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PubMed2003

First-year mortality rates for selected birth defects, Hawaii, 1986-1999.

Birth defects have been the leading cause of infant death in the United States for over the last decade. However, there is little population-based data on the first-year mortality rates for many specific birth defects and the factors that may affect these mortality rates. This investigation examined the first-year mortality rates for 54 selected birth defects of various organ systems in Hawaii during 1986-1999 using data from a population-based birth defects registry and evaluated the impact of the presence of chromosomal abnormalities and other structural birth defects and the year of delivery on the mortality rates. Mortality rates varied widely by defect, being highest for anencephaly (100%), trisomy 13 (82%), and trisomy 18 (74%), while no first-year deaths were reported for glaucoma, bladder exstrophy, and persistent cloaca. The majority (36 of 54 or 67%) of the birth defects had a mortality rate of less than 25%. Among the 51 structural birth defects, 38 (75%) had higher first-year mortality rate for cases with chromosomal abnormalities and 42 (82%) had higher first-year mortality rates for cases with other major structural birth defects. The mortality rate among 1986-1992 deliveries was higher than the mortality rate among 1993-1999 deliveries for 37 (69%) of the 54 birth defects. This study indicates that first-year mortality rates vary widely by type of birth defect, although the mortality rate for the majority of birth defects is relatively low. The presence of a chromosomal abnormality or other structural birth defect increases the mortality rate, and mortality rates for the majority of birth defects have declined in Hawaii during the study period.

Congenital Abnormalities↗
PubMed2003

Epidemiology of triploidy in a population-based birth defects registry, Hawaii, 1986-1999.

Triploidy is a highly lethal chromosomal abnormality with few fetuses surviving to term. Triploidy has not been extensively studied using data from a population-based birth defect registry. This investigation examined the epidemiology of triploidy using data from the Hawaii Birth Defects Program (HBDP) and compared its findings with the literature. Of the 38 identified cases of triploidy delivered in Hawaii during 1986-1999, 31 (82%) were early fetal deaths, 3 (8%) late fetal deaths, and 4 (11%) elective terminations. The distribution of cases by sex chromosome combination was 15 (39%) XXX, 22 (58%) XXY, and 1 (3%) XYY. Triploidy was prenatally diagnosed in eight (21%) of the cases, of which four were electively terminated, two resulted in early fetal death, and two resulted in late fetal death. The detected triploidy prevalence in 1993-1999 was higher than the prevalence in 1986-1992, although the difference was not statistically significant (rate ratio (RR) 1.20, 95% confidence interval (CI) 0.73-1.86). The detected triploidy prevalence for maternal age of 35 years or greater was significantly higher than the prevalence for maternal age less than 35 years (RR 4.07, 95% CI 2.22-6.83). In spite of under detection of cases, many aspects of the epidemiology of triploidy identified in a population-based birth defects registry were consistent with that reported in the literature.

Congenital Abnormalities↗
PubMed2006

Descriptive epidemiology of anophthalmia and microphthalmia, Hawaii, 1986-2001.

BACKGROUND: Population-based epidemiologic data on anophthalmia and microphthalmia in the United States are limited and have come mainly from only a few states. The intent of this study was to report on the epidemiology of these eye defects. METHODS: Cases were derived from a population-based birth defects registry in Hawaii and comprised all infants and fetuses with anophthalmia and microphthalmia who were delivered during 1986-2001. Anophthalmia and microphthalmia rates per 10,000 births were determined for selected factors, and comparisons were made by calculating the rate ratios and 95% confidence intervals (CIs). RESULTS: Ninety-six cases of anophthalmia and microphthalmia were identified, with a rate of 3.21 per 10,000 live births. The eye defects were isolated in 5 cases (5.2%), and 24 cases (25.0%) had confirmed chromosomal abnormalities. The risk of anophthalmia and microphthalmia varied over time and was significantly higher for live-born infants with low birth weights and gestational ages. The anophthalmia and microphthalmia rates also varied by maternal race/ethnicity, sex, and plurality, although these differences were not statistically significant. CONCLUSIONS: Anophthalmia and microphthalmia frequently occurred with other birth defects, and the rate was consistent with that found in the literature. The risk of defects differed significantly with time period, birth weight, and gestational age. The impact of many factors on anophthalmia and microphthalmia in Hawaii was frequently consistent with that reported elsewhere.

Abnormalities, Multiple↗
PubMed1984

Complete hydatidiform mole in Hawaii: an epidemiological study.

