Adiposity is not equal in a multi-race/ethnic adolescent population: NHANES 1999-2004

BMI is the preferred measure of adiposity in adolescents. Recent evidence suggests that in adults the relationship between BMI and adiposity can vary by age and race/ethnicity. We investigated the relationship between BMI and percent body fat (%BF) in a large multi-ethnic, nationally representative sample of US adolescents (National Health and Nutrition Examination Survey, NHANES, 1999-2004). BMI was calculated; %BF was derived from dual-energy X-ray absorptiometry data and compared to BMI among adolescents from three groups: non-Hispanic white (NHW), non-Hispanic black (NHB), and Mexican-American (MA). Fractional polynomials were used to model a new equation to estimate %BF from a given BMI. MA boys weighed significantly less than either NHW or NHB boys, while only NHB girls weighed significantly more than the other girls. Among the boys there were no differences in mean BMI, whereas %BF differed significantly between all three groups. For the girls, both BMI and %BF differed significantly the groups with MA girls having the highest %BF. The significant correlates for modeling %BF from BMI included gender, age, race/ethnicity, weight, [formula in text]: the final model explained 79% of the variance in %BF. NHB adolescents had significantly lower %BF for BMI and MA had higher than NHW. Our results indicate that BMI may not be an equivalent measure of %BF in a multi-ethnic population of US adolescents.     

American Indian/Alaska Native and black colon cancer patients have poorer cause-specific survival based on disease stage and anatomic site of diagnosis

ObjectivesStudies of race-specific colon cancer (CC) survival differences between right- vs. left-sided CC typically focus on Black and White persons and often consider all CC stages as one group. To more completely examine potential racial and ethnic disparities in side- and stage-specific survival, we evaluated 5-year CC cause-specific survival probabilities for five racial/ethnic groups by anatomic site (right or left colon) and stage (local, regional, distant).MethodsWe obtained cause-specific survival probability estimates from National Cancer Institute’s population-based Surveillance, Epidemiology, and End Results (SEER) for CC patients grouped by five racial/ethnic groups (Non-Hispanic American Indian/Alaska Native [AIAN], Non-Hispanic Asian/Pacific Islander [API], Hispanic, Non-Hispanic Black [NHB], and Non-Hispanic White [NHW]), anatomic site, stage, and other patient and SEER registry characteristics. We used meta-regression approaches to identify factors that explained differences in cause-specific survival.ResultsDiagnoses of distant-stage CC were more common among NHB and AIAN persons (>22 %) than among NHW and API persons (< 20 %). Large disparities in anatomic site-specific survival were not apparent. Those with right-sided distant-stage CC had a one-year cause-specific survival probability that was 16.4 % points lower (99 % CI: 12.2–20.6) than those with left-sided distant-stage CC; this difference decreased over follow-up. Cause-specific survival probabilities were highest for API, and lowest for NHB, persons, though these differences varied substantially by stage at diagnosis. AIAN persons with localized-stage CC, and NHB persons with regional- and distant-stage CC, had significantly lower survival probabilities across follow-up.ConclusionsThere are differences in CC presentation according to anatomic site and disease stage among patients of distinct racial and ethnic backgrounds. This, coupled with the reality that there are persistent survival disparities, with NHB and AIAN persons experiencing worse prognosis, suggests that there are social or structural determinants of these disparities. Further research is needed to confirm whether these CC cause-specific survival disparities are due to differences in risk factors, screening patterns, cancer treatment, or surveillance, in order to overcome the existing differences in outcome.     

