Tecumseh Community Health Study Research Articles

Observations on the distribution of serum uric acid levels in participants of the Tecumseh, Michigan, Community Health Studies: A comparison of results of one method used at two different times and of two methods used simultaneously

Individuals participating in the Tecumseh Community Health Study, in 1959–1960 (TCHS I) and 1962–1965 (TCHS II), had serum uric acid determinations by an enzymatic spectrophotometric method, SUA(ES), as part of a comprehensive health examination. Among the 1633 male and 1725 female subjects, the mean serum uric acid concentration had increased by 0.32 mg per 100 ml for males, and by 0.18 for females, over the the average of 4.1 yr between determinations. It was found that, approximately, 40 per cent of subjects had a decrease, and 56 per cent, an increase, in serum uric acid concentration. The change was greater than plus or minus 2.0 mg per 100 ml for 28.7 per cent of males and 19.4 per cent of females. Decreases of as much as 8.2, and increases of as much as 9.9 mg per 100 ml were observed. How much of the average increase, in an average 4.1 yr interval between tests, is due to ageing, except for males in the age range of 10–19 yr, is problematical. It seems probably that most of the average increase was due to technical factors in performance of the test. In the study of 1962–1965, serum uric acid determinations were done by two methods. An automated colorimetric method was compared with an enzymatic spectrophotometric method. Both methods showed the same types of distribution curves of serum uric acid concentrations and curves of age-sex specific mean serum uric acid. The values obtained by the automated colorimetric method were slightly, but, consistently, higher to a statistically significant degree than those of the enzymatic spectro-photometric method. For 2092 male subjects, the mean SUA(AC) was 0.21 mg per 100 ml greater than the mean SUA(ES), while for 2104 females subjects, this difference was 0.14. Of 4196 study subjects, whose sera were tested by both methods, about 90.0 per cent showed an agreement of the two values within ± 0.9 mg per 100 ml. However, 1.9 per cent of males and 1.6 per cent of females, had ES values which exceeded AC values by 2.0 mg per 100 ml, while 2.8 per cent of male and 2.3 per cent of female subjects had AC values greater than ES values by 2.0 mg per 100 ml. The extremes of differences range from 4.4 to 7.3 mg per 100 ml. The data in this paper gives us increased confidence in the essential validity of the mean age and sex distributions of serum uric acid values, from the Tecumseh Community Health Studies, published in an earlier paper [2]. It is concluded that, for the purposes of population studies, the automated colorimetric method is more advantageous than the enzymatic spectrophotometric method, because of its lesser cost. Comparison of the results of the two studies emphasizes the problems of definition of hyperuricemia. Further mathematical analysis of the distribution curves obtained in such studies may lead to definitions of normo- and hyperuricemia of greater precision for clinical purposes.

The Tecumseh study.

The Tecumseh Community Health Study has been described in terms of its history, aims, design, conduct and current results, work in progress and future plans. This prospective epidemiological investigation of health and disease, especially cardiovascular disease and related disorders, in a total, natural community has its emphasis on the early detection of disease precursors in susceptible individuals, families, and other groups; the outlook is on prevention. An extensive and intensive study of this kind has been shown to be both feasible and productive. It represents what Dr. Thomas Francis, Jr., has called “clinical investigation on a community level,” including data on man and his environment. The key contribution of Dr. Francis in the establishment and conduct of the study is recalled and remembered with deep appreciation and respect.

The increased prevalence of allergic disease in anhidrotic congenital ectodermal dysplasia

Anhidrotic congenital ectodermal dysplasia (ACED) is a sex-linked recessive disorder which is characterized by anodontia or severe hypodontia, anhidrosis or severe hypohidrosis, and hypotrichosis. Afflicted individuals may also demonstrate evidence of hypoplastic changes in the respiratory mucosa. Seven male patients with ACED were found to have a statistically significant increased prevalence of extrinsic bronchial asthma and/or allergic rhinitis and an increased prevalence of positive prick test reactions to common inhalant allergens when compared with a control population examined in the Tecumseh Community Health Study. Four patients with ACED and allergic disease had no consistent abnormality in serum IgG, IgA, or IgM levels, and both transport piece and IgA were demonstrable in their salivary secretions or parotid fluid. It is postulated that the increased prevalence of allergic disease in patients with ACED may be due to an abnormality of the nasal mucosa resulting in an increased permeability to or decreased destruction of inhaled allergens.

Familial factors in premature coronary heart disease--a preliminary report from the Tecumseh Community Health Study.

