Obesity differences between African-American men and women.

The purpose of this study was to examine the socio-demographic and behavioral differences related to obesity between African-American men and women. Obesity was defined as a body mass index of greater than 27.3 kg/m2 for women and 27.8 kg/m2 for men. Data were collected from 661 African-Americans, 418 women and 243 men, residing in wards 7 and 8 in Washington, DC through telephone interviews. Obesity was prevalent among 38.3% of the women and 20.1% of the men (p < 0.01). For women age 55 or older, annual income over $20K, having less than a high school education, and alcohol and tobacco consumption were associated with being overweight in the initial bivariate analysis (p < 0.05). For men, being 35 years or older and unemployment were significant factors associated with obesity. Our final analysis, when known dietary risk factors were adjusted, revealed that in women, obesity was associated with age, hard liquor consumption and non use of tobacco. For men, older age was a primary association. We concluded that gender, with increasing age, plays a significant role in predicting obesity, as defined by concurrent national standards. African American men 55 years of age or older are the most likely group to be overweight even after predisposing and behavioral risk factors are considered.

Black-white differences in the stage at presentation of prostate cancer in the District of Columbia.

OBJECTIVES: Prostate cancer (PC) is a major health problem for American black males. Blacks experience higher PC incidence and mortality compared to whites. Although the racial difference in PC incidence remains unexplained, the difference in PC mortality has been largely attributed to the late stage of disease at presentation. By using the incidence data on District of Columbia residents, this study compares the stage at diagnosis between black men and white men and attempts to determine if observed differences may be attributed to socioeconomic status (SES). METHODS: Reporting facilities staged PC using the Surveillance, Epidemiology, and End Results summary staging scheme. Averages of high school education, income, and home ownership at the census tract level were used as proxies for SES, and frequency distributions were reported. Data were stratified based on stage to examine the influence of race and SES on stage. RESULTS: For 1987 to 1991, 980 men (median age, 71 years) were reportedly diagnosed with PC. Black patients are younger and prostate tumors appear more likely to be more aggressive among blacks than whites. SES is negatively associated with late stage PC, and currently married men, compared with previously married, are less likely to be diagnosed with metastatic PC. Black men are more likely to present with later stage disease, and this racial difference persists even when SES is controlled. CONCLUSIONS: Late stage diagnosis is associated with favorable SES indicators. But substantial racial gradients in the distribution of diagnostic stage persisted even after adjustment for SES. This suggests the need for more intensive efforts to address issues related to access, quality, and utilization of cancer screening services as they pertain to all African-American men in the District of Columbia irrespective of their social status.

Cancer prevention behaviors among African-American adults: a survey of wards 7 and 8 in Washington, DC.

A telephone survey of knowledge, attitude, and health practices regarding cancer was undertaken in wards 7 and 8, Washington, DC in 1988. These wards have the highest cancer rates in the city and are predominantly African American. Of the 670 randomly selected persons over 18 years of age, 243 were males and 427 were females. Among females, 84% believed cigarette smoking causes cancer, and 48% thought alcohol causes cancer; 31% smoked cigarettes and 38% consumed alcoholic beverages. Among males, 91% and 52% thought cigarettes and alcohol causes cancer respectively; 41% smoked and 54% consumed alcoholic beverages. Only 6% of the males over age 40 practiced all eight recommended cancer prevention behaviors, while 2% of the females over age 40 practiced all preventive health behaviors. Cancer preventive behavior was examined in relation to socioeconomic status. This study indicates that preventive health behaviors were not associated with socioeconomic status. Data suggest that cancer prevention and control programs and services targeted to this Washington, DC population should be increased and intensified.

Who won't tell: predictors of refusal to report number of sex partners.

Data from 1475 respondents to a telephone survey are used to examine whether those who refused to report the number of their sex partners in the 12-month period prior to the interview are more likely to engage in HIV risk behaviours than those who did report this number. Logistic regression shows that refusal is associated with being single of low education (OR(adj) = 8.0, 95% CI 2.7-23.7), using condoms in the last year (OR(adj) = 4.2, 95% CI 1.6-11.1), self-reporting of HIV-risk behaviours (OR(adj) = 3.6, 95% CI 1.3-9.6), and being male (OR(adj) = 2.7, 95% CI 1.1-6.6). These associations apply only to a subsample of individuals who provided complete information for HIV risk and other related behaviours. Results from the total sample indicate that individuals in our study who did not report their number of partners are more likely to have characteristics that are compatible with a higher probability of HIV risk practices. This pattern of associations suggests that refusers are indeed at higher risk for HIV infection than those sexually active individuals who did report the number of partners.