Racial/ethnic differences in the utilization of chemotherapy among stage I-III breast cancer patients,stratified by subtype: Findings from ten National Program of Cancer Registries states

BackgroundThe study aimed to examine racial/ethnic differences in chemotherapy utilization by breast cancer subtype.MethodsData on female non-Hispanic white (NHW), non-Hispanic black (NHB), and Hispanic stage I-III breast cancer patients diagnosed in 2011 were obtained from a project to enhance population-based National Program of Cancer Registry data for Comparative Effectiveness Research. Hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2) were used to classify subtypes: HR+/HER2-; HR+/HER2+; HR-/HER2-; and HR-/HER2 + . We used multivariable logistic regression models to examine the association of race/ethnicity with three outcomes: chemotherapy (yes, no), neo-adjuvant chemotherapy (yes, no), and delayed chemotherapy (yes, no). Covariates included patient demographics, tumor characteristics, Charlson Comorbidity Index, other cancer treatment, and participating states/areas.ResultsThe study included 25,535 patients (72.1% NHW, 13.7% NHB, and 14.2% Hispanics). NHB with HR+/HER2- (adjusted odds ratio [aOR] 1.22, 95% CI 1.04–1.42) and Hispanics with HR-/HER2- (aOR 1.62, 95% CI 1.15–2.28) were more likely to receive chemotherapy than their NHW counterparts. Both NHB and Hispanics were more likely to receive delayed chemotherapy than NHW, and the pattern was consistent across each subtype. No racial/ethnic differences were found in the receipt of neo-adjuvant chemotherapy.ConclusionsCompared to NHW with the same subtype, NHB with HR+/HER2- and Hispanics with HR-/HER2- have higher odds of using chemotherapy; however, they are more likely to receive delayed chemotherapy, regardless of subtype. Whether the increased chemotherapy use among NHB with HR+/HER2- indicates overtreatment needs further investigation. Interventions to improve the timely chemotherapy among NHB and Hispanics are warranted.     

Reassessing the Impact of Smoking on Preeclampsia/Eclampsia: Are There Age and Racial Differences?

Objective

To investigate the association between cigarette use during pregnancy and pregnancy-induced hypertension/preeclampsia/eclampsia (PIH) by maternal race/ethnicity and age.

Methods

This retrospective cohort study was based on the U.S. 2010 natality data. Our study sample included U.S. women who delivered singleton pregnancies between 20 and 44 weeks of gestation without major fetal anomalies in 2010 (n = 3,113,164). Multivariate logistic regression models were fit to estimate crude and adjusted odds ratios and the corresponding 95% confidence intervals.

Results

We observed that the association between maternal smoking and PIH varied by maternal race/ethnicity and age. Compared with non-smokers, reduced odds of PIH among pregnant smokers was only evident for non-Hispanic white and non-Hispanic American Indian women aged less than 35 years. Non-Hispanic Asian/Pacific Islander women who smoked during pregnancy had increased odds of PIH regardless of maternal age. Non-Hispanic white and non-Hispanic black women 35 years or older who smoked during pregnancy also had increased odds of PIH.

Conclusion

Our study findings suggest important differences by maternal race/ethnicity and age in the association between cigarette use during pregnancy and PIH. More research is needed to establish the biologic and social mechanisms that might explain the variations with maternal age and race/ethnicity that were observed in our study.     

Examining the incidence of human papillomavirus-associated head and neck cancers by race and ethnicity in the U.S., 1995-2005

Background

Head and neck cancer (HNC) incidence, mortality and survival rates vary by sex and race, with men and African Americans disproportionately affected. Risk factors for HNC include tobacco and alcohol exposure, with a recent implication of human papillomavirus (HPV) in the pathogenesis of HNC. This study describes the epidemiology of HNC in the United States, examining variation of rates by age, sex, race/ethnicity and potential HPV-association.

Methods

We used the North American Association of Central Cancer Registries (NAACCR) Cancer in North America (CINA) Deluxe Analytic Data to analyze HNC incidence for 1995–2005 from forty population-based cancer registries. We calculated age-adjusted incidence rates and incidence trends using annual percent change by age, sex, race/ethnicity and HPV-association.

Results

Males and Non-Hispanic Blacks experienced greater HNC incidence compared to women and other race/ethnicity groupings. A significant overall increase in HNC incidence was observed among HPV-associated sites during 1995–2005, while non HPV-associated sites experienced a significant decline in HNC incidence. Overall, younger age groups, Non-Hispanic Whites and Hispanics experienced greater increases in incidence for HPV-associated sites, while HNC incidence declined for Non-Hispanic Blacks independent of HPV-association. In particular, for HPV-associated sites, HNC incidence for Non-Hispanic White males aged 45–54 increased at the greatest rate, with an APC of 6.28% (p<0.05). Among non HPV-associated sites, Non-Hispanic Black males aged 0–44 years experienced the greatest reduction in incidence (APC, −8.17%, p<0.05), while a greater decline among the older, 55–64 year age group (APC, −5.44%, p<0.05) occurred in females.

