US White Population Research Articles

The Incidence, Prevalence, and Outcomes of Patients With Gastroparesis in Olmsted County, Minnesota, From 1996 to 2006

The epidemiology of gastroparesis is unknown. We aimed to determine the incidence, prevalence, and outcome of gastroparesis in the community. Using the Rochester Epidemiology Project, a medical records linkage system in Olmsted County, Minnesota, we identified county residents with potential gastroparesis. The complete medical records were reviewed by a gastroenterologist. Three diagnostic definitions were used: (1) definite gastroparesis, delayed gastric emptying by standard scintigraphy and typical symptoms for more than 3 months; (2) probable gastroparesis, typical symptoms and food retention on endoscopy or upper gastrointestinal study; (3) possible gastroparesis, typical symptoms alone or delayed gastric emptying by scintigraphy without gastrointestinal symptoms. Poisson regression was used to assess the association of incidence rates with age, sex, and calendar period. Among 3604 potential cases of gastroparesis, 83 met diagnostic criteria for definite gastroparesis, 127 definite plus probable gastroparesis, and 222 any of the 3 definitions of gastroparesis. The age-adjusted (to the 2000 US white population) incidence per 100,000 person-years of definite gastroparesis for the years 1996-2006 was 2.4 (95% confidence interval [CI], 1.2-3.8) for men and 9.8 (95% CI, 7.5-12.1) for women. The age-adjusted prevalence of definite gastroparesis per 100,000 persons on January 1, 2007, was 9.6 (95% CI, 1.8-17.4) for men and 37.8 (95% CI, 23.3-52.4) for women. Overall survival was significantly lower than the age- and sex-specific expected survival computed from the Minnesota white population (P<.05). Gastroparesis is an uncommon condition in the community but is associated with a poor outcome.

Survival Trends in Patients With Gastric and Esophageal Adenocarcinomas: A Population-Based Study

To use a population-based approach to describe survival trends in patients diagnosed as having gastric or esophageal adenocarcinoma. A population-based complete chart review of all inpatient and outpatient records, using the resources of the Rochester Epidemiology Project, was conducted in Olmsted County, Minnesota (population 124,277), a primarily rural county with one large urban area. All residents of Olmsted County who were diagnosed as having gastric or esophageal adenocarcinoma from January 1, 1971, through December 31, 2000, were included in the study. The main outcomes were median survival and 2-year and 5-year survival rates, by decade of diagnosis. From 1971 through 2000, median survival for patients with gastric adenocarcinoma (n=121) decreased from 5.5 months to 3.2 months, whereas median survival for patients with esophageal adenocarcinoma (n=65) increased from 8.5 months to 11.7 months. Decade of diagnosis was not significantly associated with patient survival for either gastric or esophageal adenocarcinoma (P>.05). There was no significant shift in stage of disease at diagnosis during the 30-year period for either gastric or esophageal adenocarcinoma (P>.05). No significant change has occurred in the survival rates of this patient population with gastric or esophageal adenocarcinoma, which is representative of the US white population.

Incidence and Risk Factors for Stroke in American Indians

There are few published data on the incidence of fatal and nonfatal stroke in American Indians. The aims of this observational study were to determine the incidence of stroke and to elucidate stroke risk factors among American Indians. This report is based on 4549 participants aged 45 to 74 years at enrollment in the Strong Heart Study, the largest longitudinal, population-based study of cardiovascular disease and its risk factors in a diverse group of American Indians. At baseline examination in 1989 to 1992, 42 participants (age- and sex-adjusted prevalence proportion 1132/100 000, adjusted to the age and sex distribution of the US adult population in 1990) had prevalent stroke. Through December 2004, 306 (6.8%) of 4507 participants without prior stroke suffered a first stroke at a mean age of 66.5 years. The age- and sex-adjusted incidence was 679/100 000 person-years. Nonhemorrhagic cerebral infarction occurred in 86% of participants with incident strokes; 14% had hemorrhagic stroke. The overall age-adjusted 30-day case-fatality rate from first stroke was 18%, with a 1-year case-fatality rate of 32%. Age, diastolic blood pressure, fasting glucose, hemoglobin A(1c,) smoking, albuminuria, hypertension, prehypertension, and diabetes mellitus were risk factors for incident stroke. Compared with US white and black populations, American Indians have a higher incidence of stroke. The case-fatality rate for first stroke is also higher in American Indians than in the US white or black population in the same age range. Our findings suggest that blood pressure and glucose control and smoking avoidance may be important avenues for stroke prevention in this population.

