Mortality and Potential Years of Life Lost Attributable to Alcohol Consumption by Race and Sex in the United States in 2005

Background

Alcohol has been linked to health disparities between races in the US; however, race-specific alcohol-attributable mortality has never been estimated. The objective of this article is to estimate premature mortality attributable to alcohol in the US in 2005, differentiated by race, age and sex for people 15 to 64 years of age.

Methods and Findings

Mortality attributable to alcohol was estimated based on alcohol-attributable fractions using indicators of exposure from the National Epidemiologic Survey on Alcohol and Related Conditions and risk relations from the Comparative Risk Assessment study. Consumption data were corrected for undercoverage (the observed underreporting of alcohol consumption when using survey as compared to sales data) using adult per capita consumption from WHO databases. Mortality data by cause of death were obtained from the US Department of Health and Human Services. For people 15 to 64 years of age in the US in 2005, alcohol was responsible for 55,974 deaths (46,461 for men; 9,513 for women) representing 9.0% of all deaths, and 1,288,700 PYLL (1,087,280 for men; 201,420 for women) representing 10.7% of all PYLL. Per 100,000 people, this represents 29 deaths (29 for White; 40 for Black; 82 for Native Americans; 6 for Asian/Pacific Islander) and 670 PYLL (673 for White; 808 for Black; 1,808 for Native American; 158 for Asian/Pacific Islander). Sensitivity analyses showed a lower but still substantial burden without adjusting for undercoverage.

Conclusions

The burden of mortality attributable to alcohol in the US is unequal among people of different races and between men and women. Racial differences in alcohol consumption and the resulting harms explain in part the observed disparities in the premature mortality burden between races, suggesting the need for interventions for specific subgroups of the population such as Native Americans.     

Black church arson in the United States, 1989-1996

A prevalent theme in the public forum on the recent wave of black church arson in the United States is that the events are part of an overarching conspiracy on the part of hate groups to start a race war. In attempting to discount this theme, critics have concluded that events of black church arson are not racially motivated, and instead are random acts of insurance fraud and delinquency. We argue that competition theory sheds light on these recent events by moving us away from both sides of this debate. We argue that, in the absence of good data on connections between various hate groups, it is useful to consider this wave of ethnic violence as a result of ethnic competition for economic and political resources. Using yearly event counts and time-series cross sectional data, we test hypotheses derived from competition theory. We conclude that competition for both economic and political resources increases the yearly counts of black church arson.     

Ethnicity,race and class in the United States

Orlando Patterson, Ethnic Chauvinism: The Reactionary Impulse, New York: Stein and Day, 1977, 347 pp., $15.00.

William Julius Wilson, The Declining Significance of Race: Blacks and Changing American Institutions, Chicago and London: The University of Chicago Press, 1978, xxi + 204 pp. £8.85.     

Ethnicity and Educational Performance in the United Kingdom: Racism, Ethnicity, and Variability in Achievement

This article examines recent research on the variability of educational performance in Britain. The composition of Britain's minority population is reviewed, followed by a discussion of differences in attainment. The bulk of the article explores some of the social processes that lie behind the statistics, especially concerning teacher racism and student adaptations. The possibilities for improvement at the school level are considered briefly within the context of national reforms that prioritize market principles and marginalize equality concerns.     

Gender,Ethnicity, Marital Status,and Body Weight in the United States

Married individuals tend to be heavier than those who are unmarried, particularly men, and individuals in different ethnic categories vary in their involvement in marriage and in their body weights. We examined gender and ethnic differences in relationships between marital status and body weight using cross‐sectional data from the 1999–2002 National Health and Nutrition Examination Survey (NHANES) for 3,947 women and 4,019 men. The findings revealed that compared to married men in the same ethnic category, white divorced men, black never‐married men, and all Hispanic men except for widows had lower odds of being overweight. Compared to married women in the same ethnic category, white women's weights did not significantly differ by marital status, black separated women had greater odds of being overweight, and Hispanic never‐married women had lower odds of being overweight. Associations of marriage with body weight appear to be at least partly contingent upon gender and ethnicity, which may reflect larger societal patterns of involvement in marriage, commitment to family, and body‐weight norms and expectations.     

