Socioeconomic and behavioral risk factors for mortality in a national 19-year prospective study of U.S. adults

Many demographic, socioeconomic, and behavioral risk factors predict mortality in the United States. However, very few population-based longitudinal studies are able to investigate simultaneously the impact of a variety of social factors on mortality. We investigated the degree to which demographic characteristics, socioeconomic variables and major health risk factors were associated with mortality in a nationally-representative sample of 3617 U.S. adults from 1986 to 2005, using data from the 4 waves of the Americans' Changing Lives study. Cox proportional hazard models with time-varying covariates were employed to predict all-cause mortality verified through the National Death Index and death certificate review. The results revealed that low educational attainment was not associated with mortality when income and health risk behaviors were included in the model. The association of low income with mortality remained after controlling for major behavioral risks. Compared to those in the “normal” weight category, neither overweight nor obesity was significantly associated with the risk of mortality. Among adults age 55 and older at baseline, the risk of mortality was actually reduced for those were overweight (hazard rate ratio = 0.83) and those who were obese (hazard rate ratio = 0.68), controlling for other health risk behaviors and health status. Having a low level of physical activity was a significant risk factor for mortality (hazard rate ratio = 1.58). The results from this national longitudinal study underscore the need for health policies and clinical interventions focusing on the social and behavioral determinants of health, with a particular focus on income security, smoking prevention/cessation, and physical activity.     

Behavioral risk factors and unintentional injuries among U.S. immigrant adults

PURPOSE: This study compared 10 risk-taking behaviors generally considered to be risk factors for injuries and unintentional nonfatal injuries between immigrant and U.S.-born adults. METHODS: Data from the 2001 to 2002 National Epidemiologic Survey on Alcohol and Related Conditions were analyzed. The prevalence of unintentional injuries that occurred in the past 12 months was calculated for foreign-born and U.S.-born respondents by major sociodemographic characteristics. The proportion of respondents who were involved in risk-taking behaviors was compared between immigrants and U.S.-born adults using a chi(2) test. Negative binominal Poisson regression models were used to study the association among immigrant status, total number of risk-taking behaviors, and injuries while controlling for the confounding effects of sociodemographic variables. RESULTS: Of 43,093 adult respondents, 13.3% (95% confidence intervals [CI] = 12.5%-14.1%) of immigrants reported injuries compared with 19.1% (95% CI = 18.7%-19.5%) of U.S.-born respondents. Immigrants had a significantly lower risk of unintentional injuries than U.S.-born adults by most sociodemographic characteristics, but there was no statistically significant association between years of U.S. residence and injuries. Immigrants were less likely than their U.S.-born counterparts to be involved in all 10 risk-taking behaviors (p < 0.05 from chi(2) test). However, when immigrants engaged in more than four risk-taking behaviors, the difference in injury prevalence between the two groups was not statistically significant (p > 0.05). CONCLUSIONS: Immigrant and U.S.-born adults involved in high-risk behaviors face similar risks for unintentional injuries. Targeting risk-taking behaviors among immigrants warrants special attention in injury-control programs.     

Cardiovascular risk factors and confounders among nondrinking and moderate-drinking U.S. adults

BACKGROUND: Studies suggest that moderate drinkers have lower cardiovascular disease (CVD) mortality than nondrinkers and heavy drinkers, but there have been no randomized trials on this topic. Although most observational studies control for major cardiac risk factors, CVD is independently associated with other factors that could explain the CVD benefits ascribed to moderate drinking. METHODS: Data from the 2003 Behavioral Risk Factor Surveillance System, a population-based telephone survey of U.S. adults, was used to assess the prevalence of CVD risk factors and potential confounders among moderate drinkers and nondrinkers. Moderate drinkers were defined as men who drank an average of two drinks per day or fewer, or women who drank one drink or fewer per day. RESULTS: After adjusting for age and gender, nondrinkers were more likely to have characteristics associated with increased CVD mortality in terms of demographic factors, social factors, behavioral factors, access to health care, and health-related conditions. Of the 30 CVD-associated factors or groups of factors that we assessed, 27 (90%) were significantly more prevalent among nondrinkers. Among factors with multiple categories (e.g., body weight), those in higher-risk groups were progressively more likely to be nondrinkers. Removing those with poor health status or a history of CVD did not affect the results. CONCLUSIONS: These findings suggest that some or all of the apparent protective effect of moderate alcohol consumption on CVD may be due to residual or unmeasured confounding. Given their limitations, nonrandomized studies about the health effects of moderate drinking should be interpreted with caution, particularly since excessive alcohol consumption is a leading health hazard in the United States.     

