Middle-aged African-American Men Research Articles

Tailor Made: A Pilot Virtual Weight Loss Intervention Individually Tailored for African American Men.

This study tests the acceptability and feasibility of the first virtual weight loss study individually tailored for middle-aged African American men. Tailor Made is a 3-month randomized controlled pilot of a weight loss intervention that included 58 overweight or obese African American men (mean age of 50.4; SD = 7.9). Control group participants received a Fitbit activity tracker and Bluetooth-enabled scale and copies of the self-led Tailor Made curriculum. Intervention group participants received the same Fitbit, Bluetooth-enabled scale, and curriculum and also participated in weekly, 45-minute virtual small group, professional-led education sessions using the Tailor Made curriculum and received three SMS text messages weekly: (a) a message individually tailored on African American Manhood that links men's values, goals, and motivation to health-promoting behavior; (b) a goal-tracking message to monitor physical activity, healthier eating, and lifestyle changes; and (c) a reminder 24 hours before their session. Participation rates in weekly small group sessions, randomization, and attendance at the assessments suggest that Tailor Made was feasible and acceptable. Only among intervention group participants, we found a small and significant decrease in BMI between baseline and final. In addition, active minutes of physical activity decreased for the control group while active minutes for the intervention group remained steady throughout the intervention. In sum, we demonstrated that a virtual, individually tailored weight loss intervention is feasible and acceptable to African American men. Participants valued the convenience of a virtual intervention, but there were a number of ways we may be able to enhance the potential benefits of this approach.

The role of work in gender identity, stress and health in low-income, middle-aged African-American men.

Although progress has been made in reducing disparities in life expectancy, addressing the persistence of health inequities by race remains a high priority for public health professionals. The purpose of this research was to refine a minority stress model (MSM) by identifying previously unrecognized factors contributing to stress and chronic disease health disparities among low-income middle-aged African-American men. Using a Community-Based Participatory Research approach, we conducted semi-structured individual health interviews with 42 low-income middle-aged African-American men in a mid-size New England city. The interviews focused on the participants' perceptions of the causes of health disparities. Four major themes emerged from the analysis: the positive aspects of work, both financial and symbolic; and the negative repercussions of not working, both financial and symbolic in terms of a sense of self-respect. On an instrumental level, working men can support their family, be physically active and find social support. Symbolically, work provides a positive sense of identity as a man; it offers both social- and self-respect; it provides discipline and a sense of gratitude. Conversely, the lack of work is a significant source of stress, stemming both from the inability to support one's family and from having nothing to do, which lead to depression, low self-esteem, suicidal ideation and anger. With no perceived viable routes to socially approved roles, many low-income men of color succumb to internalizing a negative identity. This research demonstrates a clear link between structural problems with the US economy and harms to sense of identity among low-income, middle-aged African-American men.

Psoas and paraspinous muscle index as a predictor of mortality in African American men with type 2 diabetes mellitus

AimRecent studies revealed a correlation between skeletal muscle mass index and density with longevity; these studies largely evaluated appendicular skeletal muscles in older Caucasians. This retrospective cohort study assessed the association between axial skeletal muscles size and density with survival in African Americans with type 2 diabetes mellitus. MethodsPsoas and paraspinous muscle mass index (cross sectional area/height2) and radiographic density (in Hounsfield Units) were measured using computed tomography in African American-Diabetes Heart Study participants, 314 women and 256 men, with median (25th, 75th quartile) age 55.0(48.0, 62.0) and 57.0(50.0, 64.0) years, respectively. Covariates in fully-adjusted model included age, sex, BMI, smoking, hormone replacement therapy (women), cardiovascular disease, hypertension, coronary artery calcified plaque mass, carotid artery calcified plaque mass, and African ancestry proportion. ResultsAfter median of 7.1(5.9, 8.2) years follow-up, 30(9.6%) of women and 49(19.1%) of men were deceased. In fully-adjusted models, psoas muscle mass index and paraspinous muscle mass index were inversely associated with mortality in men (psoas muscle mass index, hazard ratio [HR] = 0.61, P = 0.004; paraspinous muscle mass index, HR = 0.64, P = 0.004), but not in women. Psoas and paraspinous muscle densities did not associate with all-cause mortality. A penalized Cox regression that involved all covariates and predictors associated with mortality showed that only paraspinous muscle mass index remained a significant predictor of mortality (HR = 0.65, P = 0.02). ConclusionIndependent from established risk factors for mortality, higher psoas and paraspinous muscle index associate with reduced all-cause mortality in middle-aged African American men with type 2 diabetes mellitus.

