Biomedical subjects

S Sidney

Publications and source records attributed to S Sidney.

At least 55 records · Page 3Linked to original sources

PubMed1997

Serum total cholesterol and risk of hospitalization, and death from respiratory disease.

BACKGROUND: In earlier studies, serum total cholesterol was inversely associated with death due to respiratory diseases. METHODS: Relationships of cholesterol with risk of respiratory diseases were examined between 1978 and 1993 in a health maintenance organization in Northern California (48,188 men, 55,276 women, about 60% white, age range 25-89). Incident and fatal endpoints were ascertained using hospital discharge diagnostic codes and underlying cause of death, respectively. RESULTS: An inverse association of cholesterol level with pneumonia/influenza hospitalization was found among men and women except that, contrary to hypothesis, a positive association was seen in women under 55 years of age. Inconsistent inverse associations were found in men, but not women, between cholesterol level and hospitalization for chronic obstructive pulmonary disease (COPD). Hospitalization for asthma was unrelated to cholesterol level. An inverse association existed between cholesterol level and hospitalization for miscellaneous respiratory diseases among men, but not women. Exclusion of early hospitalizations tended to attenuate risk for cholesterol level below 4.14 mmol/l, but not the risk gradient across higher cholesterol levels. For deaths, cholesterol level was statistically significantly inversely associated only with COPD. CONCLUSIONS: Cholesterol had graded inverse associations with some respiratory diseases, but not others, tending to be stronger in men than in women, and in older than in younger participants. Associations varied for hospitalizations compared to deaths. More epidemiological and basic research is needed to elucidate the potential mechanisms underlying the observed associations.

Adult↗

PubMed1997

The safety of transurethral prostatectomy: a cohort study of mortality in 9,416 men.

PURPOSE: We assessed the mortality rate from transurethral resection of the prostate. MATERIALS AND METHODS: From 1976 to 1984, 4,708 patients undergoing transurethral resection of the prostate for benign prostatic hypertrophy (BPH) were compared retrospectively to an age-matched group of 4,708 randomly selected Kaiser Permanente Medical Care Program members not undergoing surgery. The risk of mortality associated with transurethral resection of the prostate relative to no surgery was determined using proportional hazards models. RESULTS: The relative risk for surgery versus no surgery for the total group was 0.88 (95% confidence interval 0.82 to 0.95). Similarly, the results for each 5-year age group demonstrated a relative risk of 0.77 to 0.95. CONCLUSIONS: This cohort study showed no excess mortality for patients undergoing transurethral resection of the prostate compared to age-matched comparison subjects randomly selected from health plan members who did not undergo surgery. Information from this study about the safety of transurethral resection of the prostate can be shared with patients when discussing treatment options.

Aged↗

PubMed1997

Incidence of stroke and myocardial infarction in women of reproductive age.

BACKGROUND AND PURPOSE: Information on the incidence of vascular disease in women of reproductive age has been limited. These disease are rare in this age group, and a large population base is required for reliable estimation of incidence. METHODS: For a case-control study of vascular disease and low-dose oral contraceptive use, we used emergency department logs and hospital admission and discharge records to ascertain fatal and nonfatal cases of first-ever stroke and myocardial infarction (MI) in women 15 to 44 years of age who were-members of a large California HMO. Incidence rates of stroke and MI were calculated on the basis of these data. RESULTS: The incidence of MI not associated with pregnancy was 5.0 per 100,000 women-years. The incidence of stroke not associated with pregnancy was 10.7 per 100,000 women-years. MI was very rare until age 35 years. At every age, about half of hemorrhagic strokes were due to subarachnoid hemorrhage. CONCLUSIONS: The incidence rates of stroke and MI are low in women of reproductive age in the United States.

Adolescent↗

PubMed1997

Racial differences in bone density between young adult black and white subjects persist after adjustment for anthropometric, lifestyle, and biochemical differences.

