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Reduction of sample heterogeneity through use of population substructure: an example from a population of African American families with sarcoidosis.

Sarcoidosis is a granulomatous inflammatory disorder of complex etiology with significant linkage to chromosome 5, and marginal linkage was observed to five other chromosomes in African Americans (AAs) in our previously published genome scan. Because genetic factors underlying complex disease are often population specific, genetic analysis of samples with diverse ancestry (i.e., ethnic confounding) can lead to loss of power. Ethnic confounding is often addressed by stratifying on self-reported race, a controversial and less-than-perfect construct. Here, we propose linkage analysis stratified by genetically determined ancestry as an alternative approach for reducing ethnic confounding. Using data from the 380 microsatellite markers genotyped in the aforementioned genome scan, we clustered AA families into subpopulations on the basis of ancestry similarity. Evidence of two genetically distinct groups was found: subpopulation one (S1) comprised 219 of the 229 families, subpopulation two (S2) consisted of six families (the remaining four families were a mixture). Stratified linkage results suggest that only the S1 families contributed to previously identified linkage signals at 1p22, 3p21-14, 11p15, and 17q21 and that only the S2 families contributed to those found at 5p15-13 and 20q13. Signals on 2p25, 5q11, 5q35, and 9q34 remained significant in both subpopulations, and evidence of a new susceptibility locus at 2q37 was found in S2. These results demonstrate the usefulness of stratifying on genetically determined ancestry, to create genetically homogeneous subsets--more reliable and less controversial than race-stratified subsets--in which to identify genetic factors. Our findings support the presence of sarcoidosis-susceptibility genes in regions identified elsewhere but indicate that these genes are likely to be ancestry specific.

Black or African American↗

Revisiting mortality predictability of serum albumin in the dialysis population: time dependency, longitudinal changes and population-attributable fraction.

BACKGROUND: Hypoalbuminaemia is a marker of malnutrition-inflammation complex syndrome (MICS) and a strong predictor of cardiovascular (CV) death in maintenance haemodialysis (MHD) patients. However, serum albumin may change over time. Hence, its time-varying associations with outcome may be different. METHODS: Associations between 3-month averaged serum albumin levels, measured in a single laboratory using bromocresol green, and CV mortality were studied longitudinally in a 2-year cohort of 58,058 MHD patients. Mortality predictability of fixed baseline and trimonthly-varying serum albumin concentrations were compared. RESULTS: Hazard ratios (HRs) of CV death strictly increased across decrements of baseline serum albumin, whereas the HR for time-varying serum albumin decrements below 3.8 g/dl did not differ. A drop in serum albumin in the first 6 months was associated with increasing all-cause and CV death risks in the subsequent 18 months, while a rise in serum albumin was a predictor of better survival independent of baseline serum albumin. The multivariate adjusted population-attributable fraction of death due to baseline serum albumin <3.8 g/dl was 19%. CONCLUSIONS: Time-varying hypoalbuminaemia predicts all-cause and CV death differently from fixed measures of serum albumin in MHD patients. An increase in serum albumin over time is associated with better survival independent of baseline serum albumin or other MICS surrogates. If this association is causal, an intervention that could increase serum albumin >3.8 g/dl might reduce the number of MHD deaths in the USA by approximately 10,000 annually. Nutritional interventions examining benefits of increasing serum albumin in MHD patients are urgently needed.

Aged↗

Evaluation of three population-based strategies for fracture prevention: results of the osteoporosis population-based risk assessment (OPRA) trial.

