Annals of Epidemiology

Editorial Board

2012-02-01

Potentially Modifiable Pre-, Peri-, and Postdeployment Characteristics Associated With Deployment-Related Posttraumatic Stress Disorder Among Ohio Army National Guard Soldiers

2012-02-01

Purpose: To evaluate potentially modifiable deployment characteristics—predeployment preparedness, unit support during deployment, and postdeployment support—that may be associated with deployment-related posttraumatic stress disorder (PTSD).Methods: We recruited a sample of 2616 Ohio Army National Guard (OHARNG) soldiers and conducted structured interviews to assess traumatic event exposure and PTSD related to the soldiers’ most recent deployment, consistent with DSM-IV criteria. We assessed preparedness, unit support, and postdeployment support by using multimeasure scales adapted from the Deployment Risk and Resilience Survey.Results: The prevalence of deployment-related PTSD was 9.6%. In adjusted logistic models, high levels of all three deployment characteristics (compared with low) were independently associated with lower odds of PTSD. When we evaluated the influence of combinations of deployment characteristics on the development of PTSD, we found that postdeployment support was an essential factor in the prevention of PTSD.Conclusions: Results show that factors throughout the life course of deployment—in particular, postdeployment support—may influence the development of PTSD. These results suggest that the development of suitable postdeployment support opportunities may be centrally important in mitigating the psychological consequences of war.

Estimated Effects of Potential Interventions to Prevent Decreases in Self-Rated Health Among Breast Cancer Survivors

Mario Schootman, Anjali D. Deshpande, Sandi Pruitt, Rebecca Aft, Donna B. Jeffe — 2012-02-01

Purpose: To estimate the effect of hypothetical changes in modifiable predictors on the incidence of fair-to-poor self-rated health (SRH) in breast cancer survivors.Methods: In 2007–2008, we interviewed 832 breast cancer survivors 1 year after diagnosis (baseline) and 1 year later. First, multivariable logistic regression models estimated the association between the predictors (sociodemographic factors, access to medical care, comorbid conditions, psychosocial factors, perceived neighborhood conditions, cancer-related behaviors, clinical factors) and SRH. Second, we estimated the probabilities of fair-to-poor SRH for values of the predictors for each breast cancer survivor. Third, we estimated the population-wide effect of potential changes in modifiable predictors on the incidence of fair-to-poor SRH.Results: A total of 7.6% of participants (92.4% white; mean age, 58.0 years) whose SRH was rated good-to-excellent at baseline reported fair-to-poor SRH 1 year later. The largest potential reduction in incidence of fair-to-poor SRH could be obtained by eliminating surgical side effects (27.8% reduction) and comorbidity (21.8% reduction) and by engaging in any physical activity (19.6% reduction).Conclusions: A significant portion of the decline in SRH can be avoided by reducing surgical side effects, preventing comorbidity, and improving physical activity with the use of evidence-based strategies.

Socioeconomic Inequalities in the Morbidity and Mortality of Acute Coronary Events in Finland: 1988 to 2002

2012-02-01

Purpose: To examine the changes in socioeconomic disparities in the incidence of coronary heart disease (CHD) and mortality in Finland and to analyze the effects of the severe economic recession of the early 1990s on these disparities.Methods: The population-based FINAMI Myocardial Infarction (MI) register recorded all suspected MI events among men and women ages 35 to 99 years in four geographical areas of Finland. Record linkage with the files of Statistics Finland provided us with detailed information on the indicators of socioeconomic status (SES; income, education, and profession). Rates were expressed per 100,000 inhabitants of each socioeconomic group per year and age-standardized to the European standard population. Poisson regression was used for analyzing rate ratios and time trends of coronary events in different socioeconomic groups.Results: The mortality rate ratio of coronary events among 35- to 64 year-old men was 5.21 (95% confidence interval, 4.23–6.41) when the lowest income sixth to the highest income sixth were compared. Among women, the respective rate ratio was 11.13 (5.77–21.45). Significant differences in the incidence and 28-day mortality by SES were seen also in the older age groups. Some socioeconomic differences were found in the proportions of patients receiving thrombolysis or undergoing early revascularization. No substantial changes were observed in inequalities between the socioeconomic groups during the study period.Conclusions: The excess CHD morbidity and mortality among persons with lower SES is still considerable in Finland, but the economic recession did not widen the differences.