This study tested whether racial differences in bone density can be explained by differences in bone metabolism and lifestyle. A cohort of 402 black and white men and women, ages 25-36 yr, was studied at the Kaiser Permanente Medical Care Program in Northern California, a prepaid health plan. Body composition (fat, lean, and bone mineral density) was measured using a Hologic-2000 dual-energy x-ray densitometer. Muscle strength, blood and urine chemistry values related to calcium metabolism, bone turnover, growth factors, and level of sex and adrenal hormones were also measured. Medical history, physical activity, and lifestyle were assessed. Statistical analyses using t- and chi-square tests and multiple regression were done to determine whether racial difference in bone density remained after adjustment for covariates. Bone density at all skeletal sites was statistically significantly greater in black than in white subjects; on average, adjustment for covariates reduced the percentage density differences by 42% for men and 34% for women. Adjusted bone density at various skeletal sites was 4.5-16.1% higher for black than for white men and was 1.2-7.3% higher for black than for white women. We concluded that racial differences in bone mineral density are not accounted for by clinical or biochemical variables measured in early adulthood.

Adult↗

PubMed1997

Marijuana use and mortality.

OBJECTIVES: The purpose of this study was to examine the relationship of marijuana use to mortality. METHODS: The study population comprised 65171 Kaiser Permanente Medical Care Program enrollees, aged 15 through 49 years, who completed questionnaires about smoking habits, including marijuana use, between 1979 and 1985. Mortality follow-up was conducted through 1991. RESULTS: Compared with nonuse or experimentation (lifetime use six or fewer times), current marijuana use was not associated with a significantly increased risk of non-acquired immunodeficiency syndrome (AIDS) mortality in men (relative risk [RR] = 1.12, 95% confidence interval [CI] = 0.89, 1.39) or of total mortality in women (RR = 1.09, 95% CI = 0.80, 1.48). Current marijuana use was associated with increased risk of AIDS mortality in men (RR = 1.90, 95% CI = 1.33, 2.73), an association that probably was not causal but most likely represented uncontrolled confounding by male homosexual behavior. This interpretation was supported by the lack of association of marijuana use with AIDS mortality in men from a Kaiser Permanente AIDS database. Relative risks for ever use of marijuana were similar. CONCLUSIONS: Marijuana use in a prepaid health care-based study cohort had little effect on non-AIDS mortality in men and on total mortality in women.

Acquired Immunodeficiency Syndrome↗

PubMed1997

Lifetime cocaine use and cardiovascular characteristics among young adults: the CARDIA study.

OBJECTIVES: Cocaine is a central nervous system stimulant associated with cardiovascular disease risk factors, morbidity, and mortality. Despite these demonstrated relationships, it has been difficult to assess the long-term cardiovascular consequences of cocaine use. METHODS: The Coronary Artery Risk Development in Young Adults study provides an opportunity to evaluate the association of lifetime cocaine use with cardiovascular disease risk factors in a randomly sampled biethnic cohort of men and women of varied socioeconomic status, aged 20 to 32 in 1987. RESULTS: More extensive cocaine use experience was associated with being White, older, and less educated, regardless of sex. Higher levels of licit and illicit substance use behavior were reported by those reporting more extensive cocaine experience; however, most cardiovascular disease risk factors such as systolic and diastolic blood pressure, heart rate, hypertension, physical activity, and anthropometric measurements were not related to lifetime cocaine experience. CONCLUSIONS: In this age group, the detrimental cardiovascular effects of cocaine may be limited to acute effects. Further studies are needed to determine whether continued exposure is related to cardiovascular disease risk factors later in life.

Adult↗

PubMed1997

Prevalence and health implications of anti-gay discrimination: a study of black and white women and men in the CARDIA cohort. Coronary Artery Risk Development in Young Adults.

This study investigates the prevalence of self-reported experiences of discrimination based on sexual orientation among black and white women and men (25 to 37 years old) who are members of CARDIA, a multisite longitudinal study of cardiovascular risk factors. Among the 1,724 participants who responded to a 1989 questionnaire obtaining data on lifetime number of sexual partners and who participated in the Year 7 exam (1992-1993), which included questions about discrimination, 204 (12 percent) reported having at least one same-sex sexual partner: 27 (7 percent) of the 412 black women, 13 (6 percent) of the 221 black men, 87 (14 percent) of the 619 white women, and 77 (16 percent) of the 472 white men. Among these four groups, 33, 39, 52, and 56 percent, respectively, reported having experience discrimination based on sexual orientation. Additionally, 85 percent of black women and 77 percent of the black men reported having experienced racial discrimination, and 89 percent of the black women and 88 percent of the white women reported having experience gender discrimination. In the light of research associating negative stressors with poor health outcomes, including elevated blood pressure, future studies should assess public health implications of discrimination based on sexual orientation, in conjunction with racial and gender discrimination.