Abstract P330: Childhood Material Deprivation and Self-reported, Physician-diagnosed Myocardial Infarction in a Southern Cohort of Middle-aged African American Men and Women

Introduction: The antecedents of cardiovascular disease occur early in life. However, most studies reporting associations between childhood social conditions and adult myocardial infarction (MI) have been conducted on European and US white populations. Hypothesis: We hypothesized that adverse childhood social conditions would be associated with increased risk for MI in a Southern cohort of middle-aged African American men and women. Methods: Multiple logistic regression models were used to investigate sex-specific associations between childhood material deprivation and 13 year incidence of self-reported-physician diagnosed MI among 413 Black men and 754 Black women in the Pitt County (NC) Study. Cohort members were aged 25 to 50 years in 1988, the baseline year, and were re-interviewed in 2001. For this study, childhood was defined as birth to age 13 years; and childhood material deprivation was measured by a composite index of receipt of public assistance, food insecurity, and the lack of household heat, electricity, or plumbing. Odds ratios (OR) of the association between childhood material deprivation and adult MI were estimated after adjusting for both childhood and adulthood socioeconomic position, demographics, lifestyle, co-morbidities and psychosocial factors. For women, menopausal status was also controlled. Results: Men exposed to 1-2 types of childhood material deprivation had 38% lower odds of MI than men unexposed to such deprivation during childhood, OR = 0.62; 95%CI: (0.41, 0.92). However, men exposed to 3+ types of material deprivation during childhood were 3 times more likely to report a physician-diagnosed heart attack than men who were unexposed, OR = 3.07; 95%CI: (1.79, 5.29). No difference in 13 year MI risk was observed between women exposed to 1-2 types of childhood material deprivation and women who were unexposed, OR = 1.23; 95%CI: (0.70, 2.16). However, women exposed to 3+ types of early-life material deprivation were 5 times more likely to report a physician-diagnosed MI compared to women who were unexposed, OR = 5.20; 95%CI: (2.58, 10.48). Conclusions: Our findings suggest that early childhood is a sensitive period wherein severe socioeconomic disadvantage may trigger, or exacerbate, biological processes that increase risk of MI, by middle age, in African American men and women.

Presence of an Alcohol Use Disorder is Associated with Greater Pneumonia Severity in Hospitalized HIV-Infected Patients.

Pneumonia is common and more severe in human immunodeficiency virus (HIV)-infected patients. Alcohol consumption in pneumonia patients without HIV is associated with excess mortality and morbidity. However, studies are lacking on the impact of alcohol on pneumonia and HIV. Our goal was to determine if alcohol use was an independent risk factor for pneumonia severity in HIV-infected patients. Secondary analysis of prospective cohort study data evaluating early bronchoscopy for pneumonia diagnosis in HIV patients between 2007 and 2011 was conducted. We defined AUDs using an alcohol use disorder identification test (AUDIT) scoreas follows: ≥8 indicates hazardous drinking and≥14 indicates dependence. We quantified pneumonia severity using the pneumonia severity index (PSI). Multivariable linear regression was used to investigate the independent association between alcohol and pneumonia severity. A total of 196 HIV+ individuals comprised our cohort. Most cohort subjects were middle-aged African American men. Most subjects (70%) reported not taking antiretroviral therapy. The overall prevalence of hazardous drinking was 24% in our cohort (48/196) with 10% (19/196) meeting the criteria for alcohol dependence. Alcohol consumption was significantly associated with pneumonia severity (r=0.25, p<0.001). Hazardous drinking (β-coefficient 10.12, 95% CI 2.95-17.29, p=0.006) and alcohol dependence (β-coefficient 12.89, 95% CI 2.59-23.18, p=0.014) were independent risk factors for pneumonia severity. Reported homelessness and men who have sex with men (MSM) status remained independent risk factors for more severe pneumonia after adjustment for the effects of alcohol. In a cohort of HIV patients with pneumonia, presence of an AUD was an independent risk factor for pneumonia severity. Homelessness and MSM status were associated with greater pneumonia severity in AUD patients.