浙江省德清县农村社区成人血小板减少调查

目的:了解德清农村社区成人居民血小板减少情况及可能影响因素。方法:采用流行病学现况研究设计,整群抽取浙江省德清县4个农村社区,面对面调查上述社区中所有18周～64周岁的社区户籍居民。血小板减少定义为<100×109/L。在Epidata3.1中文版建立数据库,SPSS11.0中进行数据分析。结果:在4479名调查对象中,血小板减少粗患病率为21.2%;按照2000年全国人口进行年龄性别标化的患病率为18.6%,患病率随着年龄的增加而增加(χ2趋势=14.43,P<0.001)。在非条件logistic回归分析中,年龄较大、女性、吸烟、家庭年人均收入中低水平可能增加血小板减少的风险,而BMI与之负相关。结论:农村社区成人居民血小板减少患病率较高,应加强监控。     

Nutritional risk assessment and obesity in rural older adults: a sex difference

BACKGROUND: Many older Americans are overweight or obese, but it is unclear whether obesity is associated with other nutritional risk indicators. OBJECTIVE: This study investigated sex-associated differences in nutritional risk among community-dwelling, rural older adults and determined whether weight status [body mass index (BMI; in kg/m(2)) and waist circumference] was related to other measures of nutritional risk. DESIGN: This cross-sectional study explored relations between weight status and nutritional risk, which was determined on the basis of the Level II Screen, overall diet quality, nutrient intakes, and plasma biomarkers. RESULTS: Of the 179 subjects, 44% were overweight (BMI 25-29.9) and 35% were obese (BMI > 30). There were few differences in nutrient intakes between older men and women after we controlled for energy intake. In women, BMI was directly associated with multiple additional nutritional risk indicators, including the number of Level II items (r = 0.30), intakes of fat (r = 0.26) and saturated fat (r = 0.21), and homocysteine concentration (r = 0.25). Weight status in women was inversely associated with intakes of carbohydrates (r = -0.25), fiber (r = -0.35), folate (r = -0.24), magnesium (r = -0.29), iron (r = -0.22), and zinc (r = -0.23); Healthy Eating Index scores (r = -0.22); and plasma pyridoxal 5' phosphate (r = -0.30). Associations with waist circumference were similar. In men, weight status was associated only with plasma cobalamin (r = -0.33 for BMI) and pyridoxal 5' phosphate (r = -0.24 for waist circumference). CONCLUSIONS: Overweight and obese older women, particularly those living alone, may be at greater nutritional risk than are men with a high BMI. Targeted nutritional intervention emphasizing nutrient-dense food choices to improve dietary patterns may be warranted.     

Living arrangements and dietary quality of older U.S. adults

The association between living arrangement and dietary quality of older U.S. adults was investigated in 4,402 adults aged 55 years or older who participated in the Nationwide Food Consumption Survey, 1977 to 1978. Dietary quality was based on percent of Recommended Dietary Allowances for 3-day intakes of nine nutrients. More men living alone consumed a poor-quality diet than did men living with a spouse, particularly those 75 years or older; for women, this effect was seen only in the 55- to 64-year-old group. In general, more women than men had poor-quality diets. A number of factors (economic, employment, health status, energy intake, body mass index, and nutrient supplement use) were examined for their importance in accounting for differences in dietary quality of older men and women living alone compared with those living with a spouse. Energy intake was the most important variable accounting for the association of living arrangement with dietary quality. Evidence indicated that older adults living alone did not make poorer food choices than those living with a spouse, but rather that they consumed fewer calories.     

