African medical students

The African population in South Africa is undergoing relatively rapid transition in lifestyle, with increasing proneness to western diseases. At the Medical University of Southern Africa (MEDUNSA), the majority of the African students come from homes where mainly cereal‐based diets are eaten. They are now exposed to ‘western’ foods. To throw light on the subsequent changes, between 1989 and 1993, 383 third year students underwent a practical course on nutritional assessment, which included determinations of anthropometry, 3 days’ estimated dietary intake record, and serum lipid analysis. Results indicated that their dietary risk levels for western diseases were now approaching the high levels prevailing in white populations. While the likelihood of influencing African students to meaningfully conform to a ‘prudent’ diet and lifestyle is remote, every endeavour must be made to fully inform them of the benefits likely to follow.     

Changes in diet and coronary heart disease mortality among social classes in Great Britain.

Coronary heart disease (CHD) mortality has declined in Britain since the early 1970s and followed a reduction in dietary fat intake in the population. We attempted to determine whether there have been changes in dietary fat intakes by social classes and to see whether they correspond to social class changes in CHD mortality, where the greatest reduction has been in the upper social class groups. Dietary fat intake was specially obtained by social class on a household basis from the National Food Survey (NFS) for 1974 and 1981. The decline in saturated fat intake and increase in polyunsaturated fat is shown to have occurred in each social class group, although it was not possible to examine the data separately for men and women. In contrast, the decline in the proportion of current smokers between 1974 and 1980 (from the General Household Survey) was greatest in the higher social classes. Rates of CHD mortality showed the greatest decline among men in social classes I & II over the period 1969/73 to 1979/83. However, despite some problems in the interpretation of the data collected by the NFS, this study shows that recent social class trends in dietary fat intakes are unlikely to account for the differential changes in CHD mortality. Changes in the prevalence of smoking among social classes are more consistent with the change in CHD mortality.     

Anthropometric predictors of coronary heart disease and total mortality: findings from the US Railroad Study.

Prospective data from the US Railroad Study were used to investigate the relations of several anthropometric variables to coronary heart disease and all-cause mortality in males initially free of cardiovascular disease. Middle-aged men were examined in 1957-1960 and followed until 1977 or death. Anthropometric indicators of total body fat (body mass index and the sum of the subscapular and triceps skinfolds) and central body fat (the ratios chest circumference/biacromial (shoulder) diameter, and chest circumference/standing height) were significantly and directly associated with age-adjusted coronary heart disease mortality. When systolic blood pressure, serum cholesterol, cigarette smoking, and vital capacity were also taken into account, the ratio chest circumference/biacromial diameter remained significantly associated with coronary heart disease mortality. Total, central, and peripheral body fat had a "U"-shaped relation with all-cause mortality. Measures of the ratio of central to peripheral body fat were inconsistently related to mortality. These results indicate that certain anthropometric measurements, especially those that may indicate central adiposity, are positively related to the development of fatal coronary heart disease and quadratically related to all-causes death rates.     

Trends in asthma mortality among African Americans and whites in Chicago, 1968 through 1991.

Death certificate data were used to examine asthma mortality among African Americans and Whites aged 5 through 34 years in Chicago from 1968 through 1991. African Americans experienced consistently higher asthma mortality throughout the period. Asthma mortality remained stable among Whites from 1968 through 1991 but increased by 337% among African Americans from 1976 through 1991 (P < .001). The increase was greatest among 20- through 34-year-olds. Between 1979 and 1991, outpatient and emergency department deaths increased significantly, while the proportion of dead-on-arrival cases remained stable at 51%. This shift to non-inpatient deaths suggests that lack of access to health care may play a role in increasing asthma mortality.     

Continued adverse trends in coronary heart disease mortality among blacks, 1980-91.

