Biomedical subjects

M J Klag

Publications and source records attributed to M J Klag.

At least 91 records · Page 5Linked to original sources

PubMed1993

Agreement between overnight and 24-hour urinary cation excretions in southern Chinese men.

Agreement between overnight and 24-hour urinary sodium, potassium, calcium, and magnesium excretion was studied in a sample of 63 normotensive Southwestern Chinese men: 30 Yi farmers and 33 urban residents in April 1989. Overnight (8-hour) and 24-hour urine specimens were collected on 3 consecutive days. Estimated correlation coefficients between 24-hour and overnight mean true values were 0.863 and 0.906 for sodium, 0.736 and 0.816 for potassium, 0.902 and 0.725 for calcium, and 0.733 and 0.703 for magnesium in Yi farmers and urban residents, respectively. Hourly overnight urinary sodium and potassium excretion rates were significantly lower than the corresponding hourly 24-hour urinary excretion rates: -0.60 and -1.99 mmol/hour for sodium, -1.24 and -0.48 mmol/hour for potassium (all p < 0.05) in Yi farmers and urban residents, respectively. In multiple regression analyses, the differences between 24-hour and overnight urinary sodium and potassium excretion rates were significantly and positively related to differences between 24-hour and overnight creatinine excretion rates. The ratios of intraindividual to interindividual variance were lower for 24-hour collections than for overnight collections for sodium and calcium, but the differences in these ratios for potassium and magnesium were small. For sodium and calcium, twice as many overnight as 24-hour collections were required to estimate the correlation between cations and blood pressure with the same accuracy; for potassium and magnesium, overnight and 24-hour collections were equally accurate. These results indicate that in normotensive populations such as the one studied, overnight urine collections may be used to estimate 24-hour cation excretion. The underestimate of cation excretion by assessments based on collection of overnight specimens may be due to either a lower creatinine clearance or a lower intake of cations at night.

Adult↗

PubMed1993

Variation in utilization of procedures for treatment of peripheral arterial disease. A look at patient characteristics.

OBJECTIVE: To examine associations between demographic characteristics and use of interventional procedures in patients with peripheral arterial disease. DESIGN: Case series drawn from a statewide hospital discharge database. SETTING: Nonfederal acute-care hospitals in Maryland. PATIENTS AND INTERVENTIONS: A total of 7080 cases of angioplasty, bypass surgery, or amputation for lower-extremity peripheral arterial disease in 1988 through 1989. MAIN OUTCOME MEASURE: Use of angioplasty, bypass surgery, and lower-extremity amputation. RESULTS: A total of 1185 angioplasties, 4005 bypass operations, and 1890 amputations were identified. Population-based annual rates showed that angioplasty use peaked at about 70 per 100,000 at the age of 65 to 74 years, bypass surgery use peaked at more than 250 per 100,000 at 75 to 84 years of age, and amputation use peaked at about 225 per 100,000 at 85 years of age and older. The age-adjusted likelihood of having a procedure for peripheral arterial disease was 1.7 times higher in men than in women and 1.6 times higher in blacks than in whites. Compared with patients who had angioplasty or bypass surgery, patients who had amputations were more likely to be more than 65 years old, to be black (odds ratio, 2.5), to have Medicaid or no insurance (odds ratio, 1.7), to have diabetes mellitus (odds ratio, 3.0), and not to have hypertension (odds ratio, 3.1). Compared with patients who had bypass surgery, patients who had angioplasty were more likely to be under 65 years old, to be white (odds ratio, 1.7), and not to have diabetes mellitus (odds ratio, 1.3). CONCLUSION: Patient race is associated with differences in the frequency with which angioplasty, bypass surgery, and amputation are performed for peripheral arterial disease, and insurance status is associated with the likelihood of having amputation.

Black or African American↗

PubMed1993

Projections of hypertension-related renal disease in middle-aged residents of the United States.