Prevalence of five lifestyle risk factors among U.S. adults with and without stroke

Background

History of stroke increases cardiometabolic risk, which can be exacerbated by the presence of unhealthy lifestyle factors. Population-based estimates of lifestyle risk factors in people with stroke are lacking but could be used to inform research, policy, and healthcare practice.

Occurrence of malnutrition and associated factors in community-dwelling older adults: Those with a recent diagnosis of cancer are at higher risk

Objectives

In older adults, nutritional health is essential for good quality of life and living independently at home. Especially in cancer patients, malnutrition is common and known to complicate treatment. This study aims to evaluate the nutritional status and its associated factors in community-dwelling older adults with and without cancer.

Design

This is an observational study.

Setting

This study focuses on older community-dwelling people.

Participants

This study included older people with and without cancer (≥70 years). Cancer patients included patients with a new diagnosis of breast, lung, prostate, or colorectal cancer.

Measurements

Data collection included measures of nutritional status, quality of life, depression, fatigue, distress and functional status. We used multivariate logistic regression analysis to assess the association between personal characteristics and malnutrition.

Results

Data were available for 657 people; 383 people without cancer and 274 with a cancer diagnosis. Overall, malnutrition was detected in 245 (37.5%) people; in cancer patients this was 66.1%. Multivariate analysis showed that having cancer (OR 14.4, 95% CI: 8.01 - 23.3), being male (OR 2.38, 95% CI: 1.49–3.70), having depression (OR 13.5, 95% CI: 6.02-30.0), distress (OR 2.60, 95% CI: 1.55–4.37) and impaired instrumental activities of daily living (IADL) (OR 2.63, 95% CI: 1.63–4.24) were associated with a higher risk of malnutrition.

Conclusion

The prevalence of malnutrition in community-dwelling older people is high, particularly in patients with cancer. Benchmarking and routine screening of older patients may be helpful strategies to increase awareness of (risk of) malnutrition among professionals.

     

Disabilities during aging: descriptive approach and risk factors. 4-year longitudinal study of an aged rural population

A longitudinal survey has been conducted from 1982 to 1986 in a rural population of 645 persons aged 60 and over. The aim of this study is to analyse the evolution of disabilities in this population and the main risk factors. The incidence of disabilities within 4 years is more important in the oldest birth-cohort groups and this result suggests a cumulative effect of the ageing process and chronic diseases. Indeed, the assessment of predictive factors shows that age and reported morbidity are related to the incidence of disabilities, but two other factors are strongly related to the loss of functional abilities after age adjustment: socioeconomic status and the feeling of uselessness. We conclude that disability in the elderly is not an inevitable consequence of the physiological ageing process and that a preventive approach should be based on a multidimensional concept: physical, social and psychological.     

Carbohydrate intake is associated with diet quality and risk factors for cardiovascular disease in U.S. adults: NHANES III

