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Biomedical subjects

B E Klein

Publications and source records attributed to B E Klein.

At least 91 records · Page 5Linked to original sources
PubMed1998

Association of NIDDM and hearing loss.

OBJECTIVE: To evaluate the association of NIDDM with hearing loss in a large population-based study. RESEARCH DESIGN AND METHODS: Data from population-based longitudinal studies of aging conducted in Beaver Dam, Wisconsin, were used in these analyses. Hearing thresholds were determined by pure-tone air- and bone-conduction audiometry performed by trained technicians following American Speech-Language-Hearing Association specifications. Hearing loss was defined as the pure-tone average of the frequencies 500, 1,000, 2,000, and 4,000 Hz greater than 25 decibels hearing level in the worse ear. Diabetes status was determined by self-report of physician-diagnosed diabetes or by elevated glucose or glycated hemoglobin levels at examination. RESULTS: Of 3,571 study participants, 344 were classified as having NIDDM. Subjects with NIDDM were more likely to have a hearing loss than were subjects without diabetes (59 vs. 44%). After results were adjusted for age, this difference was not statistically significant. After individuals with hearing loss patterns inconsistent with presbycusis were excluded, there was an association between NIDDM and hearing loss when controlling for potential confounders (odds ratio [OR] 1.41, 95% CI 1.05-1.88). There was no association between duration of diabetes or glycemic control and hearing loss. Individuals with NIDDM and nephropathy were more likely to have a hearing loss than were those with NIDDM but no nephropathy (OR 2.28, 95% CI 1.04-5.00). CONCLUSIONS: These data are suggestive of a weak association between NIDDM and hearing loss.

Adult↗
PubMed1998

Aging and word recognition in competing message.

As part of an epidemiologic study of hearing disorders in older adults, word recognition performance (NU-6 word lists in quiet and in competing message) was evaluated for 3189 adults grouped by age (48-59 years, n = 1176; 60-69 years, n = 979; 70-79 years, n = 794; 80-92 years, n = 240). Overall, scores for all measures were worse for older age groups and worse for men than for women. Word recognition scores in competing message were poorer than word recognition scores in quiet for all subjects and age groups. Further, differences in scores across age groups and gender were greater for the word recognition test in competing message than for the word recognition test in quiet. Although degree of hearing loss accounted for the largest portion of variation in word recognition scores, the observed age and gender differences remained significant after adjusting for the degree of sensorineural hearing loss.

Age Distribution↗
PubMed1998

Correlates of lens thickness: the Beaver Dam Eye Study.

PURPOSE: To evaluate the relationships of lens thickness to age, to the presence of a nuclear, cortical, or posterior subcapsular cataract, and to other personal characteristics in participants in the Beaver Dam Eye Study. METHODS: Slit lamp photographs taken during a population-based prevalence study were measured for lens thickness. In addition, slit lamp photographs were graded for nuclear cataracts, and retroillumination photographs were graded for cortical and posterior subcapsular cataracts. A questionnaire was administered, and height, weight, and blood pressure were measured by protocol. RESULTS: Lens thickness increased systematically with age in men and women. In multivariate analysis, age, sex (male), cortical cataract, diabetes, nuclear cataract, and former cigarette smoking were related significantly to lens thickness. CONCLUSIONS: Age was the most significant personal characteristic associated with lens thickness among those subjects considered. In addition, other characteristics, including specific cataract types and risk factors for cataracts, also were associated with thickness. Whether lens thickness among people of the same age is associated prospectively with these characteristics requires a longitudinal follow-up.

Adult↗
PubMed1998

Renal function abnormalities and incident cataract after a five-year interval: The Beaver Dam Eye Study.

PURPOSE: To evaluate the relationship between renal function abnormalities and incidence of age-related cataract. METHODS: In a population-based epidemiologic study of age-related eye disease, cataract was classified based on lens photographs. Standard methods of grading were used. Blood urea nitrogen, serum creatinine, and gross proteinuria were measured using standard protocols. RESULTS: Cortical cataract was associated with increased BUN, but after controlling for age, this relationship was no longer significant. In those with diabetes, elevated BUN or elevated creatinine was associated with increased odds of posterior subcapsular cataract, but these relationships were not significant. CONCLUSION: Renal function abnormalities were not significantly associated with incidence of cataract after controlling for age and gender. However, the power to test these associations was limited. Further longitudinal follow-up of this cohort as well as other studies designed to evaluate these associations are needed.