An analysis of hydatidiform moles occurring in Hawaii over a 14-year period (1968-1981) was undertaken. The pathology of all 278 reported molar pregnancies was reviewed and showed 69.4% to be complete, 24.5% to be partial, and 6.1% to be nonmolar. A case-control epidemiological investigation of the complete moles showed maternal age and race to be important, moles being significantly more prevalent in women under 20 and over 40 yr of age and also in women of Japanese, Filipino, and other Oriental ancestry. However no difference was seen in the prevalence of moles between Oriental women born in the Orient and those born and raised in Hawaii. No significant difference was found in paternal age, paternal race, socioeconomic status, or reproductive history, suggesting that these factors do not play an important role in the etiology of complete hydatidiform mole. Incidence rates for complete moles were calculated taking age and race into consideration and ranged from a high of 1 in 150 to a low of 1 in 2,000 naturally terminating pregnancies.

Adolescent↗
PubMed1981

Differences in lung cancer risk from smoking among Japanese, Chinese and Hawaiian women in Hawaii.

The age-adjusted lung cancer incidence rates among Japanese, Chinese and Hawaiian women in Hawaii do not correlate to their respective cigarette smoking exposures. We conducted a case-control study to determine the lung cancer risk associated with smoking among these three ethnic groups of women by reviewing the medical records of 176 Japanese, 67 Chinese and 132 Hawaiian lung cancer patients diagnosed from 1968 to 1978. Smoking histories, as well as socioeconomic indexes, for these cases were compared to those of 2,404 sex- and race-matched controls from the general population. Controlling for age and socioeconomic index, we found that lung cancer risk associated with smoking was greatest for Hawaiian (O.R.=10.5), less for Japanese (O.R.=4.9) and least for Chinese women (O.R.=1.8). While smoking was associated with a significant increase in lung cancer risk for all histologies among Japanese and Hawaiian woman, the risk was much greater for epidermoid and small-cell types than for adenocarcinoma. Among Chinese women, epidermoid and small-cell lung cancer were the only histologies showing a significant association with smoking. There was some suggestion that increased lung cancer risk was associated with a higher socioeconomic index after controlling for age and smoking, at least among Japanese born in Japan and Hawaiians with adenocarcinoma. The population risk for lung cancer attributable to smoking was found to be 79% for Hawaiian women, but only 44% for Japanese and merely 11% for Chinese women. Thus, we concluded that the majority of lung cancer occurring in Japanese and particularly Chinese women in Hawaii is due to factors other than cigarette smoking.

Adult↗
PubMed2002

Descriptive epidemiology of anal atresia in Hawaii, 1986-1999.

BACKGROUND: Anal atresia is one of the more common birth defects affecting the gastrointestinal tract. This study examined the relationship between anal atresia and selected demographic and clinical factors in Hawaii. METHODS: Data were obtained from a population-based birth defects registry and included all cases of anal atresia identified in Hawaii among 1986-1999 deliveries. RESULTS: There were 124 cases of anal atresia, resulting in a rate of 4.38 per 10,000 live births and fetal deaths (95% confidence interval (CI) 3.65-5.23). Cases consisted of 115 (92.7%) live births, 6 (4.8%) fetal deaths, and 3 (2.4%) elective terminations. Chromosomal abnormalities were reported for 10 (8.1%) of the cases, 7 of which were trisomy 21. Family history of anal atresia was reported for 3 (2.4%) of the cases. No secular trend in anal atresia rates was identified (p=0.617). Risk of anal atresia was highest for the 25-29-year maternal age group and lower among younger and older maternal age groups. Risk for anal atresia was lower for females (relative risk (RR) 0.69 95% CI 0.51-0.91) and higher for live births with a birth weight less than 3,000 grams (RR 2.75, 95% CI 2.08-3.56) or less than 38 weeks' gestation (RR 3.90, 95% CI 2.88-5.15) and for multiple births (RR 3.34, 95% CI 1.44-6.57). Anal atresia rates did not vary significantly by maternal race/ethnicity, residence at delivery, gravidity, or prenatal care. CONCLUSIONS: Anal atresia risk was associated with maternal age, infant/fetus sex, birth weight, gestational age, and plurality but not maternal race/ethnicity, residence at delivery, gravidity, or prenatal care. Except for maternal age, these findings are consistent with the literature.

Anus, Imperforate↗
PubMed1992

Comparative study of prostatic carcinoma bone metastasis among Japanese in Japan and Japanese Americans and whites in Hawaii.