OBJECTIVE: To establish nationwide projections for hypertension-related renal disease among middle-aged residents of the United States and compare disease burden in demographic subgroups. DESIGN: Integrated analysis of data from the US Census, the National Health and Nutrition Examination Survey of 1976 through 1980 (NHANES II), the 1971 through 1975 NHANES I Epidemiologic Follow-up Study, the Hypertension Detection and Follow-up Program trial, and the US Renal Data System. POPULATION: African-American and white residents of the United States, aged 30 to 69 years. MAIN OUTCOME MEASURES: Incidence rates and counts of hypertension, hypertension-related hypercreatinemia, and hypertension-related end-stage renal disease (ESRD). RESULTS: Each year, approximately 1.8 million middle-aged Americans develop hypertension, 140,000 develop hypertension-related hypercreatinemia, and 5300 develop hypertension-related ESRD. African Americans are at increased risk for hypertension (relative risk [RR], 1.6; population-attributable risk [PAR], 5%), hypercreatinemia if hypertensive (RR, 2.4; PAR, 18%), ESRD if hypertensive with hypercreatinemia (RR, 2.7; PAR, 32%), and hypertension-related ESRD overall (RR, 8.0; PAR, 44%). Compared with women, men are at increased risk for hypertension (RR, 1.3; PAR, 13%) and hypertension-related ESRD (RR, 1.6; PAR, 23%). Most cases of hypercreatinemia in hypertensives (73%) occur among those with mild hypertension. CONCLUSIONS: Progression to ESRD is rare in persons with hypertension-related renal disease, and factors other than blood pressure probably play an important role. A large proportion of hypertension-related renal disease cases occur among population subgroups considered to be at low risk. Interventions that favorably influence factors associated with the progression of hypertension-related renal disease in African Americans, in men, and in persons with mild hypertension, hold the greatest potential for reducing the population burden of hypertension-related ESRD.

Adult↗

PubMed1993

Serum cholesterol in young men and subsequent cardiovascular disease.

BACKGROUND: The increased risk of cardiovascular disease associated with higher serum cholesterol levels in middle-aged persons has been clearly established, but there have been few opportunities to examine a potential link between serum cholesterol levels measured in young men and clinically evident premature cardiovascular disease later in life. METHODS: We performed a prospective study of 1017 young men (mean age, 22 years) followed for 27 to 42 years to quantify the risk of cardiovascular disease and total mortality associated with serum cholesterol levels during early adult life. The mean serum cholesterol level at entry was 192 mg per deciliter (5.0 mmol per liter). RESULTS: During a median follow-up of 30.5 years, there were 125 cardiovascular-disease events, 97 of which were due to coronary heart disease. The serum cholesterol level at base line was strongly associated with the incidence of events related to coronary heart disease and cardiovascular disease, as well as to total mortality and mortality due to cardiovascular disease. The risks were similar whether the events occurred before or after the age of 50. In a proportional-hazards analysis adjusted for age, body-mass index (the weight in kilograms divided by the square of the height in meters), the level of physical activity, coffee intake, change in smoking status, and the incidence of diabetes and hypertension during follow-up, a difference in the serum cholesterol level at base line of 36 mg per deciliter (0.9 mmol per liter)--the difference between the 25th and 75th percentiles of cholesterol level in the study population at base line--was associated with an increased risk of cardiovascular disease (relative risk, 1.72; 95 percent confidence interval, 1.39 to 2.14), coronary heart disease (relative risk, 2.01; 95 percent confidence interval, 1.59 to 2.53), and mortality due to cardiovascular disease (relative risk, 2.02; 95 percent confidence interval, 1.23 to 3.32). A difference in the base-line serum cholesterol level of 36 mg per deciliter was significantly associated with an increased risk of death before the age of 50 (relative risk, 1.64; 95 percent confidence interval, 1.03 to 2.61), but not with the overall risk of death (relative risk, 1.21; 95 percent confidence interval, 0.93 to 1.58). CONCLUSIONS: These findings indicate a strong association between the serum cholesterol level measured early in adult life in men and cardiovascular disease in midlife.

Adult↗

PubMed1993

A prospective study of blood pressure and serum creatinine. Results from the 'Clue' Study and the ARIC Study.