Inked: historic African-American beach site as collective memory and group ‘Third Place’ sociability on Martha’s Vineyard

Using data gained from ethnographic research and interviews, this article examines ‘third place’ sociability in the social interactions of the Polar Bears of Martha’s Vineyard, a group of predominantly but not exclusively middle-aged and senior African-American men and women who swim, exercise and socialise together each morning at ‘the Inkwell’ beach. Using Georg Simmel’s concept of sociability and Ray Oldenburg’s third-place theoretical framework, this study explores the key role of the Monday communal breakfast and the function of conversation in establishing bonds between individuals. It further investigates the promotion of strong feelings of social connectedness, belonging, social support, social capital gains and community among its group members. The ongoing sociability and informal rules of the Polar Bears of Martha’s Vineyard has enabled it to become a model group demonstration of third-place community building. The importance of race, class and place is socio-historically investigated within the broader social context of the popular racialised section of the beach, ‘the Inkwell’, of African-American community life, and within the sub-community milieu of group social interaction.

Abstract P343: Racial Differences In The Progression Of Carotid Intima-media Thickness In Middle-aged Men-the Era Jump Study

Introduction: Intima-media thickness (IMT) of the carotid artery is an independent predictor of future cardiovascular events. A few studies have examined the racial differences in IMT progression. We aimed to study the racial differences in IMT progression over 4-6 years among middle-aged Caucasian, African and Japanese American men. Methods: Population-based samples of 393 men (Caucasian=199, African Americans=39, Japanese Americans=155; aged 40-49 years at baseline) free of clinical cardiovascular disease and not on lipid lowering, anti-diabetic or anti-hypertension medications at baseline were examined for IMT at two time points (baseline (2004-07) and follow-up (2008-13). Measurements of IMT were standardized and performed by University of Pittsburgh. Progression of IMT was defined as (follow-up IMT [[Unable to Display Character: &amp;#8211;]] baseline IMT)/duration of follow-up (years). Multivariable linear regression analyses were used and models were adjusted for traditional cardiovascular risk factors (Table). Results: In the unadjusted analyses, IMT progression was significantly associated with age and race, and marginally significantly associated with systolic blood pressure and diabetes. The progression rate of IMT (mean ± SE) was the highest in Japanese American (16 ± 1.2μm/year) compared with Caucasian (10.3 ± 1.0μm/year; P &lt; 0.01) and African American men (3 ± 2μm/year; P &lt; 0.01). In the adjusted analyses, age and race remained significantly associated with IMT progression. Japanese Americans progressed significantly faster than Caucasians. African Americans progressed slower than Caucasians but this difference was not significant. Diabetes was marginally significantly associated with IMT progression. Conclusions: Age and race are the major determinants of IMT progression in these middle-aged men. Racial differences in progression are prominent with fastest progression in Japanese Americans.

“I’m Ready to Eat and Grab Whatever I Can Get”

This article examines determinants and patterns of African American men's dietary practices. Thematic content analysis was used to analyze data from nine exploratory focus groups conducted with 83 urban, middle-aged and older African American men from southeast Michigan. The men distinguished between healthy and unhealthy foods and "meals" versus other instances of eating. Eating patterns and content differed depending on the meal, work and family schedules, food availability, and whether it was a weekday or weekend. When eating alone or outside the home, men prioritized convenience and preferences for tasty, unhealthy foods. Men often reported skipping breakfast or lunch and grabbing snacks or fast food during the day. They emphasized sharing dinner with their spouses and families-usually a home-cooked, "healthy" meal. On weekends, spouses often cooked less and men snacked and dined out more frequently. Sunday dinners involving favorite, unhealthy comfort foods were the highlight of men's eating practices. African American men tended not to follow healthy eating recommendations because of their busy lives, reliance on spouses to prepare food, and preferences for unhealthy foods. These findings suggest that healthy eating interventions must consider how the contexts of African American men's lives shape their eating practices.