EXISTENCE OF ALASKA NATIVE HEALTH DISPARITIES

The recent article by Jones rightfully emphasizes the “Persistence of American Indian Health Disparities.” For many health indicators, American Indian/Alaska Native (AIAN) people have the poorest health and greatest health disparity of any population in the nation.1 Goal 2 of the national Healthy People 2010 2 plan targets the elimination of health disparities. Jones points out that for most of the leading causes of death in the AIAN population (heart disease, accidents, diabetes, alcohol, suicide, and tuberculosis), mortality rates for American Indian/Alaska Natives are 1.2- to 7.7-times higher than the general US population, although for all AIAN people combined, death rates for cancer are not higher than the general US population. However, the author states “recent trends suggest that disparities in cancer might also emerge.”1(p2131) As has been frequently noted, data for all AIAN people combined do not show the large variation in rates between the multiple, diverse groups within the AIAN population. Disparities in cancer rates for Alaska Native people have been reported for over 25 years. Recent cancer mortality rates (1999–2003) show a 25% higher rate among Alaska Natives than among the US White population. There is no evidence this disparity is decreasing.3 The first report of cancer mortality among Alaska Natives (1960–1969) found that cancer mortality rates among Alaska Natives were slightly lower than among the US Whites population but higher than among other American Indian groups.4 A study by the National Cancer Institute of all racial/ ethnic groups in the United States (1988–1992) reported cancer death rates were highest among Alaska Native women and third for Alaska Native men.5 Cancer has been the leading cause of death among Alaska Native people since the mid-1990s. Evidence documents that a cancer disparity already exists. Having suffered through many infectious disease epidemics, Alaska Native people perceive that they are in the midst of a new epidemic. It is critical for policy makers to recognize existing disparities and take action necessary to meet the goal of Healthy People 2010 to eliminate documented disparities.

PARL Leu262Val is not associated with fasting insulin levels in UK populations

PARL, the gene encoding presenilins-associated rhomboid-like protein, maps to chromosome 3q27 within a quantitative trait locus that influences components of the metabolic syndrome. Recently, an amino acid substitution (Leu262Val, rs3732581) in PARL was associated with fasting plasma insulin levels in a US white population (N=1031). This variant was also found to modify the positive association between age and fasting insulin. The aim of this study was to test whether these findings could be replicated in two UK population-based cohorts. Participants from the Medical Research Council Ely and Hertfordshire cohort studies were genotyped for this variant using a SNaPshot primer extension assay and Taqman assay respectively. Full phenotypic and genotypic data were available for 3,666 study participants. Based on a dominant model, we found no association between the Leu262Val polymorphism and fasting insulin levels (p=0.79) or BMI (p=0.98). We did not observe the previously reported interaction between age and genotype on fasting insulin (p=0.14). Despite having greater statistical power, our data do not support the previously reported association between PARL Leu262Val and fasting plasma insulin levels, a measure of insulin resistance. Our findings indicate that this variant is unlikely to be an important contributor to insulin resistance in UK populations.

Lung cancer epidemiology in mainland China

Lung cancer incidence has increased rapidly in China over the last 20 years, especially in females. Among the 183 registered world-wide populations, lung cancer incidence in males was ranked as the 73rd, 74th, 127th and 23rd respectively for Shanghai, Tianjin, Qidong and Hong Kong, and in females the 52nd, 13th, 102nd and 23rd. The sex ratio (M/F) ranged from 1.5 to 3.5 for most areas. The ratio of squamous/adenocarcinoma was 2.01 in males and 0.67 in females in Tianjin, 0.97 and 0.28 in Hong Kong, 1.00 and 0.61 in the US white population and 1.18 and 0.49 in US blacks. Much research on risk factors have been conducted and documented including the following: genetic predisposition/polymorphism, smoking/coal soot and DNA adduct, cytochrome p450-1A1 (CYP1A1), glutathione S-transferase-M (GST-M), viral infection/HPV infection, high background radiation, family history, tobacco consumption, mental health, prior lung diseases, coal soot indoor air pollution, cooking fume indoor air pollution, hormones, diet, occupational exposure, outdoor air pollution, socioeconomic level/education, alcohol consumption and their interactions(addition/synergy). Based on current information we should carefully devise a plan to control lung cancer that can be put into practice.