Adolescent↗

PubMed1996

Adverse effect of pregnancy on high density lipoprotein (HDL) cholesterol in young adult women. The CARDIA Study. Coronary Artery Risk Development in Young Adults.

The authors analyzed data from the Coronary Artery Risk Development in Young Adults (CARDIA) Study in order to examine associations between parity and lipoproteins. Of 2,787 women recruited in 1985-1986, 2,534 (91%) returned in 1987-1988 and 2,393 (86%) returned in 1990-1991 for repeat evaluations. Two-year change (1987-1988 to 1985-1986) in high density lipoprotein (HDL) cholesterol was significantly different among the parity groups. HDL cholesterol decreased in women who had their first pregnancy of at least 28 weeks duration during follow-up (mean +/- standard error, -3.5 +/- 1.2 mg/dl), and this change was significantly different from the increase in women parous at baseline who had no further pregnancies (2.5 +/- 0.3 mg/dl) and in nullipara (2.4 +/- 0.3 mg/dl). There was a nonsignificant trend for a greater decrease in HDL2 cholesterol fraction in the primipara compared with the other groups. The HDL cholesterol decrease remained significant after controlling for race, age, education, oral contraceptive use, and changes in body mass index, waist-hip ratio, physical activity, smoking status, and alcohol intake. Change in HDL cholesterol was also significantly different among the parity groups in analyses of pregnancies that occurred during the subsequent 3 years of follow-up. There were no differences for change in LDL cholesterol or triglycerides. Potential mechanisms for a detrimental effect of pregnancy on HDL cholesterol include hormonal, body composition, or life-style/behavioral changes.

Adolescent↗

PubMed1996

Stroke in users of low-dose oral contraceptives.

BACKGROUND: Previous studies have linked the use of oral contraceptive agents to an increased risk of stroke, but those studies have been limited to oral contraceptives containing more estrogen than is now generally used. METHODS: In a population-based, case-control study, we identified fatal and nonfatal strokes in female members of the California Kaiser Permanente Medical Care Program and who were 15 through 44 years of age. Matched controls were randomly selected from female members who had not had strokes. Information about the use of oral contraceptives (essentially limited to low-estrogen preparations) was obtained in interviews. RESULTS: A total of 408 confirmed strokes occurred in a total of 1.1 million women during 3.6 million woman-years of observation. The incidence of stroke was thus 11.3 per 100,000 woman-years. On the basis of data from 295 women with stroke who were interviewed and their controls, the odds ratio for ischemic stroke among current users of oral contraceptives, as compared with former users and women who had never used such drugs, was 1.18 (95 percent confidence interval, 0.54 to 2.59) after adjustment for other risk factors for stroke. The adjusted odds ratio for hemorrhagic stroke was 1.14 (95 percent confidence interval, 0.60 to 2.16). With respect to the risk of hemorrhagic stroke, there was a positive interaction between the current use of oral contraceptives and smoking (odds ratio for women with both these factors, 3.64; 95 percent confidence interval, 0.95 to 13.87). CONCLUSIONS: Stroke is rare among women of childbearing age. Low-estrogen oral-contraceptive preparations do not appear to increase the risk of stroke.

Adolescent↗

PubMed1996

Change and secular trends in physical activity patterns in young adults: a seven-year longitudinal follow-up in the Coronary Artery Risk Development in Young Adults Study (CARDIA).