OBJECTIVES: To describe associations of past and current blood pressure levels with serum creatinine levels and hypercreatinemia in the general population. POPULATION: 1399 middle-aged residents of Washington County, Maryland, who had their blood pressure measured during a cancer screening campaign in 1974 (the "Clue" Study) and had their blood pressure and serum creatinine level measured in an atherosclerosis risk factors study from 1986 through 1989 (the Atherosclerosis Risk in Communities [ARIC] Study). DESIGN: Nonconcurrent prospective study. The outcome variables were serum creatinine level and hypercreatinemia (serum creatinine > 115 mumol/L in men, > 97 mumol/L in women) measured from 1986 through 1989. Main predictors were 1986-1989 blood pressure values (cross-sectional association) and 1974 blood pressure values (longitudinal association). Gender-adjusted associations were assessed and compared by linear and logistic regression. RESULTS: Both serum creatinine and hypercreatinemia were better predicted by past than by current blood pressure values. Creatinine values exhibited a gradual and statistically significant association with blood pressure levels measured in 1974, even across "normal" values of blood pressure and creatinine. The association with 1986-1989 blood pressure measurements was weaker and nonsignificant. The odds of hypercreatinemia in 1986-1989 were increased 1.5-fold to twofold, with a 20 mm Hg increment in 1974 blood pressure values, but the odds remained constant across 1986-1989 blood pressure values. CONCLUSIONS: Blood pressure and creatinine level are associated in the general population. The observed association was stronger when a number of years had elapsed between the assessments of blood pressure and creatinine level. These findings are consistent with the hypothesis that blood pressure elevations, even below the hypertensive range, may induce early renal damage.

Blood Pressure↗

PubMed1993

Validity of physicians' self-reports of cardiovascular disease risk factors.

To determine the accuracy of self-reported risk factors in 78 physicians, self-reported information was compared to findings on a standardized examination. Measured weight (r = 0.98), height (r = 0.95), body mass index (r = 0.96), systolic blood pressure (SBP) (r = 0.72), and diastolic blood pressure (DBP) (r = 0.60) were highly correlated with self-reported values (all P < 0.0001). Mean self-reported SBP and DBP did not differ from measured values; measured weight was 1.5 kg greater and measured height 1.4 cm less than self-reported values (both p < 0.0001). Regression of measured on self-reported values indicated excellent agreement except for DBP and heart rate. Differences between measured and self-reported values were not associated with a variety of variables except for a greater difference in SBP at higher levels of SBP. None of the 60 self-reported nonsmokers had expired carbon monoxide levels greater than 10 ppm. These results indicate that physicians' self-reports of height, body mass index, SBP, and smoking are extremely accurate and suitable for research purposes.

Aged↗

PubMed1993

The decline in stroke mortality. An epidemiologic perspective.

The evidence that treatment of hypertension prevents stroke is incontrovertible. Several observations, however, suggest that improvements in the prevalence of antihypertensive treatment cannot explain all of the recent decline in stroke mortality. Changes in nutritional patterns may explain some of the observed decline. Prospective studies have demonstrated conclusively an independent, increasing risk of hemorrhagic, but not thrombotic, stroke at higher levels of alcohol use. Stroke mortality is associated inversely with fat and protein intake. Dietary sodium has been linked to stroke in ecologic studies but not in prospective studies. Ecologic studies have suggested that foods high in vitamin C and potassium protect against stroke; an inverse association of potassium intake with fatal stroke has been demonstrated in cohort studies. Two studies in humans also suggest a protective effect of serum selenium against subsequent stroke. Determination of the influence of nutrients on stroke incidence offers tantalizing opportunities for future research and possibly, intervention.

Alcohol Drinking↗

PubMed1993

Epidemiologic analysis of existing data to investigate hypertensive renal disease: an example from the Maryland End-Stage Renal Disease Registry.

