Adjuvant Radiation for Rectal Cancer: Do We Measure Up to the Standard of Care? An Epidemiologic Analysis of Trends Over 25 Years in the United States

In the United States, adjuvant radiation therapy is currently recommended for most patients with rectal cancer. We conducted this population-based study to evaluate the rate of radiation therapy and the factors affecting its delivery.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/41393/1/10350_2004_Article_792.pd

Complementary and alternative medicine for mental disorders among African Americans, black Caribbeans, and whites.

OBJECTIVES: This study examined racial and ethnic differences in the use of complementary and alternative medicine (CAM) for the treatment of mental and substance use disorders. METHODS: Data were from the National Survey of American Life (NSAL) and the National Comorbidity Survey-Replication (NCS-R). The analytic sample included 631 African Americans and 245 black Caribbeans from the NSAL and 1,393 non-Hispanic whites from the NCS-R who met criteria for a mood, anxiety, or substance use disorder in the past 12 months. Logistic regression was used to examine racial and ethnic differences in the use of any CAM and in the use of CAM only versus the use of CAM plus services in another treatment sector. RESULTS: Thirty-four percent of respondents used some form of CAM. Whites were more likely than blacks to use any CAM, although there was no racial or ethnic difference in CAM use only versus CAM use plus traditional services. A higher proportion of blacks than whites used prayer and other spiritual practices. Among those with a mood disorder, black Caribbeans were less likely than African Americans to use any CAM. CONCLUSIONS: Findings of this study were similar to those of previous studies that examined physical illness in relation to CAM use in terms of its overall prevalence, the predominant use of CAM in conjunction with traditional service providers, and racial and ethnic differences in the use of CAM. The use of prayer was a major factor in differences between blacks and whites in CAM use; however, there were also differences among black Americans that warrant further research.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/78173/1/1342.pd

Biological and cultural influences in the relationship between depressive symptoms, type 2 diabetes risk, and all-cause mortality in older Mexican Americans.

A confluence of biological and cultural factors may impact the relation of high depressive symptoms to elevated mortality risk and incident type 2 diabetes among older Mexican Americans. The present study examined this association between depressive symptoms, incident diabetes, and all-cause mortality risk, while elucidating plausible mechanisms in this population. Longitudinal data were analyzed from the Sacramento Latino Study on Aging, a cohort study initiated in 1998. Cox proportional hazards models were used to test the influence of depressive symptoms on mortality and Type 2 diabetes incidence in Latinos aged 60-101 in 1998-99. The sample comprised self-identified Latinos, of whom 49% were of Mexican origin. The Center for Epidemiologic Studies Depression scale (CES-D) was used to measure depressive symptoms (16). High depressive symptoms were associated with elevated mortality risk among foreign-born Mexican Americans and US-born Mexican Americans. Within the foreign-born, cultural orientation modified the effect of depressive symptoms on mortality. Depressive symptoms were associated with an approximate 58% percent excess risk of incident Type 2 diabetes in this population of elderly Mexican Americans with a greater than two-fold risk among foreign-born Mexican American drinkers. Since diabetes is the one of the leading causes of death among Hispanic elderly, understanding the pathways in the association between depressive symptoms and diabetes may elucidate plausible mechanisms between depressive symptoms and mortality. This study also demonstrated the importance of observing subgroups even within ethnic minority populations when examining the effect of depressive symptoms on adverse health outcomes.Ph.D.GerontologyHealth and Environmental SciencesHispanic American studiesMental healthPublic healthSocial SciencesUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/126631/2/3276101.pd

Indicators of abdominal size relative to height associated with sex, age, socioeconomic position and ancestry among US adults