An abrupt downturn in mortality rates from coronary heart disease occurred in the United States in the mid-1960s, and for the next decade all four major sex-race groups experienced virtually identical rates of decline. Beginning around the mid-1970s, however, trends for blacks and whites began to diverge, with a deceleration in the annual fall in rates for blacks. The recent release of mortality data extending through 1991, with correction of the denominator estimates in the 1980s using the 1990 census, demonstrate a striking linearity of this trend over the entire decade. In 1989, for the first time since the category of coronary heart disease has been recorded in vital statistics, the age-adjusted death rate for it among black men exceeded that of whites. As a result of the divergent trends among men, an excess of 4,000 deaths of blacks were recorded in 1991 alone. Among women, coronary heart disease mortality was higher among blacks at the beginning of this period, and the average annual percent decline was only two-thirds that of whites. As a result, the absolute mortality gap between blacks and whites steadily increased from 19 to 33 percent (1980 to 1991). This study indicates that the factors that have led to the decline in coronary heart disease have not influenced all demographic groups equally over the last decade.     

Milk, coronary heart disease and mortality

STUDY OBJECTIVE: To study the association between reported milk consumption and cardiovascular and all cause mortality. DESIGN: A prospective study of 5765 men aged 35-64 at the time of examination. SETTING: Workplaces in the west of Scotland between 1970 and 1973. PARTICIPANTS: Men who completed a health and lifestyle questionnaire, which asked about daily milk consumption, and who attended for a medical examination. MAIN RESULTS: 150 (2.6%) men reported drinking more than one and a third pints a day, Some 2977 (51.6%) reported drinking between a third and one and a third pints a day and 2638 (45.8%) reported drinking less than a third of a pint a day. There were a total of 2350 deaths over the 25 year follow up period, of which 892 deaths were attributed to coronary heart disease. The relative risk, adjusted for socioeconomic position, health behaviours and health status for deaths from all causes for men who drank one third to one and a third pints a day versus those who drank less than a third of a pint was 0.90 (95% CI 0.83, 0.97). The adjusted relative risk for deaths attributed to coronary heart disease for men who drank one third to one and a third pints a day versus those who drank less than one third of a pint was 0.92 (95% CI 0.81, 1.06). CONCLUSIONS: No evidence was found that men who consumed milk each day, at a time when most milk consumed was full fat milk, were at increased risk of death from all causes or death from coronary heart disease.     

Regional variation in smoking among African Americans.

BACKGROUND: The impact of geographic region and metropolitan residence on smoking prevalence among African Americans has not been adequately examined. METHODS: This study analyzed 5 years of data from the National Health Interview Survey (1990-1994) on current smoking and regional variation among 16,738 African Americans. Results. Respondents in the West had the lowest unadjusted smoking prevalence rates and Midwest residents had the highest. Current smoking was lower among African Americans living in non-central cities than in central cities even after adjusting for several sociodemographic covariates. Multivariate logistic regression analysis revealed that black women in the South were significantly less likely to be smokers compared with any other gender/region group. CONCLUSIONS: These findings suggest the significance of gender and regional factors such as the social history of migration, social stress and racism, exposure to tobacco advertisement, variations in cultural influences, community structures, and coping strategies in under standing African American smoking behavior.     

Sedentary lifestyle and state variation in coronary heart disease mortality.

Using linear regression, the authors demonstrated a strong association between State-specific coronary heart disease mortality rates and State prevalence of sedentary lifestyle (r2 = 0.34; P = 0.0002) that remained significant after controlling for the prevalence of diagnosed hypertension, smoking, and overweight among the State''s population. This ecologic analysis suggests that sedentary lifestyle may explain State variation in coronary heart disease mortality and reinforces the need to include physical activity promotion as a part of programs in the States to prevent heart disease.     

Social heterogeneity in smoking among African Americans.

OBJECTIVES: This study assessed the effects of sociodemographic variables on the smoking behavior of African Americans. METHODS: Data for 14,397 African-American respondents (18-64 years old) to the National Health Interview Survey in the years 1990 through 1993 were examined in multivariate models. RESULTS: Age was the strongest predictor of smoking, and men were at least 1.75 times as likely as women to be smokers (P < .001). CONCLUSIONS: The Year 2000 goal of an 18% prevalence rate among African-American adults may not be attained without major community interventions focusing on male and middle-aged African Americans.     

Platelet aggregation and coronary heart disease risk factor variation in Australian populations with different coronary heart disease mortality.

