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disease
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ABSTRACTS (ACE)
P34 AS GOOD AS IT GETS? SENSITIVITY AND SPECIFICITY OF DEATH CERTIFICATES FOR DIABETES: THE RANCHO BERNARDO WS Cheng, DL Wingard, D Kritz-Silverstein, E Barrett-Connor, Family and Preventive Medicine, University of California, San Diego PURPOSE: Diabetes, reported as the sixth major cause of death in the US, may be an underestimate, as it is often under-reported on the death certificate. This study examines the change over time in accurate reporting and death certificate sensitivity and specificity of diabetes. METHODS: Death certificates for 3209 decedents from the Rancho Bernardo cohort were obtained. Decedents were aged 30 and older at enrollment (1972–74); mortality data was available through 2003. True diabetes status was based on history obtained at periodic clinic visits and mailed questionnaires during follow up. Diabetes listed as cause of death or reported anywhere on death certificates was abstracted. Sensitivity and specificity were stratified by sex, age at death, year, place, and cause of death, and medication use among diabetic participants; characteristics that contributed to reporting diabetes were analyzed in univariate and multivariate logistic regression models. RESULTS: There were 378 decedents with diabetes, of whom 168 had diabetes listed anywhere on the death certificates. Thus the sensitivity and specificity of diabetes reporting anywhere on the death certificate were 34.7% and 98.1% respectively. Death certificates for those with diabetes listed cardiovascular disease (CVD) as the cause of death more often than did death certificates for those without diabetes (p ! 0.05). Sensitivity for diabetes reporting was higher for deaths occurring in hospitals, CVD listed as the underlying cause, and among diabetic participants who reported use of medication for diabetes. Overall sensitivity did not vary significantly by age or year of death, or sex. After stratification by decade of death, sensitivity for diabetes reporting for deaths occurring in 1992–2003 was greater when the cause of death was listed as CVD compared to any other cause (48.9% vs. 28.6% respectively, p ! 0.05). CONCLUSION: This study showed no overall improvement in diabetes reporting on death certificates. Reporting improved in recent years (1992–2003) for those whose death certificates indicated CVD as cause of death, likely reflecting the recent interest in diabetes as a major CVD risk factor.
P35 THE ASSOCIATION BETWEEN AMBIENT PARTICULATE AIR POLLUTION AND FATAL CORONARY HEART DISEASE AMONG PERSONS WITH RESPIRATORY SYMPTOMS/DISEASE LH Chen, SF Knutsen, L Beeson, M Ghamsary, D Shavlik, F Petersen, D Abbey, Department of Epidemiology and Biostatistics, School of Public Health, Loma Linda University, Loma Linda, CA PURPOSE: To assess the effects of ambient particulate matter (PM) air pollution on risk of fatal coronary heart disease (CHD) in
AEP Vol. 15, No. 8 September 2005: 630–665
persons characterized as a sensitive subgroup, e.g. persons with known respiratory disease. METHODS: The Adventist Health Study on Smog (AHSMOG) is a cohort study of 3769 nonsmoking, adults who have been followed for 22 years. A total of 806 persons free of CHD, stroke or diabetes at baseline and who reported having symptoms of asthma, some kind of bronchial condition, or emphysema on one of the 4 follow-up questionnaires (1977, 1987, 1992, 2000) constitute the study population. Monthly concentrations of ambient air pollutants were obtained from monitoring stations (PM10, Ozone, SO2, and NO2) or airport visibility data (PM2.5) and interpolated to zip code centroids of work and residence locations. PM10-2.5 concentrations were calculated as the differences between PM10 and PM2.5. Time-dependent Cox proportional hazards regression was used for analyses. Analyses were controlled for a number of potential confounders available from a detailed lifestyle questionnaire at baseline and for environmental tobacco smoke and other personal sources of air pollution available from the 4 subsequent questionnaires. RESULTS: Elevated risk of fatal CHD was found for all ambient PM fractions with the highest risk estimates for coarse fraction (PM10-2.5). The relative risk (RR) for fatal CHD with each 10 mg/m3 increase in PM10-2.5 was 2.1 (95% confidence interval (CI): 1.3, 3.3) in the single pollutant model and 2.2 (95 % CI: 1.3, 3.8) in the two-pollutant model with ozone. Risk appeared to be stronger in females than in males. CONCLUSION: High ambient concentrations of PM, especially coarse fraction, are associated with increased risk of fatal CHD among persons with known chronic respiratory disease (asthma, bronchial condition, or emphysema). The risk appears to be stronger in females than in males.