Observational epidemiology provides powerful methods for studying the etiology and natural history of renal disease in populations. Existing data sets can be used in the conduct of cross-sectional, case-control, and cohort studies that complement experimental investigations. Analysis of existing data sets is extremely efficient and, in many instances, provides results of similar quality to those derived from studies that depend on the collection of original data. A study based on linkage of hypertensive end-stage renal disease (ESRD) incidence rates from the Maryland Regional ESRD Registry with corresponding prevalence data from a state-wide survey of cardiovascular risk factors (The Maryland Statewide Household Hypertension Survey) illustrates the power, efficiency, and flexibility of observational epidemiologic methods in investigating racial differences in hypertensive ESRD. Such analyses can both test previously established hypotheses and generate new hypotheses for subsequent investigation.

Adult↗

PubMed1993

Alcohol use and blood pressure in an unacculturated society.

Alcohol intake has been associated with higher blood pressure in acculturated populations but not in unacculturated societies. We performed a cross-sectional survey of a random community sample of 5023 male Yi rural farmers and 1656 Yi and 2173 Han men living in an urban setting. Average alcohol intake among drinkers was 36.4 g/d in Yi farmers, 56.5 g/d in Yi migrants, and 38.7 g/d in Han men. Age-adjusted mean diastolic blood pressure was 66.9, 70.5, and 71.7 mm Hg, respectively. Diastolic blood pressure was higher at higher alcohol intakes in all three groups (all P < .001). After adjustment for age, body mass index, heart rate, smoking, and physical activity, the change (95% confidence interval) in diastolic blood pressure for each standard drink was 0.50 (0.38-0.62), 0.31 (0.18-0.43), and 0.24 (0.07-0.40) mm Hg for Yi farmers, Yi migrants, and Han men, respectively. The percentage of variance in diastolic blood pressure explained by alcohol intake was 5% for Yi farmers, 4% for Yi migrants, and 2% for Han men. In a random sample of 831 men, these associations were independent of urinary sodium, potassium, calcium, and magnesium and sodium-potassium ratio. In the Yi farmers, associations were less strong for systolic blood pressure and no longer significant after adjustment. Approximately 33% of hypertension could be attributed to daily alcohol use in the Yi groups compared with 9.5% in the Han people.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1993

Cause of death in patients with end-stage renal disease: death certificates vs registry reports.

OBJECTIVES: The purpose of this study was to assess agreement on cause of death reporting in end-stage renal disease patients by comparing death certificates and reports to an end-stage renal disease registry. METHODS: Death certificates and registry reporting forms were retrieved for a random sample of 335 treated end-stage renal disease patients who died between 1980 and 1986 in Maryland. On the registry form, patient death was ascribed to 1 of 22 precoded causes by the patient's nephrologist of record. Corresponding death certificates were coded, according to rules of the International Classification of Diseases, 9th edition, by a trained observer unaware of the registry report. Agreement was measured by the kappa statistic. RESULTS: Overall cause of death agreement was poor (31%), and varied by the following categories: renal disease (40% on death certificates vs 0% on registry reports), cardiovascular disease (26% vs 47%), infectious disease (16% vs 22%), cancer (7% vs 5%), and withdrawal from therapy (0% vs 3%). Agreement was higher for transplant recipients than for dialyzed patients. CONCLUSIONS: Death certificates and registry reports yield different descriptions of mortality in end-stage renal disease patients. These sources of information should not be used interchangeably. Improvements to International Classification of Diseases coding of renal diseases and the determination of the reliability and validity of the US Renal Data System reporting process are necessary steps in the development of renal disease epidemiology.

Abstracting and Indexing↗

PubMed1993

Effect of age and gender on kidney function in renal transplant donors: a prospective study.