In a cross-sectional analytic study, we examined the differences in coronary heart disease (CHD) risk factors, including coagulation factors and platelet aggregation, among males from southern European countries and those of Anglo-Celtic descent who had widely different CHD standardized mortality ratios. The participants included 169 men aged 40 to 49 years, 27% of whom were born in southern European countries. The subjects had no history of heart disease and no other clinical conditions, or were not taking medications known to affect hemostasis. Data obtained included their medical history and CHD-related risk behaviors, blood pressure, height, weight, abdominal and pelvic circumference, and coagulation, fibrinolysis, platelet activity, lipids, and lipoproteins profiles. There were significant differences between the two groups in the prevalence of a positive family history, mean apolipoprotein A1 levels, and platelet aggregation responses to ADP. Other established risk factors, including coagulation factor levels, were not significantly different.     

Dietary intake and risk of coronary heart disease differ among ethnic subgroups of black Americans

Coronary heart disease (CHD) morbidity and mortality are more prevalent in Blacks than Whites in the United States. Most studies evaluate the dietary intake and health of Black Americans as one group and do not consider possible differences among ethnic subgroups within the U.S. Black population. We used data from NHANES III to assess whether dietary intake, CHD risk factors, and predicted 10-y risk of CHD differed between non-Hispanic Black adults born in the United States (NHB-US), and non-Hispanic and Hispanic Black adults born outside of the United States (NHB-non US, HB-non US). Data were provided from single 24-h dietary recalls, biochemical measures, the medical examination, and self-reported responses to survey questions. NHB-US had higher intakes of energy, fat, protein, meat, added sugars, and sodium, and lower intakes of fruits, fiber, and most micronutrients. NHB-US also had higher predicted 10-y risk of developing CHD (5.8%) than NHB-non US (3.7%, P<0.001) or HB-non US (4.7%, P=0.017). Both immigrant groups had better CHD risk profiles and lower proportions of persons with metabolic syndrome and other CHD-related conditions. Our findings show differences in dietary intake and risk of CHD and related health conditions among ethnic subgroups of Blacks living in the United States. Future studies of diet and health should consider cultural differences within the Black population to better understand and reduce overall health disparities in the United States.     

Ten-year mortality from coronary heart disease among 172,000 men classified by occupational physical activity.

A cohort of 172,489 males aged 20--64 years and employed by the Italian railroad system on 1 April 1963 have been classified by habitual physical activity at work and followed-up for death during a ten-year period. The overall crude mortality was 56.59 per 1,000 in ten years, and no significant differences were found between men in sedentary, moderate and heavy work. Age-corrected death rates for coronary heart disease, as manifested by myocardial infarction and sudden coronary death, were substantially different in the three activity groups, moderately active workers ranking first, sedentary workers second, but very close to the former, and very active workers being last. The age-corrected rates for all ages were 14.18, 12.55 and 7.63 per 1,000 in ten years, respectively. All differences were statistically significant, the mortality ratio between the sedentary and moderate groups combined versus the heavy group being of the order of 1.75 to 1.     

Risk factors for coronary heart disease in African American women.

There have been few studies of risk factors for coronary heart disease in African American women. The authors investigated factors associated with prevalent coronary heart disease in data provided by participants in the Black Women's Health Study. In 1995, 64,530 US Black women aged 21-69 years completed postal health questionnaires. The 352 women who reported having had a heart attack (cases) were frequency matched 5:1 on age with 1,760 women who had not (controls); medical record review for 35 cases indicated that two-thirds had had a heart attack and the remainder had other coronary heart disease. Odds ratios, obtained from multiple logistic regression analyses, were significantly elevated for cigarette smoking, drug-treated hypertension, drug-treated diabetes mellitus, elevated cholesterol level, and history of heart attack in a parent. High body mass index (kg/m2) was associated with coronary heart disease in the absence of control for hypertension, diabetes mellitus, and elevated cholesterol but not when they were controlled, suggesting that obesity may influence risk as a result of its effects on blood pressure, glucose tolerance, and cholesterol levels. Odds ratios increased with increasing parity and with decreasing age at first birth. These data suggest that important risk factors for coronary heart disease are similar in Black women and White women.