P36 EFFECT OF ALCOHOL CONSUMPTION ON OBESITY AMONG NONSMOKERS AA Arif, JE Rohrer, Department of Family & Community Medicine, Division of Health Services Research, Texas Tech University Health Sciences Center, Lubbock, TX PURPOSE: Obesity is recognized as a major public health problem in the U.S. However, the effect of alcohol consumption on obesity is not well understood. This study used data from NHANES III to explore association between overweight, obesity and alcohol consumption in the nonsmoking U.S. adult population. METHODS: We analyzed data on a total of 8,236 respondents who participated in the Third National Health and Nutrition Examination Survey. Body mass index (weight-kg/height-m2) was derived from measured height and weight data and categorized into: normal weight (BMI ! 25 kg-m2) Overweight (BMI between 25 kg-m2and 30 kg-m2), and obese (BMI > 30 kg-m2). Alcohol consumption was measured using following measures: history of drinking, quantity of drinks/day, frequency of drinking, average volume of drinks/week, and binge drinking. Multinomial logistic regression analyses were used to assess relationship between the categorical BMI variable and alcohol consumption. Pregnant women and those with missing information on alcohol consumption were excluded from the analysis. The analysis was adjusted for age, sex, race/ethnicity, poverty income ratio, education, marital status, self-rated health, and leisure time physical activities. Odds
ABSTRACTS (ACE)
P34 AS GOOD AS IT GETS? SENSITIVITY AND SPECIFICITY OF DEATH CERTIFICATES FOR DIABETES: THE RANCHO BERNARDO WS Cheng, DL Wingard, D Kritz-Silverstein, E Barrett-Connor, Family and Preventive Medicine, University of California, San Diego PURPOSE: Diabetes, reported as the sixth major cause of death in the US, may be an underestimate, as it is often under-reported on the death certificate. This study examines the change over time in accurate reporting and death certificate sensitivity and specificity of diabetes. METHODS: Death certificates for 3209 decedents from the Rancho Bernardo cohort were obtained. Decedents were aged 30 and older at enrollment (1972–74); mortality data was available through 2003. True diabetes status was based on history obtained at periodic clinic visits and mailed questionnaires during follow up. Diabetes listed as cause of death or reported anywhere on death certificates was abstracted. Sensitivity and specificity were stratified by sex, age at death, year, place, and cause of death, and medication use among diabetic participants; characteristics that contributed to reporting diabetes were analyzed in univariate and multivariate logistic regression models. RESULTS: There were 378 decedents with diabetes, of whom 168 had diabetes listed anywhere on the death certificates. Thus the sensitivity and specificity of diabetes reporting anywhere on the death certificate were 34.7% and 98.1% respectively. Death certificates for those with diabetes listed cardiovascular disease (CVD) as the cause of death more often than did death certificates for those without diabetes (p ! 0.05). Sensitivity for diabetes reporting was higher for deaths occurring in hospitals, CVD listed as the underlying cause, and among diabetic participants who reported use of medication for diabetes. Overall sensitivity did not vary significantly by age or year of death, or sex. After stratification by decade of death, sensitivity for diabetes reporting for deaths occurring in 1992–2003 was greater when the cause of death was listed as CVD compared to any other cause (48.9% vs. 28.6% respectively, p ! 0.05). CONCLUSION: This study showed no overall improvement in diabetes reporting on death certificates. Reporting improved in recent years (1992–2003) for those whose death certificates indicated CVD as cause of death, likely reflecting the recent interest in diabetes as a major CVD risk factor.