BACKGROUND: The integration of bone density testing into well-designed fracture prevention programs that can be applied in populations has not been studied. OBJECTIVES: We sought to compare the outcomes of 3 strategies for allocating bone density testing within an HMO-based fracture prevention program. RESEARCH DESIGN: Women were randomly sampled and allocated to one of 3 groups: (1) a universal group, in which all were offered bone mineral density (BMD) testing (1986 contacted; 415 participated); 2) the SCORE group, in which women scoring > or = 7 on the SCORE questionnaire were invited for BMD testing (1940 contacted; 576 participated); and (3) the Study of Osteoporotic Fracture (SOF)-based group, in which women with > or = 5 hip fracture risk factors were invited for BMD testing (5342 contacted; 2176 participated). SUBJECTS: Women aged 60-80 not taking hormone therapy or osteoporosis medication were included. MEASURES: Outcomes ascertained during 33 months of follow-up in all women contacted included initiation of osteoporosis treatment and hip and total fracture rates. Outcomes evaluated among all participants included changes in fracture risk factors, osteoporosis knowledge, and satisfaction with the program. RESULTS: Osteoporosis treatment rates did not differ among all women contacted but were slightly higher among trial participants in the universal and SCORE groups (21.1% and 20.2%, respectively; versus 16.7% in the SOF-based group (P value versus universal = 0.04). Among all women contacted, fracture rates were lowest in the universal group (74.11/1000) and differed significantly compared with the SCORE (99.44/1000; P = 0.009) and SOF-based groups (91.77/1000;P = 0.02). Knowledge about osteoporosis risk factors was highest in the universal group and lowest in the SOF-based group (P < 0.01). CONCLUSIONS: The degree to which BMD testing was offered to women in a fracture prevention program significantly affected total fracture rates, change in some fracture risk factors, and knowledge about risk factors.

Aged↗

The SCORE risk model applied to recent population surveys in Norway compared to observed mortality in the general population.

AIMS: To compare the predictions of the Systematic Coronary Risk Evaluation (SCORE) high- and low-risk functions applied to a recent population study with observed cardiovascular disease (CVD) mortality estimated from annual official mortality statistics in Norway. METHODS: Data were obtained from large epidemiological surveys conducted in five Norwegian counties in 2000-2003. RESULTS: A total of 32 251 men and women were investigated (aged 30-31, 40-41, 45-46, and 59-61). For men aged >or=59, more than 75% qualified for preventive treatment by having a 10-year risk >or=5%. Few women and practically no men younger than 46 years can be considered at high risk according to the SCORE risk prediction models. For men, the high-risk function overestimated and the low-risk model underestimated the CVD mortality as compared to the 10-year risks calculated from official mortality statistics (1999-2003). For women, however, both functions underestimated mortality in young individuals, whereas in the elderly an overestimation was observed. CONCLUSIONS: The risk predictions depended strongly on age and gender. The SCORE high-risk function overestimates the risk of fatal CVD for men in Norway, and before implementation in clinical practice, proper adjustments to national levels are required.

Adult↗

W4(4a) and W6(4b) in diverse human populations. Demonstration of their genetic identity in population and segregation studies.

The status of the W4, W6 system as related to the HL-A system was re-evaluated by means of segregation and mating studies in 200 Dutch families with 755 children. Inclusion analyses were performed on the Fifth Workshop human populations and related to a reference analysis on the main file in Leiden. The results of the mating and segregation analyses showed a good fit for W4 and W6 as a genetic system. The inclusion analyses showed a high degree of concordance. Based on those results, and other cited evidence, it was suggested that W4 and W6 may represent the basic substance of the HL-A antigens in the FOUR series.

Adult↗

The 4G/4G PAI-1 genotype is associated with elevated plasma PAI-1 levels regardless of variables of the metabolic syndrome and smoking status. A population-based study in Spanish population.

Reported data about the effect of the 4G/5G PAI-1 polymorphism on plasma PAI-1 levels are controversial. This study was designed to determine the relative effect of the 4G/5G PAI-1 polymorphism on high plasma PAI-1 levels after adjustment for metabolic syndrome - related variables, and to test if this effect is modified by the smoking status. Six hundred and thirty one unrelated subjects (292 men; 35-74 years), from a cross-sectional population-based epidemiological survey in the province of Segovia (Spain) were studied. The higher frequency of high PAI-1 levels was found in 4G/4G subjects (5G/5G 19.4%, 4G/5G 21.6%, 4G/4G 33.7%, p = 0.003). A multiple regression model, adjusted for gender, age, BMI, waist circumference, triglycerides, HDL-cholesterol, HOMA IR and leptin, showed this adjOR: 4G/4G vs 5G/5G: 2.22, p = 0.008. When smoking status - 4G/5G PAI-1 interaction was included as an independent variable these results were not modified. Our results indicate that the 4G/4G PAI-1 genotype might be strongly associated with high PAI-1 levels regardless of metabolic syndrome-related variables and smoking status.