Epidemiologic characteristics of colon cancer in Asian Indian and Pakistani population living in the USA compared to US White population in SEER database from 1988 to 2002

20112 Background: About 1.5% of the US population is South East Asian in origin and it is one of the rapidly growing groups. Colon cancer is the second most common in male and third most common cancer in females in Asian Indian and Pakistani population living in the USA. This is the first study examining the epidemiologic characteristics of colon cancer in this group. Methods: SEER cancer incidence public use database have reported cancer incidence in 13 SEER registries from 1973 to 2002. Since 1988, Indian/Pakistani populations were reported separately under race and ethnicity. Frequency sessions were performed and descriptive parameters were calculated regarding age, sex, stage, grade, tumor location and diagnostic methods used. Results: A total of 4,229 cases of cancer were reported from 1988 to 2002 in this group and 352 (9%) were colon cancers. The reported incidence of colon cancer in SEER database is increasing (11 in 1988 vs. 53 in 2002). Table shows the comparative studies of different variables of colon cancer between Indian/Pakistani and US White population reported in SEER database. Conclusions: Our study shows that the incidence of colon cancer in Asian Indian and Pakistani population under age 50 is substantially higher than the US White population and the predilection is towards the male sex. Our results suggest that this ethnic group warrants close screening and risk factor stratification for earlier detection of colon cancer as well as awareness and counseling in high-risk families. [Table: see text] No significant financial relationships to disclose.

Epidemiologic characteristics of breast cancer (BC) in Asian Indian and Pakistani population living in the US compared to US white population in SEER database from 1988 to 2002

10657 Background: It is estimated that South East Asian population comprises about 1.5% of the total US population and is rapidly growing. BC is the most common cancer in the US-based Indian/Pakistani female population (38%) as reported in the SEER database. This is the first study reporting different epidemiologic characteristics of BC in this population. Methods: From 1988, Indian and Pakistani population with cancer diagnosis was reported separately. Frequency sessions were performed and epidemiologic parameters for BC were calculated regarding age, marital status, stage, grade, laterality, nodal involvement, menopausal status and hormone receptor status. Results: BC comprises about 19% of all cancers reported in US-based Indian and Pakistani population from SEER database. A total of 804 cases of BC were reported in this group in SEER database from 1988 to 2002. BC is the most common cancer (38%) in US-based Indian and Pakistani female population. In comparison, WHO data from 2002 shows that it is the leading cancer in Pakistani females (34%) and second leading cancer in Indian females (19%). BC is more common in this ethnic group than White female (38% vs 32%, p &lt; 0.01) as reported in SEER database. Table shows the comparative studies of different variables of BC between Indian/Pakistani and US White female reported in SEER database. Conclusion: US-based Indian and Pakistani female population is diagnosed with BC at a younger age than US White population. BC tends to express more receptor positivity. A significant number of females are under 50 at the time of diagnosis. More studies in this subset of patients will help in developing screening and educational intervention in this rapidly growing population. [Table: see text] No significant financial relationships to disclose.