Adult↗
PubMed1998

Disease progression and cost of insulin dependent diabetes mellitus: development and application of a simulation model.

This paper presents the development and application of a Markov model that simulates the onset and progression of insulin dependent diabetes mellitus (IDDM) and its sequelae. The model estimates direct medical costs resulting from different patterns of health states during the course of the disease. The model is user-friendly and allows for changes in the input variables to be specified, thereby providing a frame-work for sensitivity analysis. The Markov process moves a cohort of individuals through six different health states: Healthy, IDDM without chronic microvascular complications, IDDM with retinopathy alone, IDDM with neuropathy alone or with retinopathy, IDDM with nephropathy, and death. Epidemiologic data were obtained from governmental sources as well as the medical literature. Transition probabilities were estimated using data from the Wisconsin Epidemiologic Study of Diabetic Retinopathy (WESDR). Direct medical costs were estimated from actual charges from a local health maintenance organization in Wisconsin. The validity of the model was tested in several ways including a comparison with an independent cost estimate made by the Wisconsin Department of Health and Family Services. The model appears to be useful in estimating the progression and associated costs of IDDM for any large population over any period of time and in allowing changes in the inputs to evaluate their impact thus providing pertinent information to healthcare decision-makers and health planners.

Age Factors↗
PubMed1997

Is obesity related to microvascular and macrovascular complications in diabetes? The Wisconsin Epidemiologic Study of Diabetic Retinopathy.

BACKGROUND: There are few epidemiological data describing the relationship of obesity to the incidence of microvascular and macrovascular complications in patients with diabetes. METHODS: In a population-based study performed in southern Wisconsin, 1370 persons diagnosed as having diabetes when they were 30 years of age or older (mean[+/- SD] age, 66.6 +/- 11.3 years) participated in a baseline examination, 987 in a 4-year follow-up examination, and 533 in a 10-year follow-up examination. Height and weight were measured using standard protocols. Individuals were characterized as underweight, normal weight, overweight, and obese by body mass index (expressed as weight in kilograms divided by the square of the height in meters) status. Outcomes included incidence and progression of retinopathy, incidence of gross proteinuria, incidence of lower-extremity amputation, and death due to ischemic heart disease, death due to stroke, and all-cause mortality. RESULTS: The prevalence of being obese was 25.2%. After other risk factors were controlled for, being underweight was associated with higher incidence of diabetic retinopathy, death from stroke, and all-cause mortality. Body mass was not associated with progression of retinopathy, incidence of gross proteinuria, amputation of a lower extremity, or death due to ischemic heart disease. CONCLUSIONS: These data suggest that obesity in persons with older-onset diabetes is not related to the long-term incidence of microvascular and macrovascular complications.

Adult↗
PubMed1997

Incorporating fat-modified foods into a food frequency questionnaire improves classification of fat intake.

OBJECTIVE: To determine the extent to which incorporating fat-modified foods into a food frequency questionnaire influences the agreement of energy and nutrient estimates with estimates obtained from food records. DESIGN: Subjects completed four 2-day food records at 3-month intervals. At the end of the recording period, a food frequency questionnaire was administered to assess usual daily intake during the preceding year. SUBJECTS/SETTING: One hundred and three subjects selected from a population-based sample of adults participating in the Beaver Dam Eye Study. STATISTICAL ANALYSES PERFORMED: Subjects were categorized into three groups on the basis of their frequency of consumption of fat-modified foods. For each group, correlations were calculated between food record estimates and estimates obtained from the original food frequency questionnaire, the original with a low-fat option, and the fat-modified questionnaire. RESULTS: For persons categorized as high consumers of fat-modified foods, incorporating questions regarding the consumption of these products resulted in higher correlations with food record estimates (original vs fat-modified version) for percentage of energy from total fat (.32 vs .47), saturated fat (.20 vs .41), oleic acid (.32 vs .50), and linoleic acid (.40 vs .46). High consumers differed in several characteristics that could be associated with disease risk (eg, higher ratios of serum total cholesterol to high-density lipoprotein cholesterol). CONCLUSIONS: Failure to account for the consumption of fat-modified foods in epidemiologic studies may result in misclassification of fat exposures. Because patterns of misclassification could be different for those at risk for disease, results of epidemiologic studies could be biased if these foods are excluded. Thus, incorporating fat-modified foods into food frequency questionnaires will improve the ability of researchers to correctly classify fat exposures and to evaluate potentially important relationships between fat intake and disease risk.

