Risk factors for incident self-reported arthritis in a 20 year followup of the Alameda County Study Cohort.

OBJECTIVE: This longitudinal study examined the following variables as possible risk factors for self-reported arthritis: age, sex, race, body mass index (BMI), depressive symptoms, leisure-time physical activity, cigarette use, alcohol, hypertension, diabetes mellitus, education, income, and hard physical work. METHODS: Altogether, 1149 women and 964 men from the Alameda County Study Cohort without self-reported arthritis in 1974 were assessed for incident self-reported arthritis in 1994. RESULTS: In a multivariate model, the following variables were associated with increased odds of incident arthritis: increasing age (age 45-49, odds ratio 2.00, 95% confidence interval 1.40-2.85; age 50+, OR 3.13, 95% CI 2.32-4.22), BMI for women only (4th quintile, OR 1.65, 95% CI 1.05-2.60; 5th quintile, OR 1.88, 95% CI 1.19-2.95), female sex (OR 1.48, 95% CI 1.20-1.83), and >/= 5 depressive symptoms (OR 1.53, 95% CI 1.12-2.10). Leisure-time physical activity in the highest quartile was protective (OR 0.69, 95% CI 0.51-0.95). All other factors were not associated with arthritis. CONCLUSION: This study indicates that depressive symptoms, as well as age, sex, and BMI, are independent risk factors for arthritis. This is the first longitudinal population based study to examine and establish that prior depressive symptoms are a risk factor for arthritis.

Religious attendance and cause of death over 31 years.

OBJECTIVE: Frequent attendance at religious services has been reported by several studies to be independently associated with lower all-cause mortality. The present study aimed to clarify relationships between religious attendance and mortality by examining how associations of religious attendance with several specific causes of death may be explained by demographics, socioeconomic status, health status, health behaviors, and social connections. METHOD: Associations between frequent religious attendance and major types of cause-specific mortality between 1965 and 1996 were examined for 6545 residents of Alameda County, California. Sequential proportional hazards regressions were used to study survival time until mortality from circulatory, cancer, digestive, respiratory, or external causes. RESULTS: After adjusting for age and sex, infrequent (never or less than weekly) attenders had significantly higher rates of circulatory, cancer, digestive, and respiratory mortality (p < 0.05), but not mortality due to external causes. Differences in cancer mortality were explained by prior health status. Associations with other outcomes were weakened but not eliminated by including health behaviors and prior health status. In fully adjusted models, infrequent attenders had significantly or marginally significantly higher rates of death from circulatory (relative hazard [RH] = 1.21, 95 percent confidence interval [CI] = 1.02 to 1.45), digestive (RH = 1.99, p < 0.10, 95 percent CI = 0.98 to 4.03), and respiratory (RH = 1.66, p < 0.10, 95 percent CI = 0.92 to 3.02) mortality. CONCLUSIONS: These results are consistent with the view that religious involvement, like high socioeconomic status, is a general protective factor that promotes health through a variety of causal pathways. Further study is needed to determine whether the independent effects of religion are mediated by psychological states or other unknown factors.

A prospective study of dyspepsia in primary care.

Dyspepsia is a common complaint, but its course and associated resource utilization have not been well described. In this study, 288 adult, primary care patients with dyspepsia treated at ambulatory clinics were followed prospectively for one year. Medical chart, utilization, and baseline and one-year follow-up survey data were collected. These patients had 13.3 medical visits (sex- and age-standardized) during the follow-up period, 55% above standardized mean visits for a comparison group of nondyspepsia patients. Standardized mean charges of $3542 for dyspeptics was 126% above nondyspepsia patient charges. Over half had gastrointestinal-related follow-up visits; 61% used gastrointestinal drugs; and 43% had gastrointestinal procedures. NSAID users had higher gastrointestinal-related utilization than did nonusers, recording an additional gastrointestinal visit (P < 0.001) and $678 more in charges (P = 0.03). Eighty-six percent of the 189 follow-up survey respondents experienced gastrointestinal symptoms at some time during the follow-up year. This study showed that most primary care dyspepsia patients remained symptomatic after one year and were intensive users of medical care.