Prostate cancer in Alaska Native men, 1969–2003

Objectives. The incidence of prostate cancer differs significantly between US race groups. In prior reviews of cancer in Alaska Natives, the incidence of prostate cancer has been observed to occur at a low rate compared to US Whites and Blacks. However, a detailed report of prostate cancer in this population has not been previously published.Study Design. Incidence of prostate cancer in Alaska Native men was determined for the time period 1969–2003 using data from the Alaska Native Tumor Registry. The registry is a population-based registry which participates in the National Cancer Institute Surveillance, Epidemiology and End Results Program, and has collected cancer information on Alaska Natives since 1969.Methods. Incidence rates were calculated for all Alaska Natives and for each of the three major ethnic groups (Aleut, Eskimo, Indian). Comparisons of incidence rates between Alaska Natives and US Whites were performed using odds ratios. Temporal changes were identified by a Chi square analysis for trend.Results. During the 35-year period of review, 332 Alaska Native men were diagnosed with prostate cancer. The age-adjusted incidence rate of 69.5 per 100 000 in Alaska Native men during 1994–2003 was significantly higher than the rate of 45.5 per 100 000 for the earlier period 1969-1983. The US White rate for 1994-2002 of 169.5 per 100 000 was significantly higher than the rate for Alaska Native men for 1994-2003. Results of comparisons between Alaska Native ethnic groups for 1969-2003 showed that prostate cancer was highest in Indians and Aleuts and lowest among Eskimos.Conclusions. Compared to the US White population, the incidence of prostate cancer in Alaska Native men is significantly lower. Prostate cancer rates among Alaska Native ethnic groups differ. The reason for these differences remains undetermined.

Prevalence and Burden of Fecal Incontinence: A Population-Based Study in Women

The epidemiology of fecal incontinence (FI) is incompletely understood. We report the prevalence, clinical spectrum, health care-seeking behavior, and quality of life (QOL) in community women with FI. A questionnaire was mailed to an age-stratified random sample of 5300 Olmsted County, Minnesota, women identified by the Rochester Epidemiology Project. Symptom severity was assessed by a validated scale, and impact on QOL was evaluated for subjects who had any FI during the past year. The prevalence of FI was calculated with direct age adjustment to the 2000 US white female population. Altogether, 2800 of 5300 women (53%) responded to the survey. The overall age-adjusted prevalence of FI in the past year was 12.1 per 100 (95% confidence interval, 11.0-13.1). The prevalence increased with age from 7 (third decade) to 22 (sixth decade) per 100 and was steady thereafter. Symptoms were mild (45%), moderate (50%), or severe (5%), and symptom severity was related to the impact of FI on QOL and physician-consulting behavior. Moderate to severe impact on >/=1 domain of QOL was reported by 6% with mild, 35% with moderate, and 82% with severe symptoms, whereas 5% with mild, 10% with moderate, and 48% with severe FI had consulted a physician for FI in the past year. More than 1 of 10 adult women in the population have FI; almost 1 of 15 have moderate to severe FI. FI significantly impacts QOL and prompts health care utilization predominantly in women with moderate to severe symptoms.

Incidence of hip fracture in Shiraz, Iran

Hip fracture, the most serious complication of osteoporosis, puts the burden of a lot of costs for treatment on any health system. Previous reports on rates of hip fracture in Asian countries differ a lot. The aim of this study was to estimate the incidence rate of hip fracture in Shiraz, Iran. In Shiraz, Iran, all operating-room logs with diagnosis of hip fracture were reviewed for hip fractures caused by a simple fall in patients over 50 years, during March 21, 2000, to March 21, 2003. According to patients' medical records, age, sex, type of fracture (intertrochanteric, neck, subtrochanteric) and patients' regions according to Shiraz municipality divisions were obtained. The age-adjusted incidence rates of hip fracture standardized to the 1985 US white population (325.74/100,000 for men and 519.05/100,000 for women) and to the 1989 US white population (384.61/100,000 for men and 548.17/100,000 for women) were the highest in Asia. The intertrochanteric fractures were significantly higher among females ( p =0.003). The incidence of intertrochanteric and neck fractures were increased with age. In all age groups, females had higher incidence rates, except for ages over 80 years, in which males had higher incidence rates than females. In wealthier regions of the city, the incidence rates were higher than in other regions. High incidence of hip fracture in our population, especially in males over 80 years, shows that preventive strategies for hip fracture and osteoporosis should be considered in males as well as females. Further studies are needed to find incidence rates in other cities, especially in the very urbanized city of Tehran.