Male Gender Role Strain as a Barrier to African American Men’s Physical Activity

Despite the potential health consequences, African American men tend to treat their roles as providers, fathers, spouses, and community members as more important than engaging in health behaviors such as physical activity. We conducted 14 exploratory focus groups with 105 urban, middle-aged African American men from the Midwest to examine factors that influence their health behaviors. Thematic content analysis revealed three interrelated barriers to physical activity: (a) work, family, and community commitments and priorities limited time and motivation for engaging in physical activity; (b) physical activity was not a normative individual or social activity and contributed to men prioritizing work and family responsibilities over physical activity; and (c) the effort men exerted in seeking to fulfill the provider role limited their motivation and energy to engage in physical activity. These findings highlight the need for physical activity interventions that consider how health fits in the overall context of men's lives.

The transcription factor 7-like 2 (TCF7L2) polymorphism may be associated with focal arteriolar narrowing in Caucasians with hypertension or without diabetes: the ARIC Study

BackgroundTranscription factor 7-like 2 (TCF7L2) has emerged as a consistently replicated susceptibility gene for type 2 diabetes, however, whether the TCF7L2 gene also has similar effects on the retinal microvasculature is less clear. We therefore aimed to investigate the association between the transcription factor 7-like 2 (TCF7L2) rs7903146 polymorphism and retinal microvascular phenotypes in the Atherosclerosis Risk in Communities (ARIC) Study (1993-1995).MethodsThis was a population-based, cross-sectional study of 10,320 middle-aged African American (n = 2,199) and Caucasian (n = 8,121) men and women selected from four United States communities to examine the association between TCF7L2 rs7903146 polymorphism and retinal microvascular signs (retinopathy, focal arteriolar narrowing, arteriovenous nicking, arteriolar and venular calibers). Photographs on one randomly selected eye were graded for presence of retinal microvascular signs and used to measure retinal vessel calibres.ResultsAfter adjusting for age, sex, study center, mean arterial blood pressure, total serum cholesterol, triglycerides, and other covariates, few associations of TCF7L2 rs7903146 and retinal microvascular signs were noted. TCF7L2 rs7903146 T risk allele was significantly associated with focal arteriolar narrowing in Caucasians with hypertension [odds ratio (OR)CT vs. CC (95% CI) = 1.25 (1.09-1.44); ORTT vs. CC = 1.56 (1.18-2.06); P = 0.002] and in Caucasians without diabetes [OR CT vs. CC = 1.18 (1.06-1.32); OR TT vs. CC = 1.40 (1.12, 1.75); P = 0.003]. No significant association of the TCF7L2 rs7903146 polymorphism and retinal vascular signs was noted among African American individuals.ConclusionsTCF7L2 rs7903146 is not consistently associated with retinal microvascular signs. However, we report an association between the TCF7L2 rs7903146 polymorphism and focal arteriolar narrowing in Caucasians with hypertension or without diabetes. Further research in other large, population-based studies is needed to replicate these findings.

Predictors of self-efficacy to use condoms among seropositive middle-aged African American men.

Condom use during sexual encounters continues to be a challenge for seropositive individuals. Hence, the influence of personal characteristics, AIDS knowledge, and religious well-being on perceived self-efficacy to use condoms has been examined in a convenience nonprobabilistic sample of 130 middle-aged seropositive African American men from the Mid-Atlantic region. AIDS knowledge and religious well-being are strongly related to self-efficacy to use condoms. These findings indicate that it is critical to explore further the relationship of AIDS knowledge and religious well-being with self-efficacy to use condoms.