Metastatic prostate carcinomas in autopsy cases from three populations 49 cases of indigenous Japanese, 29 cases of Japanese Americans and 14 from whites in Hawaii) were compared in terms of their clinicopathological, immunohistochemical (tenascin and ras p21) and lectin binding (Helix Pomatia antigen, HPA) properties. Only the clinicopathological features were analyzed in the cases of whites in Hawaii. The results indicate that poorly differentiated carcinoma is less common, whereas distant metastasis is more frequent, in indigenous Japanese. Some of the Japanese-American cases with poorly differentiated carcinomas did not show any distant metastases. HPA and ras p21 expression are more common, but tenascin is less common in indigenous Japanese. HPA expression is more common in cases with metastasis, especially with metastasis to the bone and other organs, than nonmetastatic cases. Prostatic cancer cases in indigenous Japanese were more aggressive biologically than those in Japanese Americans, but no phenotypic differences were seen relevant to the presence or absence of bone metastases.

Aged↗
PubMed1992

Attributable risk of breast, prostate, and lung cancer in Hawaii due to saturated fat.

The dietary data from case-control studies of breast, prostate, and lung cancer in Hawaii revealed that saturated fat was a risk factor for these malignancies. The dietary intakes from the three studies were used to calculate the attributable risk (AR) due to saturated fat. For all ethnic groups combined, the ARs for the highest quartiles of intake were 14.9 percent for female breast cancer, 13.0 percent for prostate cancer, and 23.1 percent for male lung cancer. Our results suggested that a reduction of saturated fat to the lowest quartiles of intake could result in a 10 to 20 percent decrease in risk for these three cancers in Hawaii. We also examined the ethnic-specific risks associated with saturated fat consumption among the Japanese and the Caucasians in the three studies. The ARs for the highest quartiles of intake were notably higher among the Caucasians than the Japanese, primarily due to the difference in their dietary patterns. Although the calculated AR due to saturated fat was higher among the Caucasians than among the Japanese, all persons in the population would derive considerable benefit by reducing their intake of this nutrient.

Adult↗
PubMed1990

An epidemiologic study of thyroid cancer in Hawaii.

A population-based case-control interview study was designed to test the hypothesis that dietary iodine or the consumption of goitrogenic vegetables increases the risk of thyroid cancer. A total of 191 histologically confirmed cases (64 percent female) and 441 matched controls from five ethnic groups in Hawaii were available for analysis. Among women, intake of seafood (especially shellfish), harm ha (a fermented fish sauce), and dietary iodine were associated with an increased risk of cancer, whereas consumption of goitrogenic (primarily cruciferous) vegetables was associated with a decreased risk. Non-dietary risk factors included miscarriage (especially at first pregnancy), use of fertility drugs, family history of thyroid disease, obesity, and work as a farm laborer. The odds ratio for the combined effect of a high iodine intake and a first-pregnancy miscarriage was 4.8 (95 percent confidence interval [CI] = 1.2-19.2); and for high iodine intake and use of fertility drugs 7.3 (95 percent CI = 1.5-34.5). Among men, positive associations were found for obesity, work as a farm laborer, and a past history of benign thyroid disease. Although this study identified several dietary and non-dietary risk factors for thyroid cancer, it could not fully explain the exceptionally high incidence rates among Filipino women in Hawaii.

Adult↗
PubMed1983

Trends of coronary heart disease among men of Japanese ancestry in Hawaii.

The 15-year prospective study of cardiovascular disease among a cohort of Japanese men in Hawaii provided an opportunity to examine the temporal trends of coronary heart disease (CHD) incidence and mortality rates and to compare them with Hawaii State CHD mortality rates. The State mortality records showed a decline in CHD mortality from 1968 to 1978 which was similar to the national trends. For more than 11,000 men of Japanese ancestry under surveillance, there was no evidence of declining rates for either CHD deaths or for total CHD incidence. There was also no change in case-fatality rates during this time. An explanation for these differences could not be provided but there was a suggestion that it involved changes in classification of some groups of cardiovascular disease and stroke.

Adult↗
PubMed2003

A first look at platinum in road-deposited sediments and roadside soils, Honolulu, Oahu, Hawaii.