Conclusions

This study provides evidence that HPV-associated tumors are disproportionately affecting certain age, sex and race/ethnicity groups, representing a different disease process for HPV-associated tumors compared to non HPV-associated tumors. Our study suggests that HPV tumor status should be incorporated into treatment decisions for HNC patients to improve prognosis and survival.     

Thyroid Function and Serum Copper,Selenium, and Zinc in General U.S. Population

Association of the levels of serum selenium (Se), zinc (Zn), and copper (Cu) with thyroid function was assessed by analyzing data from National Health and Nutrition Examination Survey for the cycle 2011–2012. Thyroid function variables analyzed were as follows: thyroid-stimulating hormone (TSH), free and total triiodothyronine (FT3, TT3), free and total thyroxine (FT4, TT4), and thyroglobulin (TGN). Regression models with log-transformed values of thyroid hormones as independent variables and age, race/ethnicity, smoking and iodine sufficiency status, respondents’ education, and levels of Se, Zn, and Cu as dependent variables were fitted. For males, levels of Zn were associated with decreased levels of FT4 and TT4, and levels of Cu were associated with increased levels of FT4 and TT4. For females, levels of Cu were associated with increased levels of TT3 and TT4. Smoking was found to be associated with lower levels of TSH and higher levels of TGN in males. Smoking was found to be associated with lower levels of TT4 in females. Males had about 5–10 % higher levels of both Se and Zn, but as much as 20 % lower levels of Cu than females. Smoking was associated with lower levels of Zn, but higher levels of Cu in males.     

Association between smoking status and homocysteine levels and possible effect modification by cholesterol and oestradiol

Abstract

Introduction: This study aimed to examine the association of smoking status with homocysteine levels and to determine whether the association is modified by oestradiol or cholesterol.

Methods: Data (N?=?4580) were obtained from National Health and Nutrition Examination Survey 2003–2004 with analysis done in 2018 on adults aged ≥20 years. The outcome was homocysteine; smoking status was the exposure variable and categorized as current, former or never smoker. Generalized linear models were used to examine the associations between smoking status and homocysteine levels, while assessing the impact of oestradiol and cholesterol.

Results: After adjusting for age, sex, ethnicity, education and income level, homocysteine levels did differ by smoking status ((current smokers versus never smokers: β: 0.18?CI: 0.00, 0.36), (former smokers: β: 0.10?CI: –0.09, 0.28)). The addition of oestradiol as an interaction term in adjusted models was associated with a 16.6% increase in homocysteine levels when compared to models without the interaction term. Oestradiol but not cholesterol did moderate the association between smoking status and homocysteine levels.

Discussion and conclusions: Homocysteine levels did differ across smoking status after adjusting for confounders. Oestradiol did moderate the relationship between homocysteine and smoking status.     

Esophageal cancer incidence rates by histological type and overall: Puerto Rico versus the United States Surveillance,Epidemiology, and End Results population, 1992–2005

Objective: The aim of our study was to compare the age-standardized incidence of esophageal cancer (EC) in Puerto Ricans (PRs) with that for non-Hispanic White (NHW), non-Hispanic Black (NHB), and Hispanic (USH), groups in the United States (US) as reported by the Surveillance, Epidemiology, and End Results program for the 1992–2005 period. Methods: We computed the age-standardized and age-specific incidence (per 100,000 individuals) of EC during 1992–2005 using the World Standard Population as reference. The percent changes for age-standardized rates (ASR), from 1992–1996 to 2001–2005, were calculated. The relative risks (RR) and the standardized rate ratios (SRR) were estimated, along with 95% confidence intervals (CIs). Results: The ASR of adenocarcinomas (AC) showed increases for most racial/ethnic groups from 1992–1996 to 2001–2005. All racial/ethnic groups showed ASR reductions for squamous cell carcinomas (SCC). For both sexes, PRs had lower AC incidences than NHW and USH but higher than NHB. For those younger than 80 years of age, PR men showed higher SCC incidences than NHW but lower than NHB (P < 0.05). The incidence of SCC was about two times higher in PR men than USH men (SRR: 2.16; 95% CI = 1.65–2.88). Among women, the RR for SCC increased with age when comparing PRs to groups in the US. Conclusion: Incidence disparities were observed between PRs and other racial/ethnic groups in the US. These differences and trends may reflect lifestyles of each racial/ethnic group. Further studies are warranted to explain these disparities.     