OBJECTIVES: To determine if carbohydrate intake, as a % of energy, was related to diet quality and risk factors for cardiovascular disease (CVD) in adults in a cross-sectional and population-based study in the U.S. METHODS: Data from the third National Health and Nutrition Examination Survey (NHANES III, 1988-1994) were utilized. The nationally representative sample of the U.S. population (3,754 men, 4,074 women, ages 25 to 64 years) was divided into quintiles of carbohydrate intake (% of energy), which was examined in relation to risk factors for CVD: systolic blood pressure, body mass index (BMI), and concentrations of serum triglyceride, serum total and HDL cholesterol and plasma glucose. RESULTS: When covariates (age, ethnicity, smoking, alcohol intake and total energy intake) were adjusted in multivariate analyses, carbohydrate intakes (% of energy) were inversely associated with BMI and serum total cholesterol concentration in men and BMI in women and positively associated with serum triglyceride concentration in women. When total sugar intake (% of energy) was further controlled as a step to understand the quality of carbohydrate, carbohydrate intakes (% of energy) was a stronger predictor of BMI and plasma glucose in men and BMI in women. A high carbohydrate diet (>57.4% of energy in men and >59.1% of energy in women) was associated with a low serum HDL-cholesterol concentration in men and high serum triglyceride in women. CONCLUSION: Moderately high carbohydrate (50% to 55% of energy) diets were associated with low CVD risks with favorable lipid profiles.     

Prevalence and correlates of depressive symptoms among older U.S. adults

Using data from telephone interviews conducted during 1985, we investigated the prevalence and correlates of depressive symptoms in a national probability sample of 1,232 noninstitutionalized U.S. residents 65 years of age and older. The association between depressive symptoms and personal attributes, personal resources, illness behavior, life events, and self-reported health was examined through chi-square and logistic regression analyses. We measured depressive symptoms with the Center for Epidemiologic Studies--Depression (CES-D) scale using a score of 16 or greater as an indication of high depressive symptoms. Prevalence of high depressive symptoms was 9.9% in the total sample. For black males the prevalence of depressive symptoms was 7.4%, and for white males it was 6.8%. For black females the prevalence of depressive symptoms was 20.8%, while for white females it was 11.5%. In the regression analysis, female gender, single marital status, poor self-reported assessment of health, illness behavior, and a low number of club/organization memberships were significantly associated with high depressive symptoms. In comparison to respondents reporting good to excellent health, those reporting poor to fair health were almost four times more likely to report a high number of depressive symptoms (odds ratio = 3.97).     

Risk factors for disability among U.S. adults with arthritis.

This article studies risk factors for physical and social disability among U.S. adults ages 55+ who have arthritis, compared to non-arthritis persons of those ages. The dependent variables refer to difficulties in walking, physical functioning (motions and strength), personal care, and household care. The data set is the Supplement on Aging (SOA) (n = 16,148) that accompanied the 1984 National Health Interview Survey. The SOA data are cross-sectional; relationships of risk factors to disability suggest causation but do not directly demonstrate it. Logistic regressions show that risk factors are similar for arthritis and non-arthritis people, with one important exception. (1) The similarities are: For both groups, odds of disability rise with age, diminish with education, and are higher for non-whites and non-married persons. Disability rises with number of chronic diseases and impairments, and it is elevated for underweight persons (Body Mass Index (BMI) less than 20; further analysis indicates this reflects incomplete control of their severe illness status). Long duration of arthritis and recent medical care for it are associated with disability. (2) The exception is: Severe overweight (BMI greater than or equal to 30) is a disability risk factor for arthritis people, but not for non-arthritis people. Previous research has shown that obesity/overweight is a risk factor for etiology of osteoarthritis; our analysis now shows its continued importance for disability when the disease is present.     

Disability and cognitive impairment are risk factors for pneumonia-related mortality in older adults.

The role of functional and cognitive limitations in the risk of pneumonia-related mortality in older adults was examined. As part of a cohort study in 3 communities (East Boston, MA; New Haven, CT; and Iowa and Washington Counties, IA), 6,234 women and 4,035 men ages 65 or older completed baseline interviews between 1981 and 1983 and were followed for up to 6 years. Sex-specific Cox proportional-hazards regression models were used to examine the association of baseline physical and cognitive functioning with report of pneumonia (ICD9 480-486) as an underlying, immediate, or contributing cause of death. During followup, a total of 243 men and 160 women died with pneumonia. Adjusting for age, race, education, evidence of five chronic diseases, and smoking status, a significantly increased risk of pneumonia mortality (P < 0.05) was found for limitations in activities of daily living and cognitive impairment among both men and women. Inability to walk a half mile, climb stairs, or perform heavy housework was significantly associated with increased risk of pneumonia mortality for women but not for men in the same multivariate models. Men and women whose body-mass index was above the median had significantly lower risk of pneumonia mortality compared with those in the lowest quartile. Further elucidation of the sequence between physical and cognitive impairment and risk of pneumonia will be important in reducing pneumonia-associated morbidity and mortality.     