Racial Misclassification and Disparities in Cardiovascular Disease Among American Indians and Alaska Natives

National vital event data suggest that cardiovascular disease (CVD) mortality rates are lower for American Indians and Alaska Natives (AIAN) than for the general US population, but these data are disproportionately flawed for AIAN because of racial misclassification. Vital event data adjusted for racial misclassification and published by the Indian Health Service were used to compare trends in CVD mortality from 1989 to 1991 to 1996 to 1998 between AIAN, US all-races, and US white populations. Without misclassification accounted for, AIAN initially had the lowest mortality rates from major CVD, but by the end of the study, their rates were the highest. Adjustment for misclassification revealed an early and rapidly growing disparity between CVD mortality rates among AIAN compared with rates in the US all-races and white populations. By 1996 to 1998, the age- and misclassification-adjusted number of CVD deaths per 100,000 among AIAN was 195.9 compared with age-adjusted rates of 166.1 and 159.1 for US all races and whites, respectively. The annual percent change in CVD mortality for AIAN was 0.5 compared with -1.8 in the other groups. Regardless of racial misclassification, the most striking and widening disparities were found for middle-aged AIAN, but CVD mortality among AIAN > or =65 years of age was lower than in the other populations. A previously underrecognized disparity in CVD mortality exists for AIAN, particularly among middle-aged adults. Moreover, these disparities are increasing. Efforts to reduce CVD mortality in AIAN must begin before the onset of middle age.

Cardiology patient pages. Prothrombin 20210 mutation (factor II mutation).

Testing for the prothrombin 20210 mutation, also called factor II mutation, may have been offered by your doctor because you or someone in your family, has had (1) a blood clot in one of the deep veins of the body (also called deep vein thrombosis or DVT); (2) a blood clot that has traveled to the lung (called a pulmonary embolism or PE); (3) a blood clot in an unusual site (such as the mesenteric or cerebral sinus vein); (4) a heart attack or stroke at a young age; or (5) a history of recurrent pregnancy loss or stillbirth. A history like this in yourself or a family member may be indicative of an underlying thrombophilia. Thrombophilia is a term that describes a state in which the blood has an increased tendency to clot. People can have this increased tendency because they (1) have one or more inherited (genetic) risk factors, (2) have developed a chronic condition that puts them at increased risk, such as obesity, cancer, inflammatory bowel disease, or the persistence of certain antibodies (antiphospholipid antibodies), or (3) have a temporary condition that leads to an increased clotting tendency, such as recent surgery, trauma, a cast, prolonged immobility, pregnancy, or the use of oral contraceptives or hormone replacement therapy. The purpose of this Cardiology Patient Page is to provide more information about the prothrombin mutation, which is the second most common cause of hereditary thrombophilia. Normally, there is a fine balance in the body which ensures that there is not too much bleeding or blood clotting. If this balance is disrupted, a blood clot may occur. Throughout the course of a normal day, the blood vessels sustain many minor injuries of which you are not aware. In response, the body naturally triggers the “clotting cascade”—a sequence of events …

Population-based study of symptomatic internal carotid artery occlusion: incidence and long-term follow-up.

Internal carotid artery (ICA) occlusion is an important cause of transient ischemic attack (TIA) and cerebral infarction. There are no previous population-based natural history studies evaluating outcome after symptomatic ICA occlusion (SICAO). We performed a retrospective, population-based study of SICAO. All Olmsted County (Minnesota) residents with possible SICAO from 1986 to 2000 were identified by cross-referencing appropriate clinical and imaging codes. Inclusion criteria were cerebral infarction or TIA in a carotid distribution and imaging documentation of ipsilateral ICA occlusion <3 months after the index event. Kaplan-Meier estimates were used to calculate the risk of cerebral infarction, myocardial infarction, and death after SICAO. Seventy-five patients qualified. Annual SICAO incidence was 6 per 100,000 persons (age and gender adjusted to the 2000 US white population). Risk of cerebral infarction during follow-up was 8% at 30 days, 10% at 1 year, and 14% at 5 years. Five of 11 cerebral infarctions occurred within the first week after diagnosis of occlusion. Risk of myocardial infarction was 0% at 30 days, 8% at 1 year, and 24% at 5 years. Risk of death was 7%, 13%, and 29%, respectively. There may be 15,000 to 20,000 incident cases of SICAO in the United States annually. Risk of cerebral infarction after SICAO is initially high and then stabilizes, whereas risk of myocardial infarction is initially low but gradually increases. Better strategies are needed to reduce early stroke recurrence in this setting.

