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J C Kleinman

Publications and source records attributed to J C Kleinman.

At least 55 records · Page 3Linked to original sources
PubMed1989

Maternal smoking during pregnancy: no association with congenital malformations in Missouri 1980-83.

Using a multisource birth defects registry developed by the Missouri Center for Health Statistics for the years 1980-83, we examined the relation between maternal smoking during pregnancy and the occurrence of congenital malformations. There were 288,067 live singleton births in this data set of which 10,223 had one or more congenital malformations. When adjusted for potential confounders the odds ratio for congenital malformations in the infants of women who smoked during pregnancy was not increased (odds ratio = 0.98, 95% confidence interval = 0.94 - 1.03). We examined the relation between smoking and groups of malformations using the International Classification of Diseases, 9th Revision, as well as analyzing for certain specific malformations within each group and found no increased risk for infants of smokers.

Birth Certificates↗
PubMed1988

The effects of maternal smoking on fetal and infant mortality.

Although maternal cigarette smoking has been shown to reduce the birth weight of an infant, previous findings on the relation between smoking and fetal and infant mortality have been inconsistent. This study used the largest data base ever available (360,000 birth, 2,500 fetal death, and 3,800 infant death certificates for Missouri residents during 1979-1983) to assess the impact of smoking on fetal and infant mortality. Multiple logistic regression was used to estimate the joint effects of maternal smoking, age, parity, education, marital status, and race on total mortality (infant plus fetal deaths). Compared with nonsmoking women having their first birth, women who smoked less than one pack of cigarettes per day had a 25% greater risk of mortality, and those who smoked one or more packs per day had a 56% greater risk. Among women having their second or higher birth, smokers experienced 30% greater mortality than nonsmokers, but there was no difference by amount smoked. The prevalence of smoking in this population was 30%. It was estimated that if all pregnant women stopped smoking, the number of fetal and infant deaths would be reduced by approximately 10%. The higher rate of mortality among blacks compared with whites could not be attributed to differences in smoking or the other four maternal characteristics studied. In fact, the black-white difference was greater among low-risk women (e.g., married multiparas aged 20 and over with high education) than among high-risk women (e.g., unmarried teenagers with low education).

Adolescent↗
PubMed1988

The association of maternal smoking with age and cause of infant death.

Linked birth certificate and infant death certificate data from Missouri for 1979-1983 were used to explore the association of maternal smoking with age and cause of infant death. The data included 305,730 singleton white livebirths, of which 2,720 resulted in infant deaths. Using multiple logistic regression to control for the confounding effects of maternal age, parity, marital status, and education, the authors found that smoking was associated with both neonatal and post-neonatal mortality and with each cause of death except congenital anomalies. The adjusted odds ratio for smoking was higher for postneonatal deaths than neonatal deaths and was particularly high for two causes: respiratory disease (odds ratio = 3.4) and sudden infant death syndrome (odds ratio = 1.9). A moderate odds ratio (about 1.4) was found for causes attributed to the International Classification of Diseases, 9th Revision Perinatal Conditions Chapter. Although the associations for neonatal deaths and perinatal conditions were partially attributable to the effect of maternal smoking in lowering birth weight, virtually none of the excess respiratory mortality and sudden infant death syndrome mortality among the offspring of smokers was attributable to birth weight differences between the infants of smokers and nonsmokers. This suggests that respiratory deaths and sudden infant death syndrome deaths may be related to the effect of passive exposure of the infant to smoke after birth.

Adolescent↗
PubMed1988

Mortality among diabetics in a national sample.

The authors compare the mortality experience of a national sample of diabetic men and women with their nondiabetic counterparts. The study population consists of respondents from the First National Health and Nutrition Examination Survey (NHANES I), conducted in 1971-1975, who were traced in 1982-1984 through the NHANES I Epidemiologic Follow-up Study. Over the nine-year follow-up period, the age-adjusted death rates for diabetic men and women were twice the rates for nondiabetics. About 75% of the excess mortality among diabetic men and 57% among diabetic women was attributable to cardiovascular disease deaths. After adjustment for age, systolic blood pressure, serum cholesterol, body mass index, and smoking, the relative risk of death was 2.3 for diabetic men and 2.0 for diabetic women. The relative risk for diabetics was highest for ischemic heart disease mortality (2.8 for men and 2.5 for women) and lowest for noncardiovascular disease deaths (1.4 for men and 1.1 for women). When subjects who reported having had a heart attack prior to the baseline examination were excluded, the relative risks for ischemic heart disease mortality among diabetics remained substantial (2.4 for men and 2.6 for women). There was little evidence that the relative risk of death for diabetics compared with nondiabetics differed by age or sex, although 95% confidence intervals around these estimates were wide.