Aged↗
PubMed1997

Cardiovascular disease, selected cardiovascular disease risk factors, and age-related cataracts: the Beaver Dam Eye Study.

PURPOSE: To examine the associations of cardiovascular disease and selected cardiovascular disease risk factors with the prevalence of age-related cataract. METHODS: We conducted a population-based prevalence study of adults aged 43 to 86 years (n = 4,926) in Beaver Dam, Wisconsin. An ocular examination including lens photographs, medical history, height and weight measurement, blood testing, and photograph grading was performed according to standard protocols. RESULTS: Age and sex influenced most of the relationships between risk variables and cataract. Many relationships apparent in univariate analyses were not significant when controlling for confounders. In multivariate models, higher glycated hemoglobin was significantly and consistently associated with increased risk of nuclear cataract in women. For cortical cataract, higher serum high density lipoprotein cholesterol was associated with decreased risk in women. For posterior subcapsular cataract, men with higher ratios of total to high-density lipoprotein cholesterol were at increased risk. History of cardiovascular disease was not associated with cataracts in persons with or without diabetes after controlling for additional risk indicators. CONCLUSIONS: Some risk factors for cardiovascular disease were associated with increased frequency of age-related lens opacities. Age and sex influenced these relationships but did not entirely explain them. Longitudinal follow-up is necessary to determine antecedent-consequent relationships that may suggest causal associations.

Adult↗
PubMed1997

The relation of cardiovascular disease and its risk factors to the 5-year incidence of age-related maculopathy: the Beaver Dam Eye Study.

OBJECTIVE: The purpose of the study is to examine the association between cardiovascular disease and its risk factors and the incidence of age-related maculopathy. PARTICIPANTS: A population of 3583 adults (range, 43-86 years of age at baseline) living in Beaver Dam, Wisconsin, was studied at baseline and 5 years later. METHODS: Standardized protocols for physical examination, blood collection, administration of a questionnaire, and stereoscopic color fundus photography to determine age-related maculopathy were used. Standard univariate and multivariate analyses were performed. MAIN OUTCOME MEASURES: Incidence and progression of age-related maculopathy were measured. RESULTS: After controlling for age and gender, the authors found both higher systolic blood pressure (odds ratio [OR] per 10 mmHg, 1.16; 95% confidence interval [CI] 1.05, 1.27) and uncontrolled treated hypertension (OR 1.98, 95% CI 1.00, 3.94) were related to the incidence of retinal pigment epithelial depigmentation. After controlling for age and gender, the authors found that both blood pressure and uncontrolled treated hypertension were not significantly associated with an increased risk of having exudative macular degeneration develop (for systolic blood pressure, OR 1.18, 95% CI 0.95, 1.45; for uncontrolled treated hypertension, OR 2.10, 95% CI 0.54, 8.11). After controlling for age and gender, the authors found higher pulse pressure was significantly associated with increased incidence of retinal pigment epithelial depigmentation (OR per 10 mmHg 1.27, 95% CI 1.14, 1.42) and exudative macular degeneration (OR per 10 mmHg 1.29, 95% CI 1.02, 1.65). These relations remained significant after controlling for other risk factors in multivariable analyses. CONCLUSIONS: These findings indicate modest relations between higher pulse pressure (a presumed indicator of atherosclerotic vascular disease) and uncontrolled hypertension with increased 5-year incidence of retinal pigment epithelial depigmentation. Overall, however, data from this study show neither consistent nor strong relations between cardiovascular disease and most of its risk factors with the incidence of lesions associated with age-related maculopathy.

Adult↗
PubMed1997

Incident cataract surgery: the Beaver Dam eye study.