We evaluated the long-term residual renal function in 64 living related kidney donors. Our main objective was to identify baseline factors, including gender and age, that could predict renal impairment after nephrectomy. Forty-four (69%) of the 64 donors were women. The mean +/- SEM age of those studied was 36 +/- 1.3 years and their mean +/- SEM duration of follow-up was 62 +/- 4.9 months (range, 6 to 174). Overall mean serum creatinine concentration after kidney donation was increased compared to baseline values (1.13 mg/dl vs 0.92 mg/dl, respectively, p < 0.001). At the last follow-up visit, post-nephrectomy mean glomerular filtration rate (GFR) values, adjusted for body surface area, age at donation, baseline serum creatinine and duration of follow-up, measured by 99mTc-DTPA were significantly lower in women than in men (72.11 ml/min vs 87.17 ml/min, respectively, p = 0.02). At follow-up, mean effective renal plasma flow, adjusted for the same variables, measured by 131I-hippuran was also significantly lower in women compared to men (318.07 ml/min vs 400.82 ml/min, respectively, p < 0.01). Eleven of twelve patients with post-nephrectomy GFR values less than 60 ml/min were women. Following nephrectomy, serum creatinine concentration increased significantly as a function of greater age at donation in women but not in men. Similarly, in women but not in men, follow-up GFR measurements decreased significantly as a function of age after adjusting for baseline serum creatinine and duration of follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1992

Kidney transplantation from living unrelated donors.

OBJECTIVE: To compare patient and graft survival of recipients of kidneys from living, unrelated donors (LUDs); cadaveric donors; and living, related donors (LRDs) matched for zero (mismatched), one, or two (identical) haplotypes. DESIGN: Cohort study. SETTING: Sixty-three renal transplantation centers affiliated with the Brazilian Transplantation Registry (accounting for more than 95% of the transplantation activity in Brazil). PATIENTS: Patients having renal transplantation between January 1987 and March 1991. Of 2892 patients, 165 (6%) received transplants from LUDs; 964 (33%), from cadaveric donors; 183 (6%), from zero haplotype, HLA-matched LRDs; 1259 (44%), from one haplotype-matched LRDs; and 321 (11%), from two haplotype-matched LRDs. MEASUREMENTS: Patient and graft survival. Patients were followed for an average of 15.8 months. RESULTS: After adjustment for age, race, diagnosis of primary disease, history of previous transplantation, cyclosporine use, and number of transplants from LUDs per center, patient survival did not differ statistically for recipients of kidneys from LUDs and recipients of cadaveric kidneys (risk ratio [RR], 1.16; 95% Cl, 0.68 to 1.98). Little difference was seen between the adjusted death rate for recipients of zero haplotype-matched LRDs and recipients of cadaveric kidneys (RR, 1.13; Cl, 0.69 to 1.87). Similarly, in a multivariate analysis, recipients of kidneys taken from LUDs and zero haplotype-matched LRDs had a risk for graft failure that did not differ statistically from that of cadaveric kidney recipients (RR, 0.74; Cl, 0.45 to 1.22 and RR, 0.82; Cl, 0.53 to 1.25, respectively). CONCLUSIONS: Graft survival for recipients of kidneys from LUDs is similar to that from zero haplotype-matched LRDs and is at least as good as that achieved with cadaveric transplants.

Adolescent↗

PubMed1992

The excess incidence of diabetic end-stage renal disease among blacks. A population-based study of potential explanatory factors.

OBJECTIVE: To investigate whether the excess incidence of diabetic end-stage renal disease (ESRD) among African Americans could be explained by racial differences in putative ESRD risk factors. DESIGN: Population-based, ecologic study using the 1981 and 1982 Maryland Statewide Household Hypertension Survey for data on risk factor prevalence. PARTICIPANTS: A total of 2.1 million adults residing within the boundaries of the Maryland Regional ESRD Registry, grouped by race and ZIP code into 26 subpopulations. MAIN OUTCOME MEASURE: Incidence rates of treatment for diabetic ESRD between 1980 and 1985 from the Maryland Regional ESRD Registry by subpopulation. RESULTS: Between 1980 and 1985, 442 persons entered treatment for diabetic ESRD. At the level of the subpopulation, diabetic ESRD incidence was positively associated with black race (relative risk [RR], 3.42; 95% confidence interval [CI], 2.84 to 4.13), prevalence of diabetes (RR, 2.35; 95% CI, 1.92 to 2.87), prevalence of poorly controlled hypertension (RR, 1.80; 95% CI, 1.45 to 1.86), lack of a regular source of health care (RR, 1.82; 95% CI, 1.62 to 2.05), and lower socioeconomic status as indicated by lack of college education (RR, 1.41; 95% CI, 1.32 to 1.52) (all, P < .0001). After adjusting for these risk factors, black race remained strongly associated with the overall incidence of diabetic ESRD (RR, 2.70; 95% CI, 1.89 to 3.86; P < .0001). Further analyses suggested that this excess risk among blacks was confined to ESRD related to non-insulin-dependent diabetes (RR, 4.80; 95% CI, 3.09 to 7.46; P < .0001); blacks were at no higher risk than were whites for ESRD related to insulin-dependent diabetes (RR, 0.90; 95% CI, 0.52 to 1.55; P = .70). CONCLUSIONS: These data suggest that the excess incidence of diabetic ESRD among blacks is not fully explained by a higher prevalence of diabetes or hypertension in blacks or by racial differences in age, socioeconomic status, or access to health care. Instead, they suggest an increased susceptibility to ESRD resulting from non-insulin-dependent diabetes among blacks as compared with whites.

