Biomedical subjects
Publications and source records attributed to H Jick.
In the United States edometrial cancer among women in their fifties has been declining since 1975 after having risen throughout the earlier part of the decade. Rates for older women have continued to rise steadily, suggesting that the early postmenopausal population may have determinants of endometrial cancer not shared by other age groups.
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In a series of 14,077 hospitalized medical patients receiving antibiotics, superinfection developed in 95 (0.7%) during drug therapy. The majority were yeast and fungal infections, and serious infections occurred with a frequency of less than one per 1,000 patients treated. Concurrent immunosuppression and impaired renal function increased the risk of new infections.
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We examined the incidence of endometrial cancer in a large prepaid group practice in the Seattle area. From July, 1975, to July, 1977, there was a sharp downward trend in the incidence of endometrial cancer that paralleled a substantial reduction in prescriptions for replacement estrogens. Incidence rates were estimated for estrogen users and nonusers among women 50 to 64 years of age with intact uteri; current long-term users had an annual risk for endometrial cancer between 1 and 3 per cent, whereas nonusers had a risk less than 1/10th as great. These incidence rates remained fairly constant over time among users and nonusers; the drop in overall incidence soon after estrogen use declined suggests that the increased risk associated with estrogens falls quickly after discontinuation. The reduction in incidence of endometrial cancer in this group practice was part of a general decline in the United States after 1975.
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Regional hysterectomy rates in the United States for 1970 and 1975 have been estimated from a one per cent sample of hospital discharges. All rates have been corrected for the number of women truly at risk, that is, with uteri intact, and regional and age-specific estimates of uterine prevalence in 1975 are provided. The rates rose by one-third in 1970-1975, with the increase taking place nearly uniformly over all ages below 65 years. Rates were greatest for 40--44-year-old women, but in 1970 there was a secondary peak for women between the ages of 65 and 69 years. That peak disappeared with rising rates for younger women in 1975. For women under age 35 years, the hysterectomy rate in the South was three times higher than that in the Northeast.
Incidence rates of cancer of the corpus uteri have been estimated from a one per cent sample of hospital discharges in the United States for the years 1970--1975. Among postmenopausal women, rates rose sharply in 1970--1975, while for younger women there was little net change. There were substantial regional variations in incidence, which were largest between the ages of 65 and 69 years. All rates have been corrected for the numbers of women in each region and age group with uteri intact.
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Rates of skin reactions for oral and parenteral administration of various types of penicillin were compared in an extensive series of carefully monitored patients. The rate with orally administered penicillins was consistently lower than when administered parenterally.
A comparison was made between cigarette smoking histories of 31 women below age 50 years who had a diagnosis of lung cancer on hospital discharge and smoking histories of 124 women below age 50 years who had been hospitalized for other conditions. Of the women with lung cancer, 28 (90%) were current or former cigarette smokers; 72 (58%) of the comparison women were smokers. The relative risk estimate for lung cancer among smokers as compared with nonsmokers is 6.7, with 90% confidence limits of 4.0 and 11. Risk of lung cancer increased with the amount that the women smoked. The smokers with lung cancer had been smoking for longer periods than the smokers with other conditions. Assuming that the association is causal, cigarette smoking was responsible for about 77% of the lung cancer of young women in this survey.
We studied 83 women younger than 46 years with acute myocardial infarction (MI) and 154 controls. There was a strong positive association between MI and the following: (1) age, (2) both oral contraceptive and noncontraceptive estrogen use, (3) cigarette smoking, and (4) the presence of predisposing medical conditions, eg, past MI, hypertension, and diabetes. ABO blood type and family history of arterial disease were also positively associated with MI. Whereas the risks for idiopathic stroke and venous thromboembolism have also been shown to be increased among oral contraceptive users, there is comparatively little correlation between these two illnesses and age or smoking in young women. The present study, taken together with previously published work, provides reasonable estimates of the vascular risks associated with oral contraceptive use.
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Rates of drug-induced gastrointestinal bleeding were estimated from data on 16 646 consecutively monitored medical inpatients who had no known predisposing illness. Heparin, warfarin, ethacrynic acid, steroids, and aspirin-containing drugs were associated with gastrointestinal bleeding and were estimated to account for about two-thirds of such bleeds. Major gastrointestinal bleeding, defined as bleeding severe enough to require transfusion, occurred in only 57 patients (0.3%).
We obtained information on 107 women younger than 46 years who were discharged from a hospital with a diagnosis of acute myocardial infarction. In the series 26 women were otherwise apparently healthy and potentially childbearing. Among these 26 women, 20 (77%) were taking oral contraceptives just prior to admission, and one was taking conjugated estrogens. Among 59 control women, 14 (24%) were taking oral contraceptives and one was taking conjugated estrogens. The relative risk estimate, comparing oral contraceptive users with nonusers, is 14 with 90% confidence limits of 5.5 and 37. All but two of the 26 women were cigarette smokers. While this illness is rare in most healthy young women, the risk in women older than about 37 years who both smoke and take oral contraceptive appears to be high.
We obtained information on 107 women younger than 46 years discharged from a hospital with a diagnosis of acute myocardial infarction. In the series there were 17 women aged 39 to 45 years who were otherwise apparently healthy and had had a natural menopause, hysterectomy, or tubal ligation or whose spouse had had a vasectomy. Among them, nine (53%) were taking noncontraceptive estrogens just prior to admission. Among 34 control women, four (12%) were taking estrogens. The relative risk estimate, comparing estrogen users with nonusers, is 7.5, with 90% confidence limits of 2.4 and 24. All but one of the 17 ml subjects were cigarette smokers. While this illness is rare in most healthy young women, the risk in women older than about 38 years who both smoke and take estrogens appears to be substantial.
The frequency of regular use of Vitamin A preparations was compared among 800 newly diagnosed cancer patients and 3433 patients with certain nonmalignant conditions. Overall there was no convincing evidence that regular consumption of such preparations protected against the development of cancer (risk ratio 0.85). However, there was a suggestion of a negative association among men (risk ratio 0.54, p less than 0.01) but not among women (risk ratio 1.11). The negative association among men did not increase with the period that such preparations had been regularly taken and was not greater for squamous cell tumors. The results of this study offer encouragement for further epidemiologic studies of the possible protective role of Vitamin A against cancer.