Sex,Race/Ethnicity,Socioeconomic Status,and BMI in Relation to Self‐Perception of Overweight

Objective: To compare the self‐perception of overweight in the study population according to sex, race/ethnicity, and socioeconomic status and to compare the self‐perception of overweight among individuals classified as normal weight, overweight, and obese. Research Methods and Procedures: Data from 5440 adults who participated in the 1994 to 1996 Continuing Survey of Food Intakes by Individuals and the Diet and Health Knowledge Survey conducted by the U.S. Department of Agriculture were analyzed. Data for analysis included self‐perceived weight status, self‐reported weight and height, and demographic and socioeconomic data. Underweight individuals, defined as those with a body mass index <18.5 kg/m², were excluded from the analysis. Results: Self‐perception of overweight was more common in women compared with men and in whites compared with blacks or Hispanics. Both the correct and incorrect perception of overweight was more common in normal weight and overweight white women compared with black women. More overweight and obese white men correctly perceived their overweight status compared with black men. Multiple logistic regression showed that the odds ratio of perceived overweight was significantly higher in women, whites, and individuals with higher body mass index, higher income, and higher education. Discussion: Self‐perceived overweight varied by sex, race/ethnicity, and socioeconomic status. Erroneous perception of body weight may have important health and behavioral implications. In particular, a considerable proportion of overweight men may be at risk of obesity if they continue to perceive themselves as having normal weight.     

Sex,status, and reproductive success in the contemporary United States

This paper reexamines the relationship between status and reproductive success (at the ultimate and proximate levels) using data on sex frequency and number of biological children from representative samples of the U.S. population. An ordered probit analysis of data from the 1989–2000 General Social Survey (GSS) shows that high-income men report greater frequency of sex than all others do. An OLS regression of data from the 1994 GSS shows that high-income men have more biological children than do low-income men and high-income women. Furthermore, more educated men have more biological children than do more educated women. Results also show that intelligence decreases the number of offspring and frequency of sex for both men and women.     

National Trends in the Ambulatory Treatment of Hypertension in the United States, 1997-2012

Importance

Hypertension is common and costly. Over the past decade, new antihypertensive therapies have been developed, several have lost patent protection and additional evidence regarding the safety and effectiveness of these agents has accrued.

Objective

To examine trends in the use of antihypertensive therapies in the United States between 1997 and 2012.

Design, Setting and Participants

We used nationally representative audit data from the IMS Health National Disease and Therapeutic Index to examine the ambulatory pharmacologic treatment of hypertension.

Outcome Measures

Our primary unit of analysis was a visit where hypertension was a reported diagnosis and treated with a pharmacotherapy (treatment visit). We restricted analyses to the use of six therapeutic classes of antihypertensive medications among individuals 18 years or older.

Results

Annual hypertension treatment visits increased from 56.9 million treatment visits (95% confidence intervals [CI], 53.9–59.8) in 1997 to 83.3 million visits (CI 79.2–87.3) in 2008, then declined steadily to 70.9 million visits (CI 66.7–75.0) by 2012. Angiotensin receptor blocker utilization increased substantially from 3% of treatment visits in 1997 to 18% by 2012, whereas calcium channel blocker use decreased from 27% to 18% of visits. Rates of diuretic and beta-blocker use remained stable and represented 24%–30% and 14–16% of visits, respectively. Use of direct renin inhibitor accounted for fewer than 2% of annual visits. The proportion of visits treated using fixed-dose combination therapies increased from 28% to 37% of visits.

Conclusions

Several important changes have occurred in the landscape of antihypertensive treatment in the United States during the past decade. Despite their novel mechanism of action, the adoption rate of direct renin inhibitors remains low.     

Racial differences in infant mortality attributable to birth defects in the United States, 1989-2002