Change of Sex Gaps in Total and Cause-Specific Mortality Over the Life Span in the United States

Yang Yang, Michael Kozloski — 2011-11-21

Purpose: Previous research has led to the expectation that the gap in mortality between sexes narrows in older ages as sex differences in fecundity decrease. However, the patterns and explanations of variations in sex disparities in mortality across the life span and underlying causes of death are not well understood. We conducted a population-based study to further test this hypothesis.Methods: By using a nationally representative sample of adults (N = 25,254) with mortality follow-ups for 18 years, we modeled age variations in sex differences in risks of mortality from leading causes of death.Results: Male excesses in mortality decrease at older ages significantly for some but not all causes. Differential exposures to social, physiological, and morbidity risk factors account for the late life reductions of the sex mortality gaps completely in circulatory diseases, partially or minimally in the other causes of death. Social status and relationship are more important risk factors for mortality in younger ages, health behaviors are significant for all ages, and physiological dysregulation is more predictive of mortality in older ages.Conclusions: Sex differences in the risk of mortality have strong age variations and are cause specific. Additional studies of age acceleration of cancer mortality risk are needed.

Racial Discrimination, Mood Disorders, and Cardiovascular Disease Among Black Americans

David H. Chae, Amani M. Nuru-Jeter, Karen D. Lincoln, Kimberly R. Jacob Arriola — 2011-11-21

Purpose: To examine associations between racial discrimination, mood disorders, and cardiovascular disease (CVD) among Black Americans.Methods: Weighted logistic regression analyses were performed on a nationally representative sample of Black Americans (n = 5022) in the National Survey of American Life (NSAL; 2001–2003). Racial discrimination and CVD were assessed via self-report. Mood disorder was measured with the World Health Organization Composite International Diagnostic Interview.Results: Model-adjusted risk ratios (RRs) revealed that participants with a history of mood disorder had greater risk of CVD (RR, 1.28; 95% confidence interval (CI), 1.12–1.45). This relationship was found specifically among those younger than 50 years of age (RR, 1.56; 95% CI, 1.27–1.91). There was a significant interaction between racial discrimination and mood disorder in predicting CVD in the total (F = 2.86, 3 df, p = .047) and younger sample (F = 2.98, 3 df, p = .047). Participants with a history of mood disorder who reported high levels of racial discrimination had the greatest risk of CVD.Conclusions: The association between racial discrimination and CVD is moderated by history of mood disorder. Future studies may examine pathways through which racial discrimination and mood disorders impact CVD risk among Black Americans.

Prescription Medication Use Among Normal Weight, Overweight, and Obese Adults, United States, 2005–2008

Brian K. Kit, Cynthia L. Ogden, Katherine M. Flegal — 2011-11-21

Purpose: We sought to describe differences between normal weight, overweight, and obese adults in use of specific prescription medication classes.Methods: Cross-sectional analysis of prescription medication use among 9789 adults in the National Health and Nutrition Examination Survey, a nationally representative sample of the United States.Results: In 2005–2008, 56.4% (95% confidence interval [CI], 54.6–58.3) of adults used 1+ prescription medication. Approximately one-quarter of adults used a hypertension medication (26.1%; 95% CI, 24.5%–27.8%). The use of hypertension medications increased with increasing weight status (normal weight: 17.2%; 95% CI, 15.6%–18.8%; overweight: 24.5%, 95% CI, 22.6%–26.4%; and obese: 35.1%, 95% CI, 32.8%–37.4%). Similarly, lipid-lowering, analgesic, antidepressant, proton pump inhibitors, thyroid, diabetes, and bronchodilator medication use was greater among obese compared with normal weight adults (each p < .01). Among adults 65+ years, 72% (95% CI, 68.2%–75.8%) of men and 67.7% (95% CI, 64.3%–71.2%) of women used a hypertension medication and a majority of men (51.2%, 95% CI, 48.4%–54%) and 40.3% (95% CI, 36.8%–43.8%) of women used lipid lowering medications; the use of both was greater among obese adults compared to normal weight adults (both p < .01).Conclusions: Obese adults in the United States use several prescription medication classes more frequently, than normal weight adults, including hypertension, lipid-lowering, and diabetes medications.

