Nutritional Risk Factors for Tuberculosis Among Adults in the United States, 1971–1992

The risk of developing tuberculosis (TB) may be related to nutritional status. To determine the impact of nutritional status on TB incidence, the authors analyzed data from the First National Health and Nutrition Examination Survey (NHANES I) Epidemiologic Follow-up Study (NHEFS). NHANES I collected information on a probability sample of the US population in 1971–1975. Adults were followed up in 1982–1992. Incident TB cases were ascertained through interviews, medical records, and death certificates. TB incidences were compared across different levels of nutritional status after controlling for potential confounding using proportional hazards regression appropriate to the complex sample design. TB incidence among adults with normal body mass index was 24.7 per 100,000 person-years (95% confidence interval (CI): 13.0, 36.3). In contrast, among persons who were underweight, overweight, and obese, estimated TB incidence rates were 260.2 (95% CI: 98.6, 421.8), 8.9 (95% CI: 2.2, 15.6), and 5.1 (95% CI: 0.0, 10.5) per 100,000 person-years, respectively. Adjusted hazard ratios were 12.43 (95% CI: 5.75, 26.95), 0.28 (95% CI: 0.13, 0.63), and 0.20 (95% CI: 0.07, 0.62), respectively, after controlling for demographic, socioeconomic, and medical characteristics. A low serum albumin level also increased the risk of TB, but low vitamin A, thiamine, riboflavin, and iron status did not. A population’s nutritional profile is an important determinant of its TB incidence

Perceived neighborhood safety and incident mobility disability among elders: the hazards of poverty

<p>Abstract</p> <p>Background</p> <p>We investigated whether lack of perceived neighborhood safety due to crime, or living in high crime neighborhoods was associated with incident mobility disability in elderly populations. We hypothesized that low-income elders and elders at retirement age (65 – 74) would be at greatest risk of mobility disability onset in the face of perceived or measured crime-related safety hazards.</p> <p>Methods</p> <p>We conducted the study in the New Haven Established Populations for Epidemiologic Studies of the Elderly (EPESE), a longitudinal cohort study of community-dwelling elders aged 65 and older who were residents of New Haven, Connecticut in 1982. Elders were interviewed beginning in 1982 to assess mobility (ability to climb stairs and walk a half mile), perceptions of their neighborhood safety due to crime, annual household income, lifestyle characteristics (smoking, alcohol use, physical activity), and the presence of chronic co-morbid conditions. Additionally, we collected baseline data on neighborhood crime events from the New Haven Register newspaper in 1982 to measure local area crime rates at the census tract level.</p> <p>Results</p> <p>At baseline in 1982, 1,884 elders were without mobility disability. After 8 years of follow-up, perceiving safety hazards was associated with increased risk of mobility disability among elders at retirement age whose incomes were below the federal poverty line (HR 1.56, 95% CI 1.02 – 2.37). No effect of perceived safety hazards was found among elders at retirement age whose incomes were above the poverty line. No effect of living in neighborhoods with high crime rates (measured by newspaper reports) was found in any sub-group.</p> <p>Conclusion</p> <p>Perceiving a safety hazard due to neighborhood crime was associated with increased risk of incident mobility disability among impoverished elders near retirement age. Consistent with prior literature, retirement age appears to be a vulnerable period with respect to the effect of neighborhood conditions on elder health. Community violence prevention activities should address perceived safety among vulnerable populations, such as low-income elders at retirement age, to reduce future risks of mobility disability.</p

Race and sex differentials in the impact of hypertension in the United States. The National Health and Nutrition Examination Survey I Epidemiologic Follow-up Study.

Hypertension was evaluated longitudinally in a nationally representative sample of the US population. This study, based on the data from the National Health and Nutrition Examination Survey NHANES I Epidemiologic Follow-up Study, analyzed changes in blood pressure and frequency of treatment, hypertension incidence, and ten-year survival of the cohort relative to hypertension status at baseline. Higher prevalence rates for each older age group, especially in women, as previously reported on data from community studies were confirmed. However, this analysis found minimal differences in the incidence of hypertension between men and women for all age groups. Incidence rates for blacks were at least twice the rates for whites for almost every age-sex group. Decreased survival in older hypertensive men probably explained the higher prevalence in older women. Treatment and location of measurement in clinic or household must be major considerations in the calculation of incident cases

Race and sex differentials in the impact of hypertension in the United States. The National Health and Nutrition Examination Survey I Epidemiologic Follow-up Study.

Hypertension was evaluated longitudinally in a nationally representative sample of the US population. This study, based on the data from the National Health and Nutrition Examination Survey NHANES I Epidemiologic Follow-up Study, analyzed changes in blood pressure and frequency of treatment, hypertension incidence, and ten-year survival of the cohort relative to hypertension status at baseline. Higher prevalence rates for each older age group, especially in women, as previously reported on data from community studies were confirmed. However, this analysis found minimal differences in the incidence of hypertension between men and women for all age groups. Incidence rates for blacks were at least twice the rates for whites for almost every age-sex group. Decreased survival in older hypertensive men probably explained the higher prevalence in older women. Treatment and location of measurement in clinic or household must be major considerations in the calculation of incident cases