P35 THE ASSOCIATION BETWEEN AMBIENT PARTICULATE AIR POLLUTION AND FATAL CORONARY HEART DISEASE AMONG PERSONS WITH RESPIRATORY SYMPTOMS/DISEASE LH Chen, SF Knutsen, L Beeson, M Ghamsary, D Shavlik, F Petersen, D Abbey, Department of Epidemiology and Biostatistics, School of Public Health, Loma Linda University, Loma Linda, CA PURPOSE: To assess the effects of ambient particulate matter (PM) air pollution on risk of fatal coronary heart disease (CHD) in
AEP Vol. 15, No. 8 September 2005: 630–665
persons characterized as a sensitive subgroup, e.g. persons with known respiratory disease. METHODS: The Adventist Health Study on Smog (AHSMOG) is a cohort study of 3769 nonsmoking, adults who have been followed for 22 years. A total of 806 persons free of CHD, stroke or diabetes at baseline and who reported having symptoms of asthma, some kind of bronchial condition, or emphysema on one of the 4 follow-up questionnaires (1977, 1987, 1992, 2000) constitute the study population. Monthly concentrations of ambient air pollutants were obtained from monitoring stations (PM10, Ozone, SO2, and NO2) or airport visibility data (PM2.5) and interpolated to zip code centroids of work and residence locations. PM10-2.5 concentrations were calculated as the differences between PM10 and PM2.5. Time-dependent Cox proportional hazards regression was used for analyses. Analyses were controlled for a number of potential confounders available from a detailed lifestyle questionnaire at baseline and for environmental tobacco smoke and other personal sources of air pollution available from the 4 subsequent questionnaires. RESULTS: Elevated risk of fatal CHD was found for all ambient PM fractions with the highest risk estimates for coarse fraction (PM10-2.5). The relative risk (RR) for fatal CHD with each 10 mg/m3 increase in PM10-2.5 was 2.1 (95% confidence interval (CI): 1.3, 3.3) in the single pollutant model and 2.2 (95 % CI: 1.3, 3.8) in the two-pollutant model with ozone. Risk appeared to be stronger in females than in males. CONCLUSION: High ambient concentrations of PM, especially coarse fraction, are associated with increased risk of fatal CHD among persons with known chronic respiratory disease (asthma, bronchial condition, or emphysema). The risk appears to be stronger in females than in males.
P36 EFFECT OF ALCOHOL CONSUMPTION ON OBESITY AMONG NONSMOKERS AA Arif, JE Rohrer, Department of Family & Community Medicine, Division of Health Services Research, Texas Tech University Health Sciences Center, Lubbock, TX PURPOSE: Obesity is recognized as a major public health problem in the U.S. However, the effect of alcohol consumption on obesity is not well understood. This study used data from NHANES III to explore association between overweight, obesity and alcohol consumption in the nonsmoking U.S. adult population. METHODS: We analyzed data on a total of 8,236 respondents who participated in the Third National Health and Nutrition Examination Survey. Body mass index (weight-kg/height-m2) was derived from measured height and weight data and categorized into: normal weight (BMI ! 25 kg-m2) Overweight (BMI between 25 kg-m2and 30 kg-m2), and obese (BMI > 30 kg-m2). Alcohol consumption was measured using following measures: history of drinking, quantity of drinks/day, frequency of drinking, average volume of drinks/week, and binge drinking. Multinomial logistic regression analyses were used to assess relationship between the categorical BMI variable and alcohol consumption. Pregnant women and those with missing information on alcohol consumption were excluded from the analysis. The analysis was adjusted for age, sex, race/ethnicity, poverty income ratio, education, marital status, self-rated health, and leisure time physical activities. Odds