Adult↗

Relationship between dose and serum concentrations of carbamazepine, phenytoin, phenobarbital, and primidone in a Sri Lankan population compared with a European population.

Concentrations of carbamazepine, phenytoin, phenobarbital, and primidone have been measured by high pressure liquid chromatography (HPLC) in serums of 177 Sri Lankan epileptic patients. Relationships between concentrations and dose per kg body weight of these drugs have been compared with those of patients in the Netherlands, using a matching procedure. Although variabilities in dose-concentration ratios were somewhat larger in Sri Lanka than in the Netherlands, no evidence was found of a systematic difference in pharmacokinetics between both populations.

Adolescent↗

Variation of population release kinetics in polydisperse multiparticulate systems (microcapsules, microspheres, droplets, cells) with heterogeneity of one, two or three parameters in the population of individuals.

Release kinetics of active substances from ensembles of microparticles such as microcapsules, cells, droplets and liposomes constituted of individual entities releasing their contents at constant rates may follow zero order, first order, sigmoid or biphasic equations. The release equation observed depends upon the statistical distribution of release-determining parameters among the population. Typical cases are presented in terms of the distribution of two parameters, payload (m infinity) and time for complete payload release (t infinity) which also define the release rate constant (k). Heterogeneity of the two parameters generally leads to first order ensemble behaviour, whereas heterogeneity of one parameter only may lead to different ensemble release equations, viz. zero order (m infinity heterogeneous) or first order (t infinity heterogeneous). Biphasic distribution can lead to an apparent 'burst' effect, with apparent change of kinetics. The presence of a third heterogeneous parameter, lag time, yields a sigmoid ensemble release curve. These conclusions are demonstrated by simulations or experimentally, and are also valid for linearized curves of microparticles following matrix kinetics.

Capsules↗

Health, population, and economic development. International health programs have an important role in promoting economic development and population control.

Health as a basic human value is particularly important to people in the developing world. Rates of economic development lower than had been hoped for and ever more steeply rising population growth have precipitated a reaction against public health programs. Among economists, agriculturalists, and even health professionals the philosophy arose that one should "hold back" on using modern weapons against disease because they are "too effective." To satisfy the recognized popular demand, simple and relatively ineffective measures of curative medicine could be substituted. It was said that the emphasis should be, instead, on agriculture, community development, education, and industrialization and that family planning should be pushed as a separate program. Documentation presented here sharply challenges such a point of view. No segment of the total development process can be effective without the other sectors.

Demography↗

Measuring social class differences in cancer patient survival: is it necessary to control for social class differences in general population mortality? A Finnish population-based study.

STUDY OBJECTIVES: Estimation of cancer patient survival by social class has been performed using observed, corrected (cause specific), and relative (with expected survival based on the national population) survival rates. Each of these measures are potentially biased and the optimal method is to calculate relative survival rates using social class specific death rates to estimate expected survival. This study determined the degree to which the choice of survival measure affects the estimation of social class differences in cancer patient survival. SETTING AND PARTICIPANTS: All Finnish residents diagnosed with at least one of 10 common malignant neoplasms during the period 1977-1985 were identified from the Finnish Cancer Registry and followed up for deaths to the end of 1992. DESIGN: Survival rates were calculated by site, sex, and age at 5, 10, and 15 years subsequent to diagnosis for each of three measures of survival; relative survival, corrected (cause specific) survival, and relative survival adjusted for social class differences in general mortality. Regression models were fitted to each set of rates for the first five years of follow up. MAIN RESULTS: The degree of variation in relative survival resulting from social class decreased, although did not disappear, after controlling for social class differences in general mortality. The results obtained using corrected survival were close to those obtained using relative survival with a social class correction. The differences between the three measures were largest when the proportion of deaths from other causes was large, for example, in cancers with high survival, among older patients, and for longer follow up times. CONCLUSIONS: Although each of the three measures gave comparable results, it is recommended that relative survival rates are used with expected survival adjusted for social class when studying social class variation in cancer patient survival. If this is not an available option, it is recommended that corrected survival rates are used. Relative survival rates without the social class correction overestimate social class differences and should be used with caution.