Blood Pressure Dipping and Sleep Disturbance in African-American and Caucasian Men and Women

Elevated night time/daytime blood pressure (BP) ratios are associated with cardiovascular morbidity and mortality. We evaluated the associations between sleep/awake BP ratios and sleep disturbances. Sleep disturbances were assessed by in-home actigraphy and diary measures for nine nights, and polysomnography (PSG) for two nights; ambulatory BP was measured for at least 48 h. Participants were 186 middle-aged African-American and Caucasian men and women who were free from prevalent myocardial infarction, stroke, history of interventional cardiology procedures, diabetes, and diagnosed apnea or other sleep disorders. Results showed that the greater the sleep/wake ratios of BP, the more fragmented the sleep, the greater the proportion in stage 1 (light) sleep and the smaller the proportion in rapid eye movement (REM) sleep, and the greater the number of arousals from sleep. These results were independent of age, race, gender, Framingham Risk status, cardiovascular medications, body mass index, and apnea/hypopnea index. Indicators of psychosocial stress were not greater among those with higher sleep/wake BP ratios. Findings are consistent with the hypothesis that elevated night time/daytime pressure may be a consequence of poor sleep.

Cross-Sectional Association between Perceived Discrimination and Hypertension in African-American Men and Women: The Pitt County Study

Few studies have examined the impact of the frequency of discrimination on hypertension risk. The authors assessed the cross-sectional associations between frequency of perceived racial and nonracial discrimination and hypertension among 1,110 middle-aged African-American men (n = 393) and women (n = 717) participating in the 2001 follow-up of the Pitt County Study (Pitt County, North Carolina). Odds ratios were estimated using gender-specific unconditional weighted logistic regression with adjustment for relevant confounders and the frequency of discrimination. More than half of the men (57%) and women (55%) were hypertensive. The prevalences of perceived racial discrimination, nonracial discrimination, and no discrimination were 57%, 29%, and 13%, respectively, in men and 42%, 43%, and 15%, respectively, in women. Women recounting frequent nonracial discrimination versus those reporting no exposure to discrimination had the highest odds of hypertension (adjusted odds ratio = 2.34, 95% confidence interval: 1.09, 5.02). A nonsignificant inverse odds ratio was evident in men who perceived frequent exposure to racial or nonracial discrimination in comparison with no exposure. A similar association was observed for women reporting perceived racial discrimination. These results indicate that the type and frequency of discrimination perceived by African-American men and women may differentially affect their risk of hypertension.

Migraine and retinal microvascular abnormalities

This study examined the association between vascular headaches and retinal microvascular disease. We investigated the cross-sectional association between headaches (migraine/other headaches with aura, migraine without aura, other headaches without aura, no headaches) and retinal microvascular signs (retinopathy, focal arteriolar narrowing, arteriovenous nicking; arteriolar and venular calibers) among middle-aged African American and white men and women from the third examination of the Atherosclerosis Risk in Communities Study (1993 through 1995). After controlling for age, gender, race, study center, and cardiovascular risk factors, we determined that persons with headaches were more likely to have retinopathy than those without a history of headaches (odds ratio [OR] = 1.38, 95% CI = 0.96 to 1.99 for migraine/other headaches with aura; OR = 1.49, 95% CI = 1.05 to 2.12 for migraine without aura; and OR = 1.28, 95% CI = 0.99 to 1.65 for other headaches). Associations with migraine were stronger among the subset of participants without a history of diabetes or hypertension (OR = 1.79, 95% CI = 1.09 to 2.95 for migraine/other headaches with aura; and OR = 1.74, 95% CI = 1.11 to 2.71 for migraine without aura). Headaches were not associated with focal arteriolar narrowing or arteriovenous nicking. Persons with headaches tended to have smaller mean arteriolar and venular calibers; however, these associations did not tend to persist among those without hypertension or diabetes. Middle-aged persons with migraine and other headaches were more likely to have retinopathy signs, supporting the hypothesis that neurovascular dysfunction may underlie vascular headaches.

Usefulness of Ventricular Premature Complexes to Predict Coronary Heart Disease Events and Mortality (from the Atherosclerosis Risk In Communities Cohort)

The clinical relevance of ventricular premature complexes (VPCs) in apparently healthy patients is not clear and is typically not considered when evaluating risk. We conducted a prospective longitudinal study of the population-based Atherosclerosis Risk In Communities (ARIC) study of 15,070 Caucasians and African-Americans, 45 to 64 years of age, to assess the risks of coronary heart disease (CHD) events and mortality associated with VPCs among participants with and without prevalent CHD at baseline. VPCs on a single 2-minute electrocardiogram were identified in 940 participants (6.2%). After a follow-up of >10 years, 1,762 participants died, with 366 deaths related to CHD, and 1,736 had cardiac events. The percentage of participants with CHD mortality was >3 times greater for those with VPCs compared with those without VPCs. After controlling for cardiovascular risk factors and therapy with proportional hazards regression, participants with VPCs were >2 times as likely to die due to CHD than were those without VPCs. Increased risk was found for participants with and without baseline CHD. In conclusion, a clinical finding of VPCs on electrocardiography of even apparently healthy patients may warrant a heightened awareness of and attention to cardiovascular risk assessment and management.