Platinum (Pt) has become globally distributed by anthropogenic inputs, primarily from automobile emissions resulting from degradation of catalytic converters. These inputs are greatest in urban areas, with the major sinks being road sediments and roadside soils. Limited data are available on the distribution of Pt in the environment. No data for Pt in road-deposited sediments are presently available from the United States, and only a few studies offer a limited perspective of Pt in urban soils in the United States. This investigation represents the first study in the United States to characterize Pt concentrations and enrichment ratios in both road sediments and roadside soils in an urban (nonindustrialized) basin in Honolulu, Hawaii. Two independent analytical techniques-cathodic stripping voltammetry and lead-fire assay followed by ICP-AES-were used to quantify Pt in environmental media. Data from 10 road sediments confirm Pt contamination, with a median concentration of 33 ng g(-1) and a range of 15-160 ng g(-1). Upper soil horizons in roadside areas also exhibited contamination, with a median Pt value of 14 ng g(-1) (range 2-160 ng g(-1)), but significantly lower than road sediments. Computation of robust enrichment ratios using baseline soil, geology, and tree bark data indicated that road sediments had a median Pt enrichment of 9 (range 4-46), upper soil horizons a median of 4, and lower horizons 1.1. The latter were not found to differ significantly from Pt baseline concentrations. However, several roadside sites exhibited significant enrichment with depth, which may indicate potential Pt mobility in this environment. These data support a substantial loading of Pt in the urban environment of Hawaii. Further work is required to characterize the distribution of other autocatalyst-associated noble metals palladium (Pd) and rhodium (Rh) in the environment.

Cities↗
PubMed2005

Genetic diversity of Frankia microsymbionts from the relict species Myrica faya (Ait.) and Myrica rivas-martinezii (S.) in Canary Islands and Hawaii.

In the Western Canary Islands, Myrica faya and Myrica rivas-martinezii (Myricaceae) are phylogenetically close, endemic, actinorhizal species presumed to be remnants either of the European or the African Tertiary floras. Unisolated Frankia strains from field-collected nodules on Tenerife, Gomera, and La Palma Islands were compared by their rrs gene and 16S-23S intergenic spacer (IGS) restriction patterns. To compare the genetic diversity of Frankia strains from within and outside the host's native range, nodules of M. faya field plants were collected both in Canary Islands and in Hawaii, where this species is an exotic invasive. Myrica rivas-martinezii, endemic to the Canary Islands, was sparsely nodulated in the field. Frankia strains harbored in field-collected nodules of M. faya and M. rivas-martinezii belonged to the Elaeagnaceae strains' genetic cluster and exhibited a high degree of diversity. Frankia genotypes were specific to each host species. In the Canary archipelago, we found no relationship between site of collection and Frankia genotype for M. faya. The only exceptions were strains from site 2 in Tenerife, a location with a geological history different from the other sites sampled. Hawaiian and Canarian M. faya strains had no genotypes in common, raising questions concerning the origin of M. faya-infective Frankia in Hawaii. Nodular strains of M. rivas-martinezii from nursery plants were genetically characterized and shown to be divergent from the strains of field-collected nodules and belong to the Alnus-Casuarina strains cluster. This suggests Myrica may have the potential to nodulate with a broader range of Frankia genotypes under artificial conditions than has been detected in field-collected nodules.

Atlantic Islands↗
PubMed1975

Viral gastroenteritis induced by the Hawaii agent. Jejunal histopathology and serologic response.

Peroral jejunal biopsies were performed in seven normal volunteer subjects prior to, 48 hours after and two weeks after the administration of the Hawaii agent of viral gastroenteritis. Light and electron microscopic examination revealed an intact mucosa with blunted villi, shortened and distorted microvilli, swollen mitochondria and intercellular edema. These histologic changes were seen only in acutely ill volunteer subjects and were absent two weeks after illness in three of four who were previously ill. This reversible lesion was similar to, but not identical with, that previously described in viral gastroenteritis induced by the Norwalk agent. Serum antibody increases in response to the Hawaii agent as measured by immune electron microscopy were present in three of four ill volunteer subjects and in none of three who remained well.

Acute Disease↗
PubMed1994

Reflections on national health care reform based on Hawaii's experience.

In 1974, Hawaii began addressing the problem of health care accessibility. As a result of legislative action, near universal health care coverage has been achieved. These include employer mandates to provide adequate health insurance, regulation of insurance products, control of costly health care facilities, and government assistance to those not provided health insurance through employment. By providing primary care, total health care costs are considerably below national average--even though actual cost of living is over 30% greater. Public health statistics suggest a healthier population than the national average. This cannot be attributed to a healthy or relaxed lifestyle or ethnic mix, but rather to the state health care system itself. Economically and culturally, Hawaii closely resembles the rest of the United States, and there has been no evidence of reduced employment due to the aforementioned employer mandate.

Hawaii↗
PubMed1989

Relative impact of smoking and reduced pulmonary function on peptic ulcer risk. A prospective study of Japanese men in Hawaii.