Adolescent↗

A population perspective to evidence based medicine: "evidence for population health".

We explore the notion that the public health community could learn lessons from the success of evidence based medicine (EBM) and develop a public health counterpart called "Evidence for Population Health". While EBM focuses on individual patients, its public health counterpart would aim to improve the health of communities effectively and efficiently.

Data Collection↗

Population genetic comparisons among eight populations using allele frequency and sequence data from three microsatellite loci.

Eight different population samples (Moroccans, Ovambos, Papuans, Australian aborigines, Germans, Turks, Japanese and Chinese) were studied using the tetranucleotide short tandem repeat systems HumTHO1 (THO1), Hum VWFA31 (VWA) and HumACTBP2 (ACTBP2). Ten alleles were differentiated in THO1, 11 alleles in VWA and 28 alleles in ACTBP2. THO1 showed 1 bp deletions in the repeat region, VWA sequence and structure variations of the 4-bp repeat motif and ACTBP2 sequence, structure and length variations in the repeat array and deletions/insertions (1-6 bp) in the flanking regions. A phylogenetic tree was constructed (UPGMA method) leading to branches which grouped Germans and Turks, Japanese and Chinese, and Papuans and Australian aborigines.

Asian People↗

The UCLA population studies of chronic obstructive respiratory disease. VIII. Effects of smoking cessation on lung function: a prospective study of a free-living population.

We evaluated effects of smoking cessation on lung function and respiratory symptoms of residents 25 to 64 yr of age from 3 communities in the Los Angeles area who completed a detailed respiratory questionnaire and measurements of forced expired volumes and flow rates, closing volume, and closing capacity at 2 times (T1 and T2) 5 yr apart. Results were analyzed in 2,401 participants who fit into 4 smoking categories: never smokers (414 males, 737 females); former smokers (294 males; 172 females); quitters between T1 and T2 (106 males, 62 females); and continuing smokers (278 males, 338 females). Covariance analysis was used to determine differences in lung function across smoking categories at T1 and T2 (adjusted for T1 values) and differences in decline in lung function between T1 and T2. Chi-square analysis was used to compare continuing smokers and quitters with respect to changes in respiratory symptoms. In this population, smoking at T1 was associated with impairment in all indexes of lung function evaluated. Smoking cessation led to significant improvement in symptoms of cough, wheeze, and phlegm production, and to significantly less decline in indexes of small airway function during 5 yr compared with measurements in continuing smokers. However, at T2, lung function still was lower among quitters compared with former and never smokers. Forced expiratory volume in one second (FEV1) was marginally improved in women who quit compared with those who continued to smoke.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Population science is science only if you know the population.

BACKGROUND: Cancer control efforts have had limited effect in reducing the inequities for minorities and the medically underserved. One factor is the lack of theory-based conceptualization of the terms used to define race, ethnicity, and culture. METHOD: Guidelines are provided to develop more accurate use of the terms race, ethnicity, and culture to determine standards of comparability across studies of cancer incidence, survival, and quality of life in diverse populations rather than stereotypes. RESULTS AND CONCLUSIONS: Our ability to use theoretically based criteria to differentiate groups of people could increase our ability to more effectively eliminate these disparities.

Biomedical Research↗

The prevalence of the metabolic syndrome in a danish population of women with previous gestational diabetes mellitus is three-fold higher than in the general population.