PURPOSE: The authors describe the incidence of cataract surgery in participants of the Beaver Dam Eye Study. METHODS: Objective evidence of cataract extraction as obtained at follow-up examinations of participants of a population-based cohort is given. Participants included all adults 43 to 84 years of age who lived in the city or township of Beaver Dam, Wisconsin. RESULTS: Age-adjusted incidence is significantly greater for women, for those with lower diastolic blood pressure, for those with hypertension, widows/widowers, and for those who report that their vision is worse than it had been. Multivariate analyses disclose that the following characteristics (with their respective odds ratios) are significantly associated with incident cataract surgery: age (odds ratio [OR] for 10 years 1.40; 95% confidence interval [CI] 1.02, 1.91); cigarette smoking (> or = 35 pack years; OR 1.91; 95% CI 1.16, 3.17); nuclear cataract (OR 35.58; 95% CI 10.12, 125.17 at age 50 years); cortical cataract (OR 3.75; 95% CI 2.40, 5.88); posterior subcapsular cataract (OR 15.51; 95% CI 8.27, 29.09); impaired vision (OR 3.76; 95% CI 2.33, 6.05); intraocular pressure (> or = 14 mmHg; OR 2.56; 95% CI 1.50, 4.38); visual sensitivity to light (OR 1.94; 95% CI 1.19, 3.17); refractive error (myopic) (OR 1.99; 95% CI 1.22, 3.24); yellow color (OR 1.69; 95% CI 1.02, 2.81); and being examined by an ophthalmologist within 2 years (OR 1.54; 95% CI 1.03, 2.30). CONCLUSIONS: Many factors are associated with cataract surgery, but the prior presence of posterior subcapsular cataract is the most important lens opacity. In addition, visual function changes, which may be relatively mild, are associated with subsequent incident surgery.

Adult↗
PubMed1997

The five-year incidence and progression of age-related maculopathy: the Beaver Dam Eye Study.

PURPOSE: The aim of the study was to describe the incidence and progression of retinal drusen, retinal pigmentary abnormalities, and signs of late age-related maculopathy. POPULATION: A population of 3583 adults (range, 43-86 years of age at baseline) living in Beaver Dam, Wisconsin, was studied during a 5-year period. METHODS: Characteristics of drusen and other lesions typical of age-related maculopathy were determined by grading stereoscopic color fundus photographs using the Wisconsin Age-Related Maculopathy Grading System. RESULTS: There was a statistically significant increased incidence of age-related maculopathy lesions with age (P < 0.05). Individuals 75 years of age or older had a significantly (P < 0.01) higher 5-year incidence of the following characteristics than people 43 to 54 years of age: larger sized drusen (125-249 microm, 17.6% vs. 2.1%; > or = 250 microm, 6.5% vs. 0.2%), soft indistinct drusen (16.3% vs. 1.8%), retinal pigment abnormalities (12.9% vs. 0.9%), exudative macular degeneration (1.8% vs. 0%), and pure geographic atrophy (1.7% vs. 0%). After adjusting for age, the incidence of early age-related maculopathy was 2.2 times (95% confidence interval 1.6, 3.2) as likely in women 75 years of age or older compared with men this age. At follow-up, late age-related macular degeneration was more likely to develop in eyes with soft indistinct drusen (6.5% vs. 0.1%) or retinal pigmentary abnormalities (7.1% vs. 0.1%) at baseline than in eyes without these lesions. CONCLUSIONS: These population-based estimates document the high incidence of signs of age-related maculopathy in people 75 years of age or older, and in women compared with men that age. The findings demonstrate that the presence of soft drusen and pigmentary abnormalities significantly increases the risk for the development of geographic atrophy and exudative macular degeneration.

Adult↗
PubMed1997

Epidemiological evidence for the disruption of ionized calcium homeostasis in the elderly.

Ionized calcium (Ca2+), phosphate, albumin, total calcium, and pH measurements taken from participants in a large population-based epidemiological study were examined to determine the change in physiological variation with age for persons over 43 years old. Only Ca2+ showed a statistically significant increase in SD with age (p < 0.0001). The Ca2+ coefficients of variation (CV) increased from 2.92% in the youngest age group (43-54 years) to 3.69% in the oldest age group (75-86 years of age). In females, the increase in Ca2+ variability was nearly complete by age 55. Males also showed a significant (p = 0.006) increase in SD between the 43-54 age group and the 55-64 age group, however, Ca2+ variability did not plateau after age 55 in men as it did in women. In the 43-54 (p = 0.04) and 55-64 (p = 0.03) age group men showed significantly better physiological control of Ca2+ than women. Phosphate showed a slight decrease in CV with age. These data suggest that Ca2+ homeostasis is disrupted in the same age groups that are most vulnerable to osteoporosis.