High incidence rate of hip fracture in Taiwan: estimated from a nationwide health insurance database.

The objective of this study was to describe the incidence rate of hip fracture from 1996 to 2000 in Taiwan, based on an inpatient database of the National Health Insurance Program. A total of 54,199 patients, who had a first-time admission for a diagnosis of hip fracture (ICD9 code 820.0 through 820.9, 820.21, 820.22, and 820.31) on discharge from January 1996 through December 2000 and aged 50 to 100 years, were identified and included in the study. The results showed that the age-specific incidence rates of hip fractures were higher with increasing age in both genders, in an exponential manner after 65 years of age. The incidence was 1.6 times higher and rose about 5 years earlier among women than among men. Thus in these 5 years the age-adjusted incidence rates (95% confidence interval) of hip fracture in Taiwan were 225 (95% CI, 188-263) per 100,000 in men and 505 (95% CI, 423-585) per 100,000 in women (adjusted to US white population of 1989), as compared with US white rate of 187 in men and 535 in women. More than half of the fractures were peritrochanteric, and the recorded cause in most cases was a fall on the same level, from slipping, tripping, or stumbling (ICD9 E885). A total of 37.8% patients had hip hemiarthroplasty, 51.2% had open reduction of fracture with internal fixation, and 10.5% had closed reduction of fracture with internal fixation. We concluded that, using the data from a nationwide health insurance database of Taiwan, we found a high annual incidence rate of hip fracture for both men and women in 5 consecutive years. These incidence rates were higher than other reports on Chinese populations reported in the past 10 years and similar to that of Western countries. With the rapid aging of the populations of Taiwan and other Asian countries in the years to come, our results clearly demonstrated the impact of osteoporosis and hip fracture in this region.

Stroke in a biracial population: the excess burden of stroke among blacks.

Excess mortality resulting from stroke is an important reason why blacks have higher age-adjusted mortality rates than whites. This observation has 2 possible explanations: Strokes occur more commonly among blacks or blacks have higher mortality rates after stroke. Our population-based epidemiological study is set in the Greater Cincinnati/Northern Kentucky region of 1.31 million people, which is representative of the US white and black populations with regard to many demographic and socioeconomic characteristics. Hospitalized cases were ascertained by International Classification of Diseases (ninth revision) discharge codes, prospective screening of emergency department admission logs, and review of coroner's cases. A sampling scheme was used to ascertain cases in the out-of-hospital setting. All potential cases underwent detailed chart abstraction by study nurses, followed by physician review. Race-specific incidence and case fatality rates were calculated. We identified 3136 strokes during the study period (January 1, 1993, to June 30, 1994). Stroke incidence rates were higher for blacks at every age, with the greatest risk (2- to 5-fold) seen in young and middle-aged blacks (<65 years of age). Case fatality rates did not differ significantly in blacks compared with whites. Applying the resulting age- and race-specific rates to the US population in 2002, we estimate that 705,000 to 740,000 strokes have occurred in the United States, with a minimum of 616,000 cerebral infarctions, 67,000 intracerebral hemorrhages, and 22,000 subarachnoid hemorrhages. Excess stroke-related mortality in blacks is due to higher stroke incidence rates, particularly in the young and middle-aged. This excess burden of stroke incidence among blacks represents one of the most serious public health problems facing the United States.

Estimated incidence of pseudoexfoliation syndrome and pseudoexfoliation glaucoma in Olmsted County, Minnesota.