CONTEXT: Diabetes and obesity, components of the metabolic syndrome, are common characteristics of women with prior gestational diabetes mellitus (GDM). Due to increasing incidence of diabetes and obesity, the metabolic syndrome might comprise a major health problem among these women. OBJECTIVE: The objective was to estimate the prevalence of the metabolic syndrome by three different criteria [World Health Organization 1999 (WHO), The National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults 2001, and European Group for the Study of Insulin Resistance 2002] among women with previous GDM. DESIGN: We conducted a follow-up study of a Danish cohort of women admitted in 1978-1996 to the Diabetes and Pregnancy Center, Rigshospitalet, Copenhagen University Hospital, with diet-treated GDM. The follow-up took place in 2000-2002 at median 9.8 yr (interquartile range 6.4-17.2) after pregnancy. Results were compared with a control group of 1000 age-matched women from a population-based sample (Inter99). PARTICIPANTS: Four hundred eighty-one women at median age 43 yr (interquartile range 38-48) participated. MAIN OUTCOME MEASURES: The main outcome measures were body mass index (BMI), glucose tolerance, blood pressure, lipid profile, and insulin resistance. RESULTS: Independent of the criteria, the prevalence of the metabolic syndrome was three times higher in the prior GDM group, compared with the control group (e.g. WHO: 38.4 vs. 13.4%, P < 0.0005). Age- and BMI-adjusted odds ratio for having the WHO-defined metabolic syndrome was 3.4 (95% confidence interval 2.5-4.8) for the prior GDM group vs. the control group. Obese women (BMI > 30 kg/m(2)) with previous GDM had a more than 7-fold increased prevalence of the metabolic syndrome (WHO), compared with normal-weight prior GDM women (BMI < 25 kg/m(2)). In glucose-tolerant women, the prevalence was doubled in the prior GDM group, compared with control group. CONCLUSION: The prevalence of the metabolic syndrome was three times as high in women with prior diet-treated GDM, compared with age-matched control subjects.

Adult↗

Population pharmacokinetic analysis of mexiletine in adult arrhythmic patients in Japanese population.

We analyzed mexiletine in Japanese patients using population pharmacokinetics. 139 serum concentration data, which were collected for therapeutic drug monitoring from 121 patients, were used for this analysis. We also investigated influence of age and gender on pharmacokinetics, and age was found to be an influential factor on clearance. The final pharmacokinetic parameters are, CL/F=0.580-0.00369 x AGE (l/h/kg) and Vd/F=6.63 (l/kg). These results should be useful for adjusting the dosage to a patient's age for the prevention of an adverse reaction caused by overexposure.

Adult↗

Evaluation of the population distribution of dietary contaminant exposure in an Arctic population using Monte Carlo statistics.

Organochlorines and heavy metals have bioaccumulated in Arctic wildlife, which is an important food source for the Inuit. In this study, we have developed a statistical model to describe the population distribution of contaminant exposure and the usual intake of the high-end contaminant consumers. Monte Carlo methods are used to account for variations due to seasonal dietary pattern and contaminant concentrations. Distribution of the dietary intake of the contaminants of most concern-mercury, polychlorinated biphenyls (PCBs), chlordane, and toxaphenes-are described. Over 50% of the residents had dietary exposure levels exceeding the tolerable daily intake or provisional tolerable daily intake for Hg, toxaphene, and chlordane (83, 91, and 71% for men and 73, 85, and 56% for women, respectively). The high-end consumers (i.e. the 95th centile) have intake levels 6 times higher than the provisional tolerable weekly intake of Hg, and over 20 times the tolerable daily intake of chlordane and toxaphene. Assessment of health risks of the relative high contaminant exposure in this community must also consider the nutritional, economical, cultural, and social importance of these traditional foods. A comprehensive risk management scheme has yet to be developed.

Adult↗

Population pharmacokinetics III: design, analysis, and application of population pharmacokinetic Studies.

OBJECTIVE: To present a framework within which population pharmacokinetic (PPK) studies should be designed and analyzed and discuss the application of developed PPK models. METHODS: Information on PPK was retrieved from a MEDLINE search (1979-December 2003) of the literature and a bibliographic evaluation of review articles and books. This information is used in conjunction with experience to explain the design and analysis of PPK studies. Also, examples are included to demonstrate the usefulness of PPK. SYNTHESIS: A great deal of thought must be given to the design and analysis of PPK studies (ie, development of PPK models). Models are of 2 primary types--descriptive and predictive--and the process applied to these models is necessarily different. An approach that ensures model applicability is presented. CONCLUSIONS: PPK models have great utility, and the applications are many. They are very different from single-subject pharmacokinetic models and therefore require different approaches to model estimation.

Humans↗