Adult↗

PubMed1992

Prediction of steroid responsiveness in the idiopathic nephrotic syndrome using urinary retinol-binding protein and beta-2-microglobulin.

OBJECTIVES: To determine the prevalence of early proximal tubular dysfunction, measured by urinary excretion of retinol-binding protein (RBP) and beta-2-microglobulin (B2M), in patients with the idiopathic nephrotic syndrome and to investigate the value of these tests in predicting steroid responsiveness. DESIGN: Before-after trial with 8-week treatment period. SETTING: Tertiary referral center. PATIENTS: Sequential sample of 37 patients with the idiopathic nephrotic syndrome caused by minimal change disease, focal segmental glomerulosclerosis, or mesangial proliferative glomerulonephritis. INTERVENTION: All patients were treated with prednisone as one dose of 1 to 1.5 mg/kg body weight per day for 8 weeks. MEASUREMENTS: Urinary RBP was measured by an immunoenzymometric assay and B2M, by an enzyme-linked immunosorbent assay. Remission of the nephrotic syndrome after steroid treatment was the main outcome variable. RESULTS: Elevated levels of urinary RBP and B2M before treatment were detected in 65% and 75% of the patients, respectively. Median urinary RBP and B2M, before treatment, were significantly higher in the steroid-unresponsive group than in the responsive group (P less than 0.01). In the steroid-responsive group, urinary RBP and B2M levels decreased significantly after remission (P less than 0.01). In the steroid-unresponsive group, the likelihood ratios for urinary RBP greater than 4000 micrograms/g creatinine and for B2M greater than 3000 micrograms/g creatinine were 3.8 and 3.0, respectively. The probability was 100% that values of RBP of less than 1300 micrograms/g creatinine and B2M of less than 130 micrograms/g creatinine were from steroid-responsive patients. Multivariate analysis confirmed that higher urinary levels of RBP and B2M were associated with a lower likelihood of steroid responsiveness, independent of age and histologic diagnosis. CONCLUSIONS: Proximal tubular dysfunction is frequent in patients with the idiopathic nephrotic syndrome. Pretreatment urinary RBP and B2M levels may be helpful in identifying nephrotic patients who are more likely to be responsive to steroids.

Adolescent↗

PubMed1992

Early predictors of career achievement in academic medicine.

OBJECTIVE: To identify early personal and scholastic factors that predict academic career choice and long-term career achievement among academic physicians. DESIGN: A longitudinal cohort study. PARTICIPANTS: Nine hundred forty-four male physicians who graduated from The Johns Hopkins University School of Medicine, Baltimore, MD, from 1948 through 1964. OUTCOME MEASURES: Career achievement outcomes included attained faculty rank in 1990 and the number of citations (20 to 24 years after graduation) to published work. RESULTS: Of the 944 physicians, 424 (45%) had chosen academic careers. Scholastic performance and research experience in medical school were independently associated with having chosen an academic career (P less than .001). Among academicians, higher attained rank in 1990 was independently associated with the following: (1) membership in Alpha Omega Alpha (relative risk [RR] = 4.94, P = .0001); (2) rank in the top third of the graduating class (RR = 2.68, P = .01); and (3) research experience in medical school (RR = 3.11, P = .0001). These three factors were also independently associated with more citations to participants' published work (P less than .05). CONCLUSION: These data suggest that scholastic performance and research experience during medical school predict career achievement in academic medicine over 20 years in the future.