The association of spatial T wave axis deviation with incident coronary events. The ARIC cohort

BackgroundAlthough current evidence suggests that the spatial T wave axis captures important information about ventricular repolarization abnormalities, there are only a few and discordant epidemiologic studies addressing the ability of the spatial T wave axis to predict coronary heart disease (CHD) occurrence.MethodsThis prospective study analyzed data from 12,256 middle-aged African American and white men and women, from the Atherosclerosis Risk in Communities Study (ARIC). Following a standardized protocol, resting standard 12-lead, 10-second electrocardiograms were digitized and analyzed with the Marquette GE program. The median follow-up time was 12.1 years; incident coronary heart disease comprised fatal and non-fatal CHD events.ResultsThe incidence rate of CHD was 4.26, 4.18, 4.28 and 5.62 per 1000 person-years respectively, across the spatial T wave axis quartiles. Among women for every 10 degrees increase in the spatial T wave axis deviation, there was an estimated increase in the risk of CHD of 1.16 (95% CI 1.04–1.28). After adjustment for age, height, weight, smoking, hypertension, diabetes, QRS axis and minor T wave abnormalities, this hazard rate ratio for women fell to 1.03 (0.92–1.14). The corresponding crude and adjusted hazard ratios for men were 1.05 (95% CI 0.96–1.15) and 0.95 (0.86–1.04) respectively.ConclusionsIn conclusion, this prospective, population-based, bi-ethnic study of men and women free of coronary heart disease at baseline shows that spatial T wave axis deviation is not associated with incident coronary events during long-term follow up. It is doubtful that spatial T wave axis deviation would add benefit in the prediction of CHD events above and beyond the current traditional risk factors.

Echocardiographic left ventricular mass in African-Americans: the Jackson cohort of the Atherosclerosis Risk in Communities Study.

Characterization of target organ damage from hypertension is of particular interest in African-Americans, and evidence from electrocardiographic studies suggests that left ventricular hypertrophy is a frequent clinical finding of considerable prognostic importance. Echocardiographic studies may permit more precise characterization of the pathologic impact of hypertension on cardiac structure and function. The objective of this study is to characterize left ventricular (LV) structure including measures of wall thickness, septal thickness, internal dimension, and mass in a middle-aged sample of African-Americans using echocardiography. This study is a cohort (cross-sectional) study in which 2445 middle-aged African-American study participants from a population-based sample initially enrolled by the Atherosclerosis Risk in Communities, Jackson, Mississippi Examination Center in 1987-1989 underwent an M-mode echocardiograpic examination at their third or fourth clinic visit in 1993-1996. Measures of LV mass, even where indexed by size were conspicuously greater in men compared to women, and men exhibited a demonstrably steeper gradient of LV mass across the rather restricted age range of the study. However, when gender specific thresholds for LV hypertrophy were utilized, African-American men appear to have lower prevalence of LV hypertrophy than women. The lowest prevalence of LV hypertrophy was observed in African-American men who did not have hypertension (28.4%). The findings confirm previous suggestions from electrocardiographic investigations that cardiac hypertrophy is common, if not epidemic in middle-aged African-American men and women, whether or not they have hypertension.

Insulin Resistance Syndrome and Echocardiographic Left Ventricular Mass in African-Americans

P70 The insulin resistance syndrome (IRS) has been associated with cardiovascular disease (CVD), but few studies have examined its relationship with subclinical measures such as echocardiographic left ventricular (LV) mass. This relationship is likely to be of particular importance in African-Americans where both IRS and elevated LV mass are common. Complete information was available for 1633 African-American women and men aged 49-73 who were enrolled in the Atherosclerosis Risk in Communities (ARIC) Study when M-mode echocardiography was performed at one of the four ARIC sites in Jackson, Mississippi (1993-1996). LV mass was calculated according to American Society of Echocardiography methods using the cube formula and was indexed by height. Participants were categorized by the number (0, 1, 2, or 3) of IRS characteristics (hypertension, dyslipidemia (low HDL cholesterol or high triglyceride), and glucose intolerance (diabetes or fasting glucose values ≥110 mg/dl)). Age-adjusted mean LV mass/height (g/m) increased progressively with increasing number of IRS disorders in both women and men (128.9, 148.6, 161.0, 171.6 and 135.9, 157.4, 170.6, 171.6 respectively, p&lt;0.001, tests for trend). Associations were slightly stronger in women than in men and were similar when participants were stratified by age, BMI and waist circumference. These associations were not altered by adjustment for smoking and alcohol intake, and were only slightly attenuated with adjustment for BMI and waist circumference. Analyses focusing on the components of LV mass revealed that posterior wall and interventricular septal thickness, but not LV chamber size, were significantly associated with the number of IRS disorders. In this large population-based study of middle-aged African-American women and men the degree of IRS clustering was strongly and independently related to LV mass and these associations are consistent with a possible influence of insulin resistance on myocardial thickening rather than chamber size.

A Bayesian Approach to Combining Information from a Census, a Coverage Measurement Survey, and Demographic Analysis

Demographic analysis of data on births, deaths, and migration and coverage measurement surveys that use capture-recapture methods have both been used to assess U.S. Census counts. These approaches have established that unadjusted Census counts are seriously flawed for groups such as young and middle-aged African-American men. There is considerable interest in methods that combine information from the Census, coverage measurement surveys, and demographic information to improve Census estimates of the population. This article describes a number of models that have been proposed to accomplish this synthesis when the demographic information is in the form of sex ratios stratified by age and race. A key difficulty is that methods for combining information require modeling assumptions that are difficult to assess based on fit to the data. We propose some general principles for aiding the choice among alternative models. We then pick a particular model based on these principles and imbed it within a more comprehensive Bayesian model for counts in poststrata of the population. Our Bayesian approach provides a principled solution to the existence of negative estimated counts in some subpopulations; provides for smoothing of estimates across poststrata, reducing the problem of isolated outlying adjustments; allows a test of whether negative cell counts are due to sampling variability or more egregious problems such as bias in Census or coverage measurement survey counts; and can be easily extended to provide estimates of precision that incorporate uncertainty in the estimates from demographic analysis and other sources. The model is applied to data for African-American age 30–49 from the 1990 Census, and results are compared with those from existing methods.

Electrocardiographic Findings in a Healthy Biracial Population

It has been well documented that the prevalence of certain electrocardiographic (ECG) findings among individuals free of coronary heart disease (CHD) differs by race. However, it is not known whether these differences exist independently of CHD risk factors (e.g., hypertension). We examined the ECG tracings of 2,686 apparently healthy, middle-aged African-American and white men and women who participated in the Atherosclerosis Risk in Communities Study and were at low risk of CHD. Using the Minnesota Code, among men, 46% of African-Americans, but only 25% of whites, had a minor ECG finding (p <0.001). In women, 32% of African-Americans and 23% of whites had a minor ECG finding (p <0.01). Specifically, the age-adjusted prevalences of high-amplitude R wave, ST elevation, T-wave findings, and prolonged P-R interval were statistically significantly higher in African-Americans. As for continuous ECG measurements, the R wave in leads V 5 and V 6, the S wave in V 1, the J-point amplitude in leads V 2 and V 5, the P-R interval, and the Cornell voltage (|S V 3| + R aVL) for left ventricular hypertrophy were all significantly greater in African-Americans than in whites. However, in both men and women, the heart rate corrected QT interval was shorter in African-Americans than in whites. All of these findings remained statistically significant after further adjustment for traditional CHD risk factors. These results suggest that racial differences in electrocardiograms may not be explained entirely by differences in established CHD risk factors, and because current diagnostic ECG criteria are largely based on data from middle-aged white men and women, race should be considered in the interpretation of ECG findings.