Adult↗
PubMed1988

Racial differences in pregnancy outcomes.

Black mothers in the United States are twice as likely as their white counterparts to experience a wide variety of adverse pregnancy outcomes, including prematurity, low birth weight, and infant and fetal death. Although blacks have higher proportions of births with maternal risk factors such as young age, high birth order, low education, and unmarried mothers, these differences do not account for their higher rates of adverse outcomes; the reasons for the excess remain largely unknown. To develop effective interventions to reduce the racial disparities in pregnancy outcome, we must further our understanding of the mechanisms underlying premature onset of labor and intrauterine growth.

Black or African American↗
PubMed1987

Racial differences in low birth weight. Trends and risk factors.

To identify the risk factors responsible for differences in birth weight between blacks and whites, we investigated the effects of four maternal characteristics (age, parity, marital status, and education) on rates of very low birth weight (less than 1500 g) and moderately low birth weight (between 1500 and 2500 g). Using 1983 national data, we found that the black:white rate ratio was 3.0 for very low birth weight and 2.3 for moderately low birth weight. The four maternal factors had directionally similar but quantitatively different effects on very low and moderately low birth weight among blacks and whites. Furthermore, the racial differences in infants' birth weights were greater among low-risk than among high-risk mothers, especially for very low birth weight (black:white ratios of 3.4 and 1.7, respectively). We also examined secular trends in the rates of low birth weight among blacks and whites. Between 1973 and 1983, births of infants with moderately low birth weights decreased more among whites than among blacks, whereas births of infants with very low birth weights increased among blacks and decreased among whites. Fifteen percent of the decline in the rate of moderately low birth weight among whites could be attributed to favorable changes in maternal characteristics (primarily an increase in educational level). Among blacks, adverse changes in maternal characteristics (primarily an increase in births to unmarried women) accounted for 35 percent of the increase in the rate of very low birth weight. The adverse effects of childbearing by teenagers on the outcome of pregnancy among blacks appear to have been overemphasized. The persistence of large racial differences in birth weight, even among mothers at low risk, emphasizes the need for specific targeted interventions to achieve further improvements in infant health.

Adolescent↗
PubMed1987

Representativeness of the Framingham risk model for coronary heart disease mortality: a comparison with a national cohort study.

The Framingham Heart Study has been the foundation upon which several national policies regarding risk factors for coronary heart disease mortality are based. The NHANES I Epidemiologic Followup Study is the first national cohort study based upon a comprehensive medical examination of a probability sample of United States adults. The average follow-up time was 10 years. This study afforded an opportunity to evaluate the generalizability of the Framingham risk model, using systolic blood pressure, total cholesterol, and cigarette smoking, to the U.S. population with respect to predicting death from coronary heart disease. The Framingham model predicts remarkably well for this national sample. The major risk factors for coronary heart disease mortality described in previous Framingham analyses are applicable to the United States white adult population.

Adult↗
PubMed1987

Trends in mortality caused by respiratory distress syndrome in the United States, 1969-83.

Using United States vital statistical data we examined trends in infant deaths from Respiratory Distress Syndrome/Hyaline Membrane Disease (RDS/HMD) for 1969 to 1983, by race and age at death. In order to improve comparability of diagnosis across two revisions of the International Classification of Diseases, deaths from RDS/HMD were ascertained using both underlying and associated causes of death. These data document a 2 per cent per year increase in infant mortality attributed to RDS/HMD for all races during interval I (1969-73) followed by 9 per cent per year decreases during intervals II (1974-78) and III (1979-83). However, there was a marked difference between Whites and Blacks in these trends. In the White population, RDS/HMD infant mortality increased by 2.2 per cent per year in interval I but then decreased by 10.5 per cent per year in interval II and 8.9 per cent per year in interval III. Among Blacks, on the other hand, the initial increase in RDS/HMD mortality was steeper (5.2 per cent per year) and the subsequent decreases were less (6.3 per cent per year and 8.0 per cent per year). As a result, the Black-White ratio in infant mortality attributed to RDS/HMD increased from 1.32 in 1969-73, to 1.59 in 1974-78 and to 1.72 in 1979-83. The proportion of RDS/HMD deaths that occurred in the postneonatal period increased from 1.1 per cent in interval I to 3.6 per cent in interval II to 5.0 per cent in interval III.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1987

Smoking during pregnancy, 1967-80.