Levels and changes in self-reported physical activity over a 7-year period were examined to determine tracking and to estimate the proportion of total cohort change attributable to secular trends. A population-based sample of 2,328 men and 2,787 women aged 18-30 years at baseline (52% black and 48% white) from Birmingham, Alabama, Chicago, Illinois, Minneapolis, Minnesota, and Oakland, California, were examined four times between 1985-1986 and 1992-1993. The intraclass correlation for up to four measures was 0.57 for the entire sample, varying between 0.57 for white men and 0.42 for black women, indicating a moderate tendency for tracking. The energy expenditure in physical activity at each examination was greatest in black men and, compared with black men, about 5% less in white men, 30% less in white women, and 50% less in black women. The total cohort decrease in mean physical activity was approximately 30% in each race-sex group. The secular trend accounted for 38% of the total cohort change in black men, 43% in black women, 52% in white men, and 81% in white women. Physical activity declined sharply during the early years of adulthood, partly because of secular trend. Young adults are therefore an important target group for physical activity promotion programs to reverse individual and populationwide declines prior to middle age.

Adolescent↗

PubMed1996

Television viewing and cardiovascular risk factors in young adults: the CARDIA study.

Cross-sectional associations between self-reported hours of television (TV) viewing per day and cardiovascular risk factors were assessed in a biracial (black and white) study population of 4280 men and women, ages 23 to 35 years, undergoing the year-5 follow-up examination for the Cardiovascular Risk Development in Young Adults (CARDIA) study in 1990 to 1991. Number of hours of TV viewing per day was higher in blacks than in whites and was inversely associated with education and income. Relative to "light" TV viewers (0 to 1 h/d), "heavy" TV viewers (> or = 4 h/d) had a higher prevalence (P < 0.05) of obesity, smoking, and high hostility score in all race/gender groups, and of physical inactivity in all groups except black men. Among whites, "heavy" TV viewers had higher depression scores, and among blacks, reported more alcohol use. TV viewing was not associated with hypertension and lipid abnormalities. Heavy TV viewing is a modifiable behavior that is associated with increased prevalence of several cardiovascular risk factors.

Adult↗

PubMed1996

Myocardial infarction in users of low-dose oral contraceptives.

OBJECTIVE: To determine the relationship between the use of low-dose (less than 50 micrograms estrogen) oral contraceptives (OC) and myocardial infarction. METHODS: In this population-based case-control study, all incident myocardial infarctions in women, ages 15-44 years who were members of the Kaiser Permanente Medical Care Program, Northern and Southern California regions were ascertained during a 39-month period from 1991 through 1994. For each woman with myocardial infarction, up to three age- and facility-matched controls were chosen at random from female members. Information about OC use (predominantly low-dose preparations) was obtained in face-to-face interviews. RESULTS: There were 187 incident cases of myocardial infarction during 3.6 million woman-years of observation (incidence rate, 5.2 per 100,000 woman-years). The prevalence of several risk factors for myocardial infarction was lower in controls who were current users of OCs than in controls who were noncurrent (past and never) users. The odds ratio for myocardial infarction in current OC users compared with noncurrent users was 1.65 (95% confidence interval 0.45, 6.06) after adjustment for major risk factors and for race and ethnicity, corresponding to an excess risk of less than one case per 100,000 woman-years. The study had 80% power to detect a relative risk of 2.3 (one-sided test, alpha = .05). The odds ratio of myocardial infarction in past OC users was not elevated. CONCLUSION: With respect to myocardial infarction, low-dose oral contraceptives can be used safely by women who lack risk factors for coronary heart disease.

Adolescent↗

PubMed1996

Migraine headache in a prepaid health plan: ascertainment, demographics, physiological, and behavioral factors.

BACKGROUND: Migraine is a prevalent disorder whose relationship to other conditions remains poorly understood. METHODS: Associations between migraine and physiological, behavioral, and demographic characteristics were assessed in a retrospective cohort study of 79,588 enrollees in a large prepaid health maintenance organization who underwent a multiphasic preventive health checkup in 1971-1973. RESULTS: Migraine was found to be inversely associated with age and education and strongly associated with the female sex. The likelihood of migraine was significantly higher among blacks, smokers, those who drink more than six cups of coffee per day, those with Raynaud's syndrome, and those with a family history of migraine. The magnitude of associations between migraine and other factors was, in general, reduced among those with a self-reported physician diagnosis of migraine compared to those whose migraine status was defined on the basis of reported symptoms. CONCLUSIONS: Migraine prevalence was found to be higher in blacks and other unspecified minorities than in the white population. The magnitude of the associations between migraine and behavioral risk factors was strongly influenced by the method of migraine ascertainment. The inverse association with level of education suggests that social causation or drift may have been operating in this disease in the early 1970s, 15 to 20 years earlier than recent population-based studies would suggest. Further research is needed to fully appreciate the spectrum of disease and behaviors associated with migraine.