State Quality-Adjusted Life Expectancy for U.S. adults from 1993 to 2008

Purpose

Quality-Adjusted Life Expectancy (QALE) is a summary measure of mortality and health-related quality of life (HRQOL) across different stages of life. This study developed a method to calculate state-level QALE for U.S. adults.

Methods

Population HRQOL data came from the Behavioral Risk Factor Surveillance System (BRFSS). Using age-specific deaths from the Mortality Summary File, this study constructed life tables to estimate life expectancy and QALE for all 50 States and the District of Columbia by sex and race from 1993 through 2008.

Results

From 1993 to 2008, the QALE of an U.S. adult at 18 years old had increased from 51.2 to 52.3 years. In 2006, states with the highest QALE were Hawaii (56.2), Minnesota (55.2), North Dakota (54.9), Iowa (54.7), and Nebraska (54.4), while the states with the lowest QALE were West Virginia (47.1), Mississippi (48.2), Alabama (48.5), Kentucky (48.5), and Oklahoma (49.0).

Conclusions

Because population HRQOL values and mortality statistics are available from existing and publicly accessible data and because formulas for the calculation of QALE and its standard error are easy to incorporate in a spreadsheet, State and local Health Departments can calculate QALE as a routine surveillance measurement for tracking their population??s health over time.     

A descriptive analysis of older adults with HIV/AIDS in California.

Between 10 percent and 15 percent of all AIDS cases throughout the United States have been reported in people ages 50 and over. However, older adults often have been overlooked in research on HIV/AIDS. The study discussed in this article examined 571 individuals ages 30 to 81 who had been diagnosed with symptomatic HIV or AIDS. A cross-sectional analysisfound that those in older age groups were more likely to befemale, to live alone, to have private health insurance, and to have died during the study. The results of the study suggest that social workers need to be aware of and sensitive to the role of sociodemographic factors in the lives of older HIV-infected individuals.     

Occupational risk factors for pancreatic cancer: a case-control study based on death certificates from 24 U.S. states.

BACKGROUND: The relation between occupational exposure and pancreatic cancer is not well established. A population-based case-control study based on death certificates from 24 U.S. states was conducted to determine if occupations/industries or work-related exposures to solvents were associated with pancreatic cancer death. METHODS: The cases were 63,097 persons who died from pancreatic cancer occurring in the period 1984-1993. The controls were 252,386 persons who died from causes other than cancer in the same time period. RESULTS: Industries associated with significantly increased risk of pancreatic cancer included printing and paper manufacturing; chemical, petroleum, and related processing; transport, communication, and public service; wholesale and retail trades; and medical and other health-related services. Occupations associated with significantly increased risk included managerial, administrative, and other professional occupations; technical occupations; and sales, clerical, and other administrative support occupations. Potential exposures to formaldehyde and other solvents were assessed by using a job exposure matrix developed for this study. Occupational exposure to formaldehyde was associated with a moderately increased risk of pancreatic cancer, with ORs of 1.2, 1.2, 1.4 for subjects with low, medium, and high probabilities of exposure and 1.2, 1.2, and 1.1 for subjects with low, medium, and high intensity of exposure, respectively. CONCLUSIONS: The findings of this study did not suggest that industrial or occupational exposure is a major contributor to the etiology of pancreatic cancer. Further study may be needed to confirm the positive association between formaldehyde exposure and pancreatic cancer. Published 1999 Wiley-Liss, Inc.