Racial differences in ill defined cancer mortality in the United States and in the District of Columbia.

STUDY OBJECTIVE: The aim was to examine the epidemiology of unknown primary cancer mortality in the USA during 1979 to 1988 by age, sex, race, year, and geographical area. DESIGN: National (US) and state data were abstracted for deaths due to ill defined cancer (ICD-9 195.0 to 199.1) and all cancers combined (ICD-9 140.0-209.9). Age adjusted mortality rates were calculated using the 1980 USA population as the standard, and standardised rate ratios were derived. National total cancer incidence data were obtained from the surveillance, epidemiology and end results (SEER) program, and age and sex specific relative (black/white) cancer incidence rates were derived and compared to relative (black/white) mortality rates for ill defined cancer. State and regional median family income levels were obtained from the 1980 census and compared to corresponding mortality rates. SETTING: This study used data for the US population, the 50 states, and the District of Columbia. MEASUREMENTS AND MAIN RESULTS: During 1984-1988, ill defined cancers accounted for an average of 34,921 deaths each year in the USA (13.7 per 100,000 population). The mortality rate due to ill defined cancers is greater among blacks (19.3 per 100,000) than whites (13.2 per 100,000) (RR = 1.5) and has not declined since 1979. There is considerable geographical variation in the ill defined cancer mortality rate. Thus among blacks the highest rates were clustered in the central states (23 per 100,000) and the lowest rates were seen in the mountain and western states (17 per 100,000). The District of Columbia had the highest overall rate (21.7 per 100,000) when compared to all other states. The black/white relative mortality rate due to ill defined cancer was consistently greater than the black/white relative incidence of all cancers. CONCLUSIONS: Ill defined cancer mortality is the fourth leading site of cancer mortality in the USA, and accounts for 7.4% of cancer deaths annually. The large proportion of ill defined cancer deaths may have biased the accuracy of national and local cancer incidence and mortality statistics. The higher mortality of ill defined cancer among blacks is not explained by the higher overall cancer incidence among blacks and suggests the influence of socioeconomic or cultural barriers that may result in underutilisation of health services or substandard health care. Ill defined cancer mortality may be a sentinel indicator of deficiencies in the health care delivery system as well as a measure of progress against cancer.

Surveillance of sentinel occupational mortality in the District of Columbia: 1980 to 1987.

Epidemiological surveillance of sentinel occupationally related deaths commonly relies on computerized analyses of mortality data obtained from vital statistics records. A computer search of death records in the District of Columbia for the period 1980 to 1987 identified 15 cases that noted asbestosis, silicosis, coal worker's pneumoconiosis, or primary cancer of the pleura/mesothelioma as the underlying cause of death. A manual review of the death certificates for the same period identified three times as many cases (n = 48) with any mention of these conditions. Problems with performing surveillance of these events using death certificates include the lack of sufficient information to identify mesotheliomas and the failure to code and computerize all contributing causes of death.

Black/white comparisons of deaths preventable by medical intervention: United States and the District of Columbia 1980-1986.

Blacks in the US experience increased mortality (1113 versus 745 per 100,000 males; 631 versus 411 per 100,000 females) and decreased life expectancy (63.7 years versus 70.7 years for males; 72.3 years versus 78.1 years for females); compared to Whites. In an effort to determine if the excess mortality among Black Americans might be explained by differences in access or quality of health care services, we performed a race-specific analysis of conditions for which mortality is largely avoidable given timely and appropriate medical care. Using methodology proposed by Rutstein and Charlton, mortality due to 12 causes was evaluated including tuberculosis, cervical cancer, Hodgkin's disease, rheumatic heart disease, hypertensive heart disease, acute respiratory disease, pneumonia and bronchitis, influenza, asthma, appendicitis, hernias and cholecystitis. In the US, during 1980 to 1986, an average of 17,366 deaths and 286,813 years of potential life (YPLL) before age 65 were lost each year due to all 12 sentinel causes combined. Of these causes, hypertensive heart disease, pneumonia and bronchitis, cervical cancer and asthma accounted for the greatest number of deaths. The mortality rate for all 12 causes combined among Blacks was 4.5 times that of Whites. The highest relative rates among Blacks compared to Whites were observed for tuberculosis, hypertensive heart disease and asthma. The overall mortality rate in the District of Columbia for the selected causes was 3.7 times the national rate. Compared to national rates, statistically significant elevated rates in the District were observed for tuberculosis, hypertensive heart disease and pneumonia and bronchitis.(ABSTRACT TRUNCATED AT 250 WORDS)

Comparisons of black and white smoking-attributable mortality, morbidity, and economic costs in the District of Columbia.