Adolescent↗

PubMed1996

Differences in weight gain in relation to race, gender, age and education in young adults: the CARDIA Study. Coronary Artery Risk Development in Young Adults.

OBJECTIVE: To assess ethnic differences in weight gain in young adults. DESIGN: Five-year weight change was assessed in 4207 young adults initially aged 18-30 years at the CARDIA Study baseline examination (1985-1986). RESULTS: Weight gain was significantly (p < 0.0001) greater in black versus white men (13.2 versus 9.1 lb) and in black versus white women (13.2 versus 7.4 lb). Baseline weight and year-five weight in all race and gender groups were strongly associated, suggesting a high degree of tracking of adiposity during young adulthood. Greater weight gain was noted in participants reporting baseline education of high school or less versus college graduates in black women (14.4 versus 10.0 lb, p < 0.05), white women (10.2 versus 5.2 lb, p < 0.0001) and white men (10.2 versus 7.8 lb, p < 0.001). Significantly greater weight gain was observed in younger (18-24 years) versus older (25-30 years) men, but no age-related difference was seen in women. The racial differences in weight gain remained after adjustment for age and level of education. The above trends were confirmed for other measures of body size, i.e. body mass index and skinfold thickness. CONCLUSION: These data indicate that young adults are at high risk of weight gain, and that weight gain was greatest among African Americans and among less educated participants. These high-risk groups can be identified and targeted for primary prevention of adult obesity in addition to population wide efforts that will be required to counteract the secular trend of increased obesity observed in US adults.

Adolescent↗

PubMed1996

Low total serum cholesterol and intracerebral hemorrhagic stroke: is the association confined to elderly men? The Kaiser Permanente Medical Care Program.

BACKGROUND AND PURPOSE: Epidemiological studies indicate a higher incidence of intracerebral (but not subarachnoid) hemorrhagic stroke among persons with low total serum cholesterol levels. This report further examines the prospective relationship of total serum cholesterol with subsequent intracerebral hemorrhage in a large, well-defined population. METHODS: The cohort included 61756 enrollees in a health plan from the San Francisco-Oakland metropolitan area (46% men, 63% white), aged 40 to 89 years and free of cardiovascular disease at baseline. Sixteen-year incidence of combined nonfatal and fatal intracerebral hemorrhagic stroke (International Classification of Diseases [ICD], 8th revision, code 431, or ICD, 9th revision, codes 431 and 432) was investigated in relation to serum cholesterol measured in multiphasic health checkups made in 1977 through 1985. Intracerebral hemorrhagic events were ascertained using hospital discharge records and as underlying cause of death by the California Mortality Linkage Information System. RESULTS: From 1978 through 1993 (average of 10.7 years), there were 386 events (201 in men, 29% fatal; 185 in women, 42% fatal). By multivariate proportional hazards life-table regression analysis, serum cholesterol level below the sex-specific 10th percentile (< 4.62 mmol/L [178 mg/dL] in men), compared with higher cholesterol level, was associated with a significantly increased risk of intracerebral hemorrhage in men aged 65 years or older (relative risk, 2.7; 95% confidence interval, 1.4 to 5.0). An excess risk was also observed among elderly women at the lowest cholesterol range, but a chance finding could not be ruled out. No relationship was seen among men or women aged 40 to 64, and no statistical interaction of low serum cholesterol with hypertension was found in either sex. CONCLUSIONS: In these data, the association between low serum cholesterol level and intracerebral hemorrhage was confined to elderly men.