Adult↗
PubMed1997

Changes in the optic disc over a five-year interval: the Beaver Dam Eye Study.

PURPOSE: To determine the relationship of change in vertical optic disc cupping to change in intraocular pressure over a five-year interval. METHODS: Non-simultaneous stereoscopic photographs were taken of optic discs of participants in the baseline and follow-up examinations of The Beaver Dam Eye Study cohort. Optic discs and cups were measured and other disc features were graded according to a standard protocol by trained graders. Intraocular pressures were measured by Goldmann applanation tonometry. RESULTS: Change in pressure was significantly associated with change in vertical cup-to-disc ratio. Incident disc hemorrhage, flattened temporal rim, notching, cup reaching disc margin, and undercutting were not significantly associated with change in intraocular pressure. CONCLUSION: Change in intraocular pressure in this adult population was associated with increased optic disc cupping. This finding, if confirmed, would lend support to the practice of periodic follow-up of older adults who have shown changes in their intraocular pressure.

Adult↗
PubMed1997

Incidence of self reported glaucoma in people with diabetes mellitus.

AIM: To determine the incidence of self reported glaucoma in a group of people with diabetes mellitus. METHODS: In an 11 county area in southern Wisconsin, a cohort of people with diabetes mellitus was identified and characterised by history, physical examination, fundus photographs, and laboratory evaluation in 1980-2 (n = 2366). The cohort was followed for 10 years with 891 younger onset and 987 older onset people participating in at least one follow up examination. RESULTS: The 10 year incidence of glaucoma was 3.7% in younger onset people, 6.9% in older onset people not using insulin, and 11.8% in older onset people using insulin. Univariate analyses revealed that in younger onset people greater body mass index, older age, longer duration of diabetes, history of cataract surgery, and increased severity of diabetic retinopathy at baseline conferred increased risk. In older onset people using insulin, older age and longer duration of diabetes, higher intraocular pressure, and history of cataract surgery at baseline were associated with increased risk of glaucoma. In multivariate analyses, only age was significantly related to increased incidence in younger onset people and age, intraocular pressure, and insulin use were significantly associated with increased risk in the older onset group. CONCLUSION: Most risk factors associated with self reported glaucoma in people with diabetes cannot currently be modified to decrease incidence. Older onset people who are at increased risk of many ocular complications of diabetes may be particularly in need of specialised ophthalmic observation.

Adult↗
PubMed1997

Risk of hypoglycemia in users of human insulin. The Wisconsin Epidemiologic study of Diabetic Retinopathy.

OBJECTIVE: To evaluate whether there has been a change in frequency of hypoglycemic reactions associated with use of insulin of animal or human type. RESEARCH DESIGN AND METHODS: Data are from a longitudinal population-based study of people with diabetes onset before 30 years of age who were receiving primary care in an 11-county area of south central Wisconsin in 1980. Interviews of study participants were conducted regarding occurrence of hypoglycemic reactions and the frequency, dose, and type of insulin used. At the 4-year follow-up, 727 of the 765 subjects were using only animal insulin and 33 were using human insulin; by the 10-year follow-up, 352 were using animal insulin and 388 were using human insulin. RESULTS: Those using animal insulin reported fewer hypoglycemic reactions than did users of human insulin (chi (1)2 = 4.66, P = 0.03). Those who changed insulin type between visits were no more likely to report more hypoglycemic reactions during the year before the visit than those who remained on the same type at the two examinations (chi (4)2 = 3.37, P = 0.50). At the 10-year exam, users of human insulin were more likely to be taking multiple doses of insulin (86.6%) than were users of animal insulin (73.9%; P < 0.0001). In multiple logistic regression, the following variables were significantly related to the frequency of hypoglycemic reactions at the 10-year visit: body mass index (lower), glycosylated hemoglobin (lower), and being female. CONCLUSIONS: In this population, level of glycemia is related to the frequency of hypoglycemic reactions. While type of insulin (human vs. animal) may be related to glycemia, it appears to have little independent effect on the frequency of reactions.

Adult↗