A comparative study of hepatic trace element levels in wild moose, roe deer, and reindeer from Norway

Liver samples from 422 wild moose (Alces alces), 280 roe deer (Capreolus capreolus), and 73 reindeer (Rangifer tarandus) collected by hunters in various localities in Norway, 2002-2003, were analyzed for the essential trace elements cobalt, copper (Cu), manganese (Mn), molybdenum, selenium (Se), and zinc. Significant differences in hepatic concentrations among species were found for all elements except for Mn, and considerable individual and geographic variations were seen. Roe deer had statistically significant lower Se levels (median: 0.51 μg Se/g dry weight) than did moose (0.77 μg Se/g) and reindeer (0.85 μg Se/g). Moose from two coastal municipalities with high precipitation had considerably higher Se concentrations than those from the other localities studied. Seventy-nine roe deer (28%) and 36 moose (9%) had Se concentrations below that regarded as deficient in domestic ruminants. The Se status in roe deer was lower than previously reported in Europe. Moose had a significantly higher Cu (222 μg Cu/g dw) than did roe deer (112 μg Cu/g) and reindeer (105 μg Cu/g). The Cu status of moose and roe deer in Norway are among the highest reported in Europe. However, a suboptimal Se and Cu status was found in moose from Tvedestrand, a population which has suffered from a reduced condition and productivity. The variability in trace element status among hunted cervids, with no apparent signs of deficiency or toxicity, probably reflects adaptations in these wild ruminant species to cope with this. However, subtle clinical signs and lesions are difficult to detect and further research is needed.     

Selenium serum and urine is associated to mild asthma and atopy. The SUS study.

To examine the associations between selenium (Se) status, asthma, bronchial hyperresponsiveness (BHR), and atopy in 154 male subjects (72 with mild asthma, 41 with BHR and 41 with no respiratory symptoms) aged 18 (range 17-22) years. Each subject underwent a medical interview and FEV1 and FVC were recorded. Histamine bronchial reactivity (Yan method) was measured, skin prick test (inhalant allergens) was performed and Se in urine and serum was analysed (AOAC modified fluometric method). Se in serum 74.04 (10.58) micrograms/L (mean (SD)) was lower in subjects with asthma and the logarithm of the ratio of Se in serum (microgram/L) and urine standardised to creatinine excretion (ng/mg creatinine) 0.748 (0.096) (mean (SD)) was lower in subjects with asthma and atopy compared to subjects with no allergic symptoms 77.79 (10.16) micrograms/L and 0.808 (0.111) respectively (p < 0.05). In subjects with asthma atopy was significantly associated to urine Se 0.24 (0.73) (beta (SE)) (p < 0.05). Subjects with BHR had the same Se status as subjects with no respiratory symptoms and heavy smokers had a lower concentration of Se in serum 73.80 (9.56) micrograms/L than non-smokers 78.16 (10.74) micrograms/L (p < 0.05), Se status was associated to asthma and smoking. Measuring Se in urine might add further information to possible relations between Se status, atopy and asthma.     

Socioeconomic Differentials in Smoking Duration among Adult Male Smokers in China: Result from the 2006 China Health and Nutrition Survey

Background

A smoker’s risk of diseases and death from smoking is closely related to his/her smoking duration. But little is known about the average length of smoking and the association between smoking duration and socio-economic status (SES) among Chinese smokers.