Adult↗

PubMed1996

Relationship of lipoproteins, apolipoproteins, triglycerides and lipid ratios to plasma total cholesterol in young adults: the CARDIA Study. Coronary Artery Risk Development in Young Adults.

OBJECTIVE: To characterize the association of carrier lipoproteins, apolipoproteins, triglycerides and various lipid ratios with total cholesterol in young adults. DESIGN: Cross-sectional data from the baseline examination (1985-1986) of The Coronary Artery Risk Development In Young Adults (CARDIA) Study, a multicenter investigation of a biracial cohort of 4941 men and women aged 18-30 years. METHODS: Multiple linear regression models to estimate mean levels of lipids and lipoproteins for each category of total cholesterol, stratified by race and sex and adjusted for age and education level. RESULTS: As expected, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), apolipoprotein B (ApoB), apolipoprotein A-1 (ApoA-1) and triglycerides increased linearly with the level of total cholesterol in all race-sex subgroups. The LDL-C/HDL-C, ApoB/ApoA-1 and LDL-C/ApoB ratio also increased with total cholesterol in all race-sex subgroups. The HDL-C/ApoA-1 ratio, indicative of cholesterol content per HDL particle, did not vary with total cholesterol except in white men, in whom it was slightly lower for those with high total cholesterol than those with low total cholesterol concentrations. White men showed higher triglyceride concentrations and lower HDL-C for any given total cholesterol strata. All these associations of lipoproteins, apolipoproteins and lipid ratios with total cholesterol were independent of body mass index, smoking status, fitness level and Keys score. CONCLUSIONS: Young adults with low total cholesterol have lipoprotein profiles characterized by low atherogenic potential. White men with high total cholesterol levels, compared with other groups, showed a lipid profile more conductive to atherogenesis.

Adolescent↗

PubMed1996

Racial discrimination and blood pressure: the CARDIA Study of young black and white adults.

OBJECTIVES: This study examined associations between blood pressure and self reported experiences of racial discrimination and responses to unfair treatment. METHODS: Survey data were collected in year 7 (1992/93) of the Coronary Artery Risk Development in Young Adults (CARDIA) study, a prospective multisite community-based investigation. Participants included 831 Black men, 1143 Black women, 1006 White men, and 1106 White women 25 to 37 years old. RESULTS: Systolic blood pressure among working-class Black adults reporting that they typically accepted unfair treatment and had experienced racial discrimination in none of seven situations was about 7 mm Hg higher than among those reporting that they challenged unfair treatment and experienced racial discrimination in one or two of the situations. Among professional Black adults, systolic blood pressure was 9 to 10 mm Hg lower among those reporting that they typically challenged unfair treatment and had not experienced racial discrimination. Black-White differences in blood pressure were substantially reduced by taking into account reported experiences of racial discrimination and responses to unfair treatment. CONCLUSIONS: Research on racial/ ethnic distributions of blood pressure should take into account how discrimination may harm health.

Adult↗

PubMed1996

Cocaine use and characteristics of young adult users from 1987 to 1992: the CARDIA Study. Coronary Artery Risk Development in Young Adults.

OBJECTIVES: This study examined the relationship of sociodemographic factors and use of substances other than cocaine to cocaine use from 1987 to 1992 in a cohort of Black and White men and women 20 to 32 years of age. METHODS: Data were collected as part of the Coronary Artery Risk Development in Young Adults study. Self-reported cocaine use was analyzed through chi-square tests and repeated measures analyses of variance to determine the bivariate and multivariate relationships of sociodemographics and substance use behaviors to cocaine use over the 5-year period. RESULTS: Cocaine use declined in Whites but remained stable in Blacks from 1987 to 1992. Cross-sectional results showed that use was related to being Black, male and in the older half of the cohort, single, and unemployed; it was also related to higher levels of other substance use in 1987 and 1992. Over time, the magnitude and strength of the relationship were consistent for each variable except for increased odds of cocaine use among the unemployed and Blacks in 1992. CONCLUSIONS: Sociodemographic characteristics and substance use behavior consistently identify individuals at risk for cocaine use. As a result, intervention programs should be targeted at these high-risk groups.

Adult↗