To determine the incidence of newly diagnosed pseudoexfoliation syndrome and pseudoexfoliation glaucoma in residents of Olmsted County, Minnesota from 1976 to 1991. The database of the Rochester Epidemiology Project was used to identify all patients residing in Olmsted County who were newly diagnosed with pseudoexfoliation syndrome from 1976 to 1991. The criterion used to diagnose pseudoexfoliation syndrome was the presence of pseudoexfoliation material on 1 or more anterior segment structures. Criteria used to diagnose pseudoexfoliation glaucoma were diagnosis of pseudoexfoliation syndrome with evidence of glaucomatous changes or ocular hypertension receiving therapy. The overall age and sex-adjusted annual incidences of pseudoexfoliation syndrome and pseudoexfoliation glaucoma, adjusted to the 1990 US white population, were determined with differences across age and sex using Poisson regression. Pseudoexfoliation syndrome was diagnosed in 290 patients (mean age, 73 +/- 10 years). Two hundred twenty-one (76%) were female. The overall age and sex-adjusted annual incidence of pseudoexfoliation syndrome was 25.9 per 100,000. The age-adjusted incidence was higher in females than in males (32.7 vs 16.9 per 100,000; P<0.001). Pseudoexfoliation syndrome diagnoses increased with age, from 2.8 per 100,000 in persons 40 to 49 years to 205.7 per 100,000 in persons > or =80 years (P<0.001). Thirty-five patients were excluded from pseudoexfoliation glaucoma diagnosis. Of the remaining 255 patients, 113 (44%) were diagnosed with pseudoexfoliation glaucoma during the study period (mean age, 76 +/- 10 years), 84 (74%) of whom were female. The overall age- and sex-adjusted annual incidence of pseudoexfoliation glaucoma was 9.9 per 100,000. The age-adjusted incidence was higher in females than in males (11.7 vs 7.2 per 100,000; P < 0.001). Pseudoexfoliation glaucoma was increasingly diagnosed with age, rising from 0.6 per 100,000 in persons 40 to 49 years to 114.3 per 100,000 in persons > or =80 years, (P<0.001). In a defined population, the estimated overall age- and sex-adjusted annual incidence of pseudoexfoliation syndrome was 25.9 per 100,000 population, while the estimated overall age- and sex-adjusted annual incidence of pseudoexfoliation glaucoma was 9.9 per 100,000 population. The incidence of both diseases was higher in females and increased with advancing age.

Cohort effects in a genetically determined trait: eye colour among US whites

Background : While the inheritance of eye colour is likely polygenic, blue eye colour is thought to follow an inheritance pattern similar to that of a recessive trait. Consequently, age-related differences in the prevalence of blue eye colour would be unanticipated. Aim : This study explores the finding and explanation for birth cohort differences in the prevalence of blue eye colour in the US white population. Subjects and methods : Data from the first (1971-1975) and third (1988-1994) US National Health and Nutrition Examination Surveys (NHANES-I and NHANES-III), nationally representative surveys of the US population, were analysed. Trends in eye colour prevalence by birth cohort were analysed together with mortality rates according to eye colour. US census data (1980) were examined to explore cohort differences in ancestry and assortative mating by ancestry. Results : The prevalence of blue eye colour among non-Hispanic whites in NHANES-III was 57.4% (95% CI: 50.1-64.7) for individuals born between 1899 and 1905 compared to 33.8% (95% CI: 31.3-36.5) for those born between 1936 and 1951. No association was found between survival and eye colour, nor was a cohort effect evident for primary ancestry. However, proportions reporting only one ancestry in census data declined with successive birth cohorts. Conclusions : A cohort effect in blue eye colour prevalence was found for the US white population. A secular trend of decreasing assortative mating by ancestry is the likely explanation.

Lung cancer mortality rates in birth cohorts in the United States from 1960 to 1994

We sought to describe the changing death rates from lung cancer in the US white population in sequential birth cohorts, adjusting for cohort smoking prevalence and duration. We searched the US mortality database (1960–1994) for all deaths among whites in which lung cancer was listed as the underlying cause of death. To determine the population at risk for lung cancer, we used the 1970, 1978–1980, and 1992 National Health Interview Surveys to estimate the annual number of current and recent smokers (those who had quit within 5 years) in 11 5-year birth cohorts, starting in 1901. We then determined annual lung cancer mortality rates for each birth cohort, stratified by sex and adjusting for the prevalence and duration of smoking. The population-based rates of lung cancer mortality were much higher among men than among women across all ages and birth cohorts, reflecting higher smoking rates among men. These differences decreased after we controlled for current and recent smoking within the cohorts and were slightly increased in women after we controlled for duration of smoking. Differences in lung cancer death rates across birth cohorts of US men and women primarily reflect differences in the prevalence and duration of smoking in these birth cohorts. Changes in cigarette design that have greatly reduced tar yields have a relatively small effect compared with that of people's smoking status and duration of smoking.