The aim of this study was to determine whether reduced pulmonary function is an independent risk factor for peptic ulcer. Among 5933 Japanese men studied in Hawaii, 243 developed gastric ulcers and 99 developed duodenal ulcers 20 yr after an examination completed in 1968. The examination included measurement of forced expiratory volume in 1 s and a detailed smoking history. The percent predicted forced expiratory volume was significantly and inversely related to ulcer incidence, but not after adjustment for smoking or among those who had never smoked. Cigarettes were associated with increased ulcer risk in both stomach and duodenum but showed a dose-response in pack years only for gastric ulcer. We conclude that the association of reduced pulmonary function with peptic ulcer in the Japanese in Hawaii is largely attributable to smoking and that smoking is more strongly related to gastric than duodenal ulcer. The especially strong link between cigarettes and gastric ulcer suggests that decreased smoking or synchronous decrease in cigarette tar content may have contributed to the recent unexplained decrease in male gastric ulcer.

Asian↗
PubMed1987

Time trends in characteristics at diagnosis and subsequent survival for Caucasian, Japanese and Hawaiian women with breast cancer in Hawaii.

This study examines whether the improvement in breast cancer survival in Hawaii suggested by an earlier analysis might be explained by concomitant temporal variations in prognostic factors. Characteristics at diagnosis and survival experience were compared for 1251 Caucasian, 1015 Japanese and 505 Hawaiian women diagnosed with invasive breast carcinoma during 1960-1979 and followed until the end of 1982. Time-trends were present for the patients' stage at diagnosis, age and socioeconomic status. A multivariate analysis using the Cox proportional hazards regression model revealed that adjustment for temporal variations in stage and age at diagnosis yielded a positive survival trend of a greater magnitude than that observed without adjustment, indicating that multivariate methods should be considered in time-trend analyses of cancer survival. Further analysis revealed that such improvement in breast cancer survival occurred for certain race-stage groups of patients only. Possible reasons for these trends in breast cancer prognostic factors and survival are discussed, along with potential biases. The data suggest that early detection might explain most of the survival improvement in Hawaii during the period of the study.

Adult↗
PubMed1995

Nonmelanoma skin cancer in Japanese ethnic Hawaiians in Kauai, Hawaii: an incidence report.

BACKGROUND: Incidence reports of nonmelanoma skin cancer (NMSC) in Japanese persons are limited. Most studies have relied primarily on hospital records or voluntary reporting systems. OBJECTIVE: Our purpose was to determine the incidence of basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and Bowen's disease (BD) in a defined Japanese population. METHODS: A prospective 5-year population-based incidence study was conducted on the island of Kauai, Hawaii from 1983 through 1987. RESULTS: Thirty Japanese Kauai residents, 12 men and 18 women, developed BCC during the 5-year study period. At the same time, 24 Japanese, 6 men and 18 women, were identified with SCC, and 11 had BD, three men and eight women. When standardized to the Japanese population in Japan, the annual BCC incidence rate was 30 per 100,000 Japanese Kauai residents with an average patient age of 75 years. More than 80% of these BCCs were localized to the head and neck. New BCCs developed in four patients with BCC, but none was a recurrence of a previously treated lesion. Five patients with BCC had SCC or BD concurrently or at other times. The SCC incidence was 23 per 100,000 Japanese Kauai residents with an average patient age of 80 years. The head and neck were again the most common anatomic sites. New SCCs subsequently occurred in two patients, in one of whom a localized recurrence also developed. Five patients with SCC had BCC simultaneously or at other times. The incidence of BD was 13 per 100,000 Japanese Kauai residents with an average patient age of 74 years. The extremities were the most common anatomic sites. One patient later had a new BD lesion and a recurrent BD lesion. Two patients had BCC or SCC at other times. CONCLUSION: We report incidence rates of BCC, SCC, and BD at least 45 times higher in the Japanese population in Kauai, Hawaii than rates for the Japanese population in Japan. Kauai's intense UV radiation and emphasis on outdoor activities may contribute. More Japanese women had NMSC than men, a sex difference not observed in Japan.

Aged↗
PubMed1993

Geographic patterns of low birth weight in Hawaii.

This study examines areal variations in low birth weight, using the census tract as the unit of analysis. Reports from the 1980 U.S. census were used to develop summary indicators of environmental and socio-economic conditions, including poverty, employment, education and crowding, for 155 census tracts in the state of Hawaii. Maternal socio-demographic, prenatal care utilization, and medical risk indicators and low birth weight percentages for resident, single live births were extracted from the Hawaii 1979-1987 vital record live birth files and aggregated by census tract. Multiple regression analysis was used to develop a model that predicted 61% of the variation among census tracts in the percentage of low birth weight. Patterns of low birth weight were primarily associated with ethnic patterns of maternal residence and single marital status. There was no association between inadequate prenatal care and low birth weight at the census tract level.

Adolescent↗