Use of Leg Length to Height Ratio to Assess the Risk of Childhood Overweight and Obesity: Results From a Longitudinal Cohort Study

Jian Liu, Nadia Akseer, Brent E. Faught, John Cairney, John Hay — 2012-02-01

Purpose: To determine whether leg-length to height ratio (LLHR) measured in children can be used to assess overweight and obese status 3 years later.Methods: A total of 1166 children from South Ontario, Canada, were assessed in grade five and again in grade eight were included in this analysis. On the basis of LLHR gender-specific quartile cutoffs in grade five, children were categorized into four groups (Q1[low]–Q4). Gender and age specific cutoffs of body mass index were used to categorize children as overweight/obese or normal weight in grade eight. Multiple logistic regression models were used to examine the overweight/obesity risk association with LLHR.Results: In comparing those in Q1 of LLHR, we found the odds ratios (OR, 95% confidence interval) of overweight/obese for those in the Q2–Q4 were 0.60 (0.29–1.21), 0.43 (0.21–0.89), and 0.32 (0.15–0.70) for boys and 0.77 (0.36–1.64), 0.60 (0.28–1.29), and 0.27 (0.12–0.62) for girls, respectively. The overweight/obesity risk association with LLHR remains after removing those who were considered overweight/obese at grade five.Conclusions: LLHR is associated with risk of childhood overweight/obesity. Further studies are warranted to investigate the role of LLHR on development of obesity.

Estimating the Health Effects of Exposure to Multi-Pollutant Mixture

Cécile Billionnet, Duane Sherrill, Isabella Annesi-Maesano, GERIE study — 2012-02-01

Purpose: Air pollution constitutes a major public health concern because of its ubiquity and of its potential health impact. Because individuals are exposed to many air pollutants at once that are highly correlated with each other, there is a need to consider the multi-pollutant exposure phenomenon. The characteristics of multiple pollutants that make statistical analysis of health-related effects of air pollution complex include the high correlation between pollutants prevents the use of standard statistical methods, the potential existence of interaction between pollutants, the common measurement errors, the importance of the number of pollutants to consider, and the potential nonlinear relationship between exposure and health.Methods: We made a review of statistical methods either used in the literature to study the effect of multiple pollutants or identified as potentially applicable to this problem. We reported the results of investigations that applied such methods.Results: Eighteen publications have investigated the multi-pollutant effects, 5 on indoor pollution, 10 on outdoor pollution, and 3 on statistical methodology with application on outdoor pollution. Some other publications have only addressed statistical methodology.Conclusions: The use of Hierarchical Bayesian approach, dimension reduction methods, clustering, recursive partitioning, and logic regression are some potential methods described. Methods that provide figures for risk assessments should be put forward in public health decisions.

2012-02-01

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2012-02-01

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2012-02-01

Annals of Epidemiology

Editorial Board

Potentially Modifiable Pre-, Peri-, and Postdeployment Characteristics Associated With Deployment-Related Posttraumatic Stress Disorder Among Ohio Army National Guard Soldiers

Estimated Effects of Potential Interventions to Prevent Decreases in Self-Rated Health Among Breast Cancer Survivors

Socioeconomic Inequalities in the Morbidity and Mortality of Acute Coronary Events in Finland: 1988 to 2002

Change of Sex Gaps in Total and Cause-Specific Mortality Over the Life Span in the United States

Racial Discrimination, Mood Disorders, and Cardiovascular Disease Among Black Americans

Prescription Medication Use Among Normal Weight, Overweight, and Obese Adults, United States, 2005–2008

Use of Leg Length to Height Ratio to Assess the Risk of Childhood Overweight and Obesity: Results From a Longitudinal Cohort Study

Estimating the Health Effects of Exposure to Multi-Pollutant Mixture

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