Systemic diseases associated with various types of retinal vein occlusion

PURPOSE: To investigate systemic diseases associated with various types of retinal vein occlusion. METHODS: We investigated prospectively in 1090 consecutive patients with retinal vein occlusion, almost all Caucasian (consistent with the racial pattern here), the prevalence of associated systemic disorders before or at the onset of various types of retinal vein occlusion. The patients were categorized into six types of retinal vein occlusion based on defined criteria: nonischemic and ischemic central retinal vein occlusion, nonischemic and ischemic hemi-central retinal vein occlusion, and major and macular branch retinal vein occlusion. The patients had a detailed ophthalmic and systemic evaluation according to our protocol. For data analysis, patients were divided into three age groups: young (younger than 45 years), middle-aged (45 to 64 years), and elderly (65 years or older). The observed prevalence rates of major systemic diseases were compared among central retinal vein occlusion, hemi-central retinal vein occlusion, and branch retinal vein occlusion using a polytomous logistic regression analysis adjusting for gender and age. Logistic regression adjusting for age and gender was also used to compare the observed prevalence of systemic disease between nonischemic and ischemic in central retinal vein occlusion and hemi-central retinal vein occlusion and between major and macular branch retinal vein occlusion. These observed prevalence rates were also compared with those expected in a gender-matched and age-matched control population from estimates from the US National Center for Health Statistics. RESULTS: There was a significantly higher prevalence of arterial hypertension in branch retinal vein occlusion compared with central retinal vein occlusion ( P < .0001) and hemi-central retinal vein occlusion ( P = .028). Branch retinal vein occlusion also had a significantly higher prevalence of peripheral vascular disease ( P = .0002), venous disease ( P = .011), peptic ulcer ( P = .031), and other gastrointestinal disease ( P < .0001) compared with central retinal vein occlusion. The proportion of patients with branch retinal vein occlusion with cerebrovascular disease was also significantly ( P = .049) greater than that of the combined group of patients with central retinal vein occlusion and patients with hemi-central retinal vein occlusion. There was no significant difference in prevalence of any systemic disease between central retinal vein occlusion and hemi-central retinal vein occlusion. A significantly greater prevalence of arterial hypertension ( P = .025) and diabetes mellitus ( P = .011) was present in the ischemic central retinal vein occlusion compared with the nonischemic central retinal vein occlusion. Similarly, arterial hypertension ( P = .0002) and ischemic heart disease ( P = .048) were more prevalent in major branch retinal vein occlusion than in macular branch retinal vein occlusion. Relative to the US white control population, the combined group of patients with central retinal vein occlusion and patients with hemi-central retinal vein occlusion had a higher prevalence of arterial hypertension ( P < .0001), peptic ulcer ( P < .0001), diabetes mellitus (in ischemic type only, P < .0001), and thyroid disorder ( P < .0001). The patients with branch retinal vein occlusion showed a greater prevalence of arterial hypertension ( P ≤ .005), cerebrovascular disease ( P = .007), chronic obstructive pulmonary disease ( P = .012), peptic ulcer ( P < .0001), diabetes (in young only, P = .0005), and thyroid disorder ( P = .003) compared with the US white control population. CONCLUSIONS: The findings of our study revealed that a variety of systemic disorders may be present in association with different types of retinal vein occlusion and in different age groups, and that their relative prevalence differs significantly, so that the common practice of generalizing about these disorders for the entire group of patients with retinal vein occlusion can be misleading. The presence of a particular associated systemic disease does not necessarily imply a cause-and-effect relationship with that type of retinal vein occlusion; the particular disease may or may not be one of the risk factors in a multifactorial scenario predisposing an eye to develop a particular type of retinal vein occlusion. Based on our study, we think that apart from a routine medical evaluation, an extensive and expensive workup for systemic diseases is unwarranted in the vast majority of patients with retinal vein occlusion.