<div><p>Background/Objectives</p><p>The supine sagittal abdominal diameter (SAD) and standing waist circumference (WC) describe abdominal size. The SAD/height ratio (SADHtR) or WC/height ratio (WHtR) may better identify cardiometabolic disorders than BMI (weight/height²), but population-based distributions of SADHtR and WHtR are not widely available. Abdominal adiposity may differ by sociodemographic characteristics.</p><p>Subjects/Methods</p><p>Anthropometry, including SAD by sliding-beam caliper, was performed on 9894 non-pregnant adults ≥20 years in the US National Health and Nutrition Examination Surveys of 2011–2014. Applying survey design factors and sampling weights, we estimated nationally representative SADHtR and WHtR distributions by sex, age, educational attainment, and four ancestral groups.</p><p>Results</p><p>The median (10th percentile, 90th percentile) for men’s SADHtR was 0.130 (0.103, 0.165) and WHtR 0.569 (0.467, 0.690). For women, median SADHtR was 0.132 (0.102, 0.175) and WHtR 0.586 (0.473, 0.738). Medians for SADHtR and WHtR increased steadily through age 79. The median BMI, however, reached maximum values at ages 40–49 (men) or 60–69 (women) and then declined. Low educational attainment, adjusted for age and ancestry, was associated with elevated SADHtR more strongly than elevated BMI. While non-Hispanic Asians had substantially lower BMI compared to all other ancestral groups (adjusted for sex, age and education), their relative reductions in SADHtR and WHtR, were less marked.</p><p>Conclusions</p><p>These cross-sectional data are consistent with monotonically increasing abdominal adipose tissue through the years of adulthood but decreasing mass in non-abdominal regions beyond middle age. They suggest also that visceral adipose tissue, estimated by SADHtR, expands differentially in association with low socioeconomic position. Insofar as Asians have lower BMIs than other populations, employing abdominal indicators may attenuate the adiposity differences reported between ancestral groups. Documenting the distribution and sociodemographic features of SADHtR and WHtR supports the clinical and epidemiologic adoption of these adiposity indicators.</p></div

Sex-specific beta coefficients (95% confidence range) associated with low educational attainment (less than high-school completion or high school graduation) compared with persons who attended some college or higher education.

<p>Separate models, each adjusted for age and ancestral groups, were prepared for [top] SADHtR, [middle] WHtR, and [bottom] BMI. F indicates the adjusted Wald F statistic, a summary effect describing confidence that contrasts in educational attainment (3-levels) have influenced the observed value for the adiposity indicator.</p

Women’s distributions of SAD/height ratio (SADHtR), waist circumference/height ratio (WHtR), and body mass index by 4 ancestral groups and 3 age groups.

<p>Boxes indicate population percentiles 25, 50, 75; whiskers identify p10 and p90. NHW = Non-Hispanic whites; NHB = Non-Hispanic blacks; Hispan = Hispanics; Asian = Non-Hispanic Asians.</p

Adiposity differences among US adults (according to SADHtR, WHtR, or BMI) for four ancestral groups, each compared to all other ancestries.

<p>Adiposity differences among US adults (according to SADHtR, WHtR, or BMI) for four ancestral groups, each compared to all other ancestries.</p

Age-specific medians plotted by decade for SADHtR, WHtR, and BMI.

<p>Median values were normalized with reference to the sex-specific median [1.00] estimated for the full population of [A] men or [B] women at ages 20+ years.</p

Men’s distributions of SAD/height ratio (SADHtR), waist circumference/height ratio (WHtR), and body mass index by 4 ancestral groups and 3 age groups.

<p>Boxes indicate population percentiles 25, 50, 75; whiskers identify p10 and p90. NHW = Non-Hispanic whites; NHB = Non-Hispanic blacks; Hispan = Hispanics; Asian = Non-Hispanic Asians.</p

Income-related inequalities in diagnosed diabetes prevalence among US adults, 2001−2018

Aims The overall prevalence of diabetes has increased over the past two decades in the United States, disproportionately affecting low-income populations. We aimed to examine the trends in income-related inequalities in diabetes prevalence and to identify the contributions of determining factors. Methods We estimated income-related inequalities in diagnosed diabetes during 2001−2018 among US adults aged 18 years or older using data from the National Health Interview Survey (NHIS). The concentration index was used to measure income-related inequalities in diabetes and was decomposed into contributing factors. We then examined temporal changes in diabetes inequality and contributors to those changes over time. Results Results showed that income-related inequalities in diabetes, unfavorable to low-income groups, persisted throughout the study period. The income-related inequalities in diabetes decreased during 2001−2011 and then increased during 2011−2018. Decomposition analysis revealed that income, obesity, physical activity levels, and race/ethnicity were important contributors to inequalities in diabetes at almost all time points. Moreover, changes regarding age and income were identified as the main factors explaining changes in diabetes inequalities over time. Conclusions Diabetes was more prevalent in low-income populations. Our study contributes to understanding income-related diabetes inequalities and could help facilitate program development to prevent type 2 diabetes and address modifiable factors to reduce diabetes inequalities