BACKGROUND: The objective is to study racial differences in infant mortality attributable to birth defects (IMBD) in the United States. METHODS: We analyzed 1989-1991 and 1995-2002 linked birth/death files for trends and racial differences in IMBD by selected categories of birth defects for infants of non-Hispanic white, non-Hispanic black, and Hispanic mothers. RESULTS: In 1989-2002, the IMBD rates declined. However, the decline in postneonatal mortality attributable to birth defects (PMBD) rate was significantly slower than that of overall postneonatal mortality. The adjusted rate ratio for non-Hispanic black and Hispanic versus non-Hispanic white for neonatal mortality attributable to birth defects (NMBD) remained unchanged from 1989-1991 through 2000-2002. For PMBD, it increased from 0.97 (95% confidence interval [CI], 0.90-1.13) in 1989-1991 to 1.12 (95% CI, 1.04-1.21) in 2001-2002 and from 1.08 (95% CI, 1.00-1.16) to 1.18 (95% CI, 1.10-1.27) for non-Hispanic black and Hispanic, respectively. Infant mortality due to cardiovascular and central nervous system defects were the main contributors to the increased racial disparities in PMBD rates. CONCLUSIONS: The disparity in PMBD between infants of non-Hispanic black and Hispanic mothers and infants of non-Hispanic white mothers increased significantly from 1989-1991 to 2000-2002. Further studies are needed to assess the extent to which delays in care or lack of access to care for infants with birth defects might be contributing to the disparity in IMBD.     

Trends in childlessness in the United States, 1910–1975

Abstract

This paper examines trends in childlessness for ever‐married women in the United States. Data assembled from assorted census materials permit cohort and period investigations for a number of time periods, from 1910 to 1975, for various color and ethnic groups. Whether examined at the period or cohort level, the incidences in percentage rates of childlessness have varied irregularly over time. We focus particularly on the younger cohorts of white women (those beginning fecundity after 1965); they show higher rates of childlessness at each age than any of the older cohorts at similar ages in the reproductive cycle. We suggest that a major portion of the increasing rates of these younger cohorts may be attributed to increases in voluntary childlessness, which in turn may be linked to broader changes in the fabric of society regarding fertility control, contraceptive technology, female work preferences and patterns, and sexual and family norms.     

Utilization Trends and Positive Biopsy Rates for Prostate Biopsies in the United States: 2005 to 2011

This article assesses the positive biopsy rate and core sampling pattern in patients undergoing needle biopsy of the prostate in the United States at a national reference laboratory (NRL) and anatomic pathology laboratories integrated into urology group practices, and analyzes the relationship between positive biopsy rates and the number of specimen vials per biopsy. For the years 2005 to 2011 we collected pathology data from an NRL, including number of urologists and urology practices referring samples, total specimen vials submitted for prostate biopsies, and final pathologic diagnosis for each case. The diagnoses were categorized as benign, malignant, prostatic intraepithelial neoplasia, or atypical small acinar proliferation. Over the same period, similar data were gathered from urology practices with in-house laboratories performing global pathology services (urology practice laboratories; UPLs) as identified by a survey of members of the Large Urology Group Practice Association. For each year studied, positive biopsy rate and number of specimen vials per biopsy were calculated in aggregate and separately for each site of service. From 2005 to 2011, 437,937 biopsies were submitted in > 4.23 million vials (9.4 specimen vials/biopsy); overall positive biopsy rate was 40.3%-this was identical at both the NRL and UPL (P = .97). Nationally, the number of specimen vials per biopsy increased sharply from a mean of 8.8 during 2005 to 2008 to a mean of 10.3 from 2009 to 2011 (difference, 1.5 specimen vials/biopsy; P = .03). For the most recent 3-year period (2009–2011), the difference of 0.6 specimen vials per biopsy between the NRL (10.0) and UPL (10.6) was not significant (P = 0.08). Positive biopsy rate correlated strongly (P < .01) with number of specimen vials per biopsy. The positive prostate biopsy rate is 40.3% and is identical across sites of service. Although there was a national trend toward increased specimen vials per biopsy from 2005 to 2011, from 2009 to 2011 there was no significant difference in specimen vials per biopsy across sites of service. Increased cancer detection rate correlated significantly with increased number of specimens examined. Segregation of prostate biopsy cores into 10 to 12 unique specimen vials has been widely adopted by urologists across sites of service.Key Words: Prostate cancer, Prostate biopsy, Utilization trends, National reference laboratory, Urology practice laboratoriesPublished data over the past decade suggesting that prostate cancer detection rates are enhanced with additional sampling of the prostate have resulted in modifications to the traditional 6-core (sextant) biopsy regimen^1,2 such that recent clinical guidelines recommend that extended biopsy schemes with 10 to 12 specimens be obtained.^3–5 There are also data that suggest that segregation of prostate biopsy tissue specimens into individual vials improves specimen handling, enhances tissue representation, and improves diagnostic accuracy.^6–8 Furthermore, focal prostate cancer treatment strategies gaining recent popularity are dependent on more precise tumor mapping, requiring even greater tissue sampling.⁹Over approximately the same time frame, there has been an increase in consolidation of medical practices into larger single- or multispecialty group practices. By incorporating efficiencies of scale, these groups afford physicians the opportunity to retain the characteristics of traditional medical practices while improving their ability to adapt to changing health care circumstances.¹⁰ These groups often integrate additional capabilities beyond professional services, including anatomic and clinical pathology, diagnostic imaging, and radiation therapy. Proponents of these arrangements argue that integration of medical services facilitates the development of coordinated clinical pathways, improves communication between specialists, offers better quality control of ancillary services, and enhances data collection—all of which can improve patient care and lead to lower costs.^11–13 Specifically with regard to anatomic pathology, recent data suggest that certain specimen handling errors are significantly lower (P = .018) at urology practices with integrated in-house pathology laboratories (urology practice laboratories [UPLs]) than at other sites of service¹⁴; however, some contend that group practice integration creates conflicts of interest and self-referral issues, which ultimately leads to increased utilization of services.^15–19 A recent study based on analysis of Medicare claims data purported that positive prostate biopsy rates and the number of samples submitted per biopsy are significantly different across sites of service²⁰; however, this study has been criticized as both methodologically flawed and scientifically inaccurate.²¹ Also problematic is the fact that calculation of prostate cancer incidence has been identified as particularly susceptible to error when determined by analysis of outpatient claims data alone.²²We sought to determine positive biopsy rates and utilization trends in the United States via direct analysis of laboratory records from both a national reference laboratory (NRL) and UPLs, and to determine if there was a correlation between positive biopsy rates and number of specimen vials submitted.     