Data from two national samples of live births to married mothers (the 1967 and 1980 National Natality Surveys) were used to document changes in smoking during pregnancy. Smoking among married teenagers remained essentially constant between 1967 and 1980. For married mothers age 20 and over, the prevalence of smoking during pregnancy decreased from 40 to 25 per cent among Whites and 33 to 23 per cent among Blacks. There were striking differences in the magnitude of the decrease by educational attainment. Among the White married mothers age 20 and over, the prevalence of smoking during pregnancy decreased from 48 to 43 per cent for those with less than 12 years education and from 34 to 11 per cent for those with 16 or more years education.

Adolescent↗
PubMed1986

National and state trends in use of prenatal care, 1970-83.

Using birth certificate data, national trends in prenatal care use are examined for White and Black mothers overall, as well as for 10 separate subgroups defined by marital status, maternal age, and educational attainment. The per cent of Black mothers with early prenatal care increased each year during the 1970s but the average annual percentage point increase for 1976-80 (1.2) was smaller than that for 1970-75 (2.3). Furthermore, the per cent of Black mothers with early care declined from 62.6 in 1980 to 61.4 in 1982 and remained at this lower level in 1983. Similar changes in trends were observed for all of the 10 Black subgroups despite substantial variation among the subgroups in the level of early prenatal care use. Analyses of state trends provide further evidence of a change in trend for Black mothers. For White mothers, average annual increases in the per cent with early care were similar for 1970-75 and 1976-80 (0.8 and 0.6 percentage points). In addition, the per cent with early care has remained stable since 1980.

Adolescent↗
PubMed1986

State trends in infant mortality, 1968-83.

This paper presents an analysis of state trends in infant mortality rates (IMRs) for 1968-83. In order to take into account the large random error component associated with state IMRs, weighted least squares estimates are used to fit log-linear models to these trends. Using simulated data, these estimates are shown to be nearly unbiased and to provide valid significance tests. However, the power to detect changes in trend is rather limited, especially in small states. Using these methods, separate analyses of White IMRs in 49 states and non-White IMRs in 30 states were completed. Nine states are identified which had infant mortality trends less favorable than the national experience and 1981-83 rates more than 5 per cent above the national average.

Humans↗
PubMed1985

The effects of maternal smoking, physical stature, and educational attainment on the incidence of low birth weight.

Data from the 1980 National Natality Survey were used to investigate the effects of maternal smoking, height, weight, and educational attainment on the incidence of low birth weight among white non-Hispanic married mothers aged 20-34 years, live birth order 1-3. Using multiple logistic regression to control for the effects of infant's sex, live birth order, and maternal age, women with less than 12 years education have a low birth weight odds ratio of 2.38 and women with 12 years have a low birth weight odds ratio of 1.24 relative to women with 13 or more years. After further controlling for height, weight, and smoking, these odds ratios are reduced to 1.59 and 1.11, respectively. The majority of the reduction can be attributed to differences in smoking among the education groups. Women with low education are more likely to have smoked prior to pregnancy, more likely to smoke heavily, and less likely to stop smoking during pregnancy. The odds of low birth weight increases by 26% for every five additional cigarettes smoked per day. If all women in the study population stopped smoking during pregnancy, the incidence of low birth weight would be expected to decline by 35% for those with less than 12 years education, by 20% for those with 12 years, and by 11% for those with more than 12 years. The effects of the independent variables were also estimated for two components of low birth weight: below 2,000 grams and 2,000-2,499 grams. Although the nonresponse rate for the National Natality Survey was 20%, a comparison of mail and telephone respondents suggests that the impact of nonresponse on the estimates of the logistic coefficients is minimal.

Adult↗
PubMed1985

Service areas for ambulatory medical care.

This article evaluates three alternative definitions of physician service areas using data from the 1978 National Health Interview Survey. The three types of areas are county aggregations based on different data sources: the Bureau of Economic Analysis Economic Areas (BEAAs), Ranally Basic Trading Areas (RBTAs), and Health Care Commuting Areas (HCCAs). The three types of areas differ substantially in size, population, urbanization, and the availability of physicians. The overall percentage of physician visits outside each of the three areas was small, ranging from 3 percent for BEAAs to 5 percent for RBTAs and HCCAs. Visits by nonmetropolitan residents were about four times as likely as those by metropolitan residents to occur outside of each area. The results suggest that HCCAs are the most appropriate primary care physician service areas because they are the smallest in size and population and have the greatest variability in physician supply, yet they exhibit an amount of outside-area travel for care similar to that of the two larger types of areas.

Ambulatory Care↗