Achievement↗

PubMed1992

Baseline characteristics of participants in phase I of the Trials of Hypertension Prevention.

Phase I of the Trials of Hypertension Prevention was designed to test the effectiveness and safety of three life-style (weight loss, sodium restriction, and stress management) and four nutrition supplement (calcium, magnesium, potassium, and fish oil) interventions in reducing diastolic blood pressure (DBP) in persons with a high-normal blood pressure. A total of 2182 persons with a DBP between 80 and 89 mm Hg met the eligibility criteria for participation in phase I and were randomized to one of the active intervention or control treatment groups. Most were white (82%), male (70%), married (76%), nonsmoking (88%), college graduate (53%), full-time employees (91%). The average blood pressure prior to entry into the trial was 124.9 mm Hg systolic and 83.8 mm Hg diastolic. A variety of baseline observations, including sociodemographic characteristics, personal and family medical history, health habits, diet, and biologic measurements, were documented before randomization and compared among the seven active intervention and control groups. As might be expected in a randomized trial of this sample size, the distribution of measured baseline characteristics was virtually identical in the treated and control groups. Based on this finding and the knowledge that randomization procedures were implemented without deviation from the phase I protocol, it is probable that unknown potential confounders were also equally distributed at entry into the study. Given the achievement of high rates of follow-up, subsequent differences in blood pressure are unlikely to have been due to baseline differences between the active treatment and control groups, and can probably be attributed to effects of the active interventions.

Adult↗

PubMed1992

End-stage renal disease in US minority groups.

Medicare's End-Stage Renal Disease (ESRD) Program makes renal replacement services accessible for the majority of Americans with renal failure. National data from Medicare demonstrate complex and variable patterns of use of renal replacement services among US racial and ethnic groups. The black population has consistently suffered from a greater than 3.5-fold higher rate of treated ESRD than has the white population. The rates of hypertensive, diabetic, and glomerulopathic ESRD are all substantially greater in blacks than in whites, and hypertension has accounted for a far greater proportion of ESRD in blacks than any other diagnosis. There is a paucity of national data on the occurrence of ESRD in Hispanic Americans. However, data from Texas strongly suggest that the incidence rate of treated ESRD is much higher in Mexican Americans than in non-Hispanic whites. Higher rates are apparent for each of the three most important causes of ESRD: hypertension, diabetes, and glomerulonephritis. Native Americans experience ESRD at a rate intermediate between those of whites and blacks, but their rate of diabetic ESRD is higher than in either blacks or whites. However, considerable diversity exists among Native American tribal groups. Significant barriers to the acquisition of preventive care have been identified, especially for blacks. While these barriers to preventive care are accompanied by a significantly impaired health status of the black American population, a specific causal relationship between impaired access to care for blacks and their predisposition to ESRD has not been established.

Black or African American↗

PubMed1992

Skinfold thickness and cardiovascular risk factors in American and Japanese telephone company executives.

Data from a cross-sectional study of cardiovascular disease risk factors in 962 US and 827 Japanese male telephone company executives were used to determine the associations of skinfold thickness measurements (abdominal, subscapular, triceps, ulnar) with blood pressure, blood glucose, serum cholesterol, and serum triglycerides. These associations were assessed within each group of executives and were compared between the groups. Most skinfolds showed association with risk factors in univariate regression. After adjusting for age and body mass index, the abdominal skinfold continued to be significantly associated with blood pressure and triglycerides in both groups, while the subscapular skinfold showed associations only with triglycerides. After adjustment, the peripheral skinfolds showed no association with risk factors in the US men, however, in the Japanese men the ulnar skinfold continued to be associated with blood pressure. These findings suggest that abdominal and ulnar skinfold measurement may be useful in adjusting for the effect of obesity on coronary heart disease risk in epidemiological studies.

Administrative Personnel↗