Trends in pulmonary embolism death rates for Canada and the United States, 1962-87.

To investigate the effect of advances in the prevention and treatment of pulmonary embolism, we examined the rates of death from pulmonary embolism in Canada for 1965-87 and compared them with those for the United States for 1962-84. The direct method of age standardization was used on sex-specific and age-specific death rates, with the 1960 US population as the standard. In both countries the death rates increased then decreased, although the changes in the Canadian rates occurred later and were less pronounced than those in the US rates. Men and elderly people were at higher risk of death from pulmonary embolism than women and younger people. Prevention strategies, possibly including encouraging a more active lifestyle and targetting high-risk groups, may further reduce pulmonary embolism death rates in both countries.     

Sex differentials in morbidity and mortality in the United States

Abstract

Life expectation of females in the United States exceeds that of males, but females’ health while living appears worse. Based on self‐reports of illness, females have higher incidence rates for acute conditions, and a higher percentage of them have a chronic condition. The paper examines sex differentials in mortality and morbidity for 1958–72, using national vital statistics and Health Interview Survey data. The reversal of mortality and morbidity sex differentials in the aggregate is due in part to a distribution effect, diseases with a male excess being weighted heavily in mortality, but those with a female excess dominating morbidity. For specific conditions, sex morbidity and sex mortality differentials are usually in the same direction, the sicker sex being more likely to die. For several conditions, however, females have higher morbidity but lower mortality than males. By incorporating diagnostic data, these reversals are attributed to females’ interviewing and illness behavior, rather than to higher physical morbidity.     

Race of parents and infant birthweight in the United States.

Detailed 1977 national natality data are used to investigate social, demographic, and genetic effects on birthweight differentials. Analysis of birthweight differences among infants with white, black, and mixed black-white parents indicates that a portion of the observed weight differentials appear to be due to biologic factors. Infants with a black mother and father have the lowest mean birthweights, while infants with two white parents have the highest weights. Newborns with mixed-race parents have intermediate birthweight distributions. Multivariate analysis suggests that the effects of parental race on birthweight are not the result of maternal/obstetric differences among parents of the same or mixed race.     

Remembering Exhibitions on Race in the 20th-century United States

ABSTRACT   This museum review places the American Anthropological Association's recent exhibition entitled "Race: Are We So Different?" into historical context by comparing it to other major exhibitions on race in the 20th century. I argue that although exhibitions on race in the 19th-century United States are frequently examined in the historical and anthropological literature, later exhibitions from the 20th century are frequently forgotten. In particular, I compare the AAA's recent exhibition to displays originally crafted for the 1915 and 1933 World's Fairs.