Cigarette smoking is generally considered to be the most important preventable cause of death in the United States. To determine the public health impact of smoking in the District of Columbia, the DC Commission of Public Health calculated smoking-attributable mortality, morbidity, and economic costs in this predominantly black population. In 1985, an estimated 933 district residents died from smoking-related diseases, resulting in 3535 years of potential life lost. Cigarette smoking contributed to approximately 13.5% of all District deaths in 1985 (N = 6921) and accounted for 30% of all deaths of persons over age 20, far exceeding the affect of other potentially preventable causes of mortality. Black residents, especially black men, shared a disproportionately greater burden of smoking-attributable mortality when compared with white residents. These smoking-attributable deaths resulted in over $110 million in direct medical and indirect morbidity and mortality costs to District of Columbia residents. The results indicate that cigarette smoking is a major contributing cause of the black-white disparity in health status in the District of Columbia.

Severity of Illness Index and the Adverse Patient Occurrence Index. A reliability study and policy implications.

Seven hundred fifty-two randomly selected charts from seven teaching hospitals were rated by pairs of medical record analysts. The Severity of Illness Index was unreliable with an interrater-agreement rate of 73% (kappa statistic = 0.41), and demonstrated a significant (P less than 0.0001) association with the Adverse Patient Occurrence (APO) Index. This suggests that the Severity of Illness Index is not differentiating severity of illness from quality of care. The fair to poor field reliability stems from underlying instrument subjectivity, lack of clear referent groups, and time pressure. The APO Index was also found to be unreliable (r = 0.33 and range = -0.05-0.58). Greater attention should be directed to improving objective discharge abstract, billing, and laboratory data for measuring patient severity and adverse patient occurrences.

Systemic recombinant alpha-2 interferon therapy in relapsing multiple sclerosis.

This report describes the first use of recombinant-DNA-produced human interferon in patients with multiple sclerosis (MS). Ninety-eight patients who were clinically definite for MS with two or more documented exacerbations during the preceding two years were admitted to this placebo-controlled double-blind randomized trial. Although both groups were similar, placebo patients had later MS onset. Patients injected themselves with 2 X 10(6) IU of alpha-2 interferon or placebo three times each week for up to 52 weeks. This dose of interferon was well tolerated in that side effects were minimal. During the trial, the exacerbation rate was sharply reduced in both groups. In the three-month follow-up period after stopping treatment, more patients who were receiving interferon than placebo became worse neurologically. More patients who were receiving interferon than placebo changed from exacerbating MS to progressive MS during the trial. Thus, no clear therapeutic benefit of alpha-2 interferon for MS was detected.

Prospective payment for psychiatry--feasibility and impact.

Although 15 diagnosis-related groups (DRGs) have been proposed for psychiatric hospital patients, psychiatric hospitals are currently exempt from the DRG prospective payment system. We investigated the ability of the psychiatric DRGs to predict the hospital length of stay and costs by retrospectively analyzing the charts of 8816 randomly selected patients from 32 psychiatric hospitals throughout the United States. In addition, we developed other grouping systems to see whether they would have been better predictors of length of stay. We found that grouping the patients in the 15 psychiatric DRGs reduced the total variance in length of stay by only 3.9 percent. Furthermore, our best alternative grouping--based on major diagnostic categories, whether the patient was transferred from another facility, age, and psychiatric complications and comorbidities--reduced the variance by only 7.8 percent. We conclude that DRGs do not adequately predict length of stay or costs in psychiatric hospitals. We identified factors other than diagnosis that predicted the length of stay better, but all the models we tested would create large financial "winners" and "losers" and thus introduce inappropriate incentives into the care of patients in psychiatric hospitals.