Deutscher, S., L D. Ostrander and F. H. Epstein (Univ. of Michigan School of Public Health, Ann Arbor, Mich. 48104). Familial factors in premature coronary heart disease—a preliminary report from the Tecumseh Community Health Study. Amer. J. Epid., 1970, 9J: 233–237.—Incidence rates of coronary heart disease (CHD) among men whose parents had died of CHD and of other causes, were compared in order to assess the role of familial factors in the disease. Considerable differences were found for younger men (aged 40–59). Fatal CHD was commonest when parental death from CHD occurred before 65, and rarest when due to other causes. Non-fatal CHD was more common when parental death from CHD occurred after 65 than when it occurred prior to this age. By contrast, no appreciable differences were detected for older subjects (aged 60 and over), it is concluded that familial factors play an important role in the development of premature CHD. Evidence indicating that this form of CHD is related to elevated levels of serum cholesterol, blood glucose and blood pressure, was also presented.

The relationship of serum uric acid to risk factors in coronary heart disease

Analysis of the uric acid data from the initial examination cycle of the Tecumseh Community Health Study reveals that not only age and sex but also body weight or build should be considered when evaluating serum uric acid levels in disease or relating serum uric acid levels to other physiologic variables. It was found that serum uric acid levels of persons with coronary heart disease were not significantly different from the mean of the population studied and hence cannot be considered an attribute associated with the disease. Furthermore, there appears to be no evident relationship between serum uric acid levels and serum cholesterol or blood sugar, both of which are regarded as risk factors for coronary heart disease. Although there is no consistent pattern of a relationship between uric acid levels and casual blood pressure levels, some trends are suggestive. Of the conditions and disease states studied, only gout and pregnancy differed significantly from the means of the entire population with respect to serum uric acid scores; the levels in gouty subjects, as expected, were higher and in pregnant women lower, confirming reports in the literature.

The distribution of serum uric acid values in a population unselected as to gout or hyperuricemia: Tecumseh, Michigan 1959–1960

Serum uric acid determinations were made for 6,000 study subjects from the Tecumseh Community Health Study, Tecumseh, Michigan, 1959–1960. These 6,000 subjects represent a natural population without prior selection for either hyperuricemia or gout. Male subjects, of whom there were 2,987, had serum uric acid values ranging from 1.0 to 13.6 mg. per 100 ml. with an arithmetic mean of 4.9 mg. per 100 ml. and a standard deviation of 1.40 mg. per 100 ml. Female subjects, 3,013 in all, had serum uric acid values ranging from 1.0 to 11.6 mg. per 100 ml. with an arithmetic mean of 4.2 mg. per 100 ml. and a standard deviation of 1.16 mg. per 100 ml. The sex specific distribution curve for male subjects is broad and slightly skewed to the high value end of the scale. The curve for female subjects, by contrast, is narrow, peaking sharply at a value well below that of the curve in male subjects and is somewhat more skewed toward the upper end of the scale. The age-sex specific mean serum uric acid values for both sexes are lowest in the four year olds with rising trend of values in the five to nine and ten to fourteen year age groups. At about puberty the curves begin to separate. The curve for male subjects continues to rise to a peak at ages twenty to twenty-four years; it then falls slightly and plateaus at a level of about 5.2 mg. per 100 ml. For female subjects, there is a slight rise in serum uric acid values beyond puberty but the curve shortly falls again and plateaus at a level of about 4.0 mg. per 100 ml. until the age of menopause, when it rises gradually to approach closely that of male subjects in the early fifties. The data with reference to relative distribution above arbitrarily defined cutting points suggest that these points, commonly used in clinical medicine to define “hyperuricemia,” are unrealistically low and, in addition, fail to take into account important differences associated with age. The observed serum uric acid level for each individual subject has been adjusted or standardized to that of the appropriate age-sex group. The distribution curves of the present data show no suggestion of bimodality and suggest genetic polymorphism.

Field methods and response rates in the Tecumseh community health study.

THE TECUMSEH Community Health TStudy is a comprehensive longitudinal study of the health of the entire population of Tecumseh, Mich., and the immediately surrounding area. The broad objective of the project is to study the origin, course, and distribution of disease and disability and of health knowledge and attitudes toward health problems in a natural community. The study is a collaborative undertaking by the faculty and departments of the School of Public Health of the University of Michigan and brings to bear the multiple disciplines and interests applicable to a thorough examination and extended observation of a population in its environment. The study began in 1956 under support from an appropriation which the Michigan State Legislature made to the university for Research in the Development and Utilization of Human Resources. During 1956 and 1957, this support made possible the selection of the study community, the mapping of the study area, the identification of the population and listing of the dwelling units by a census-type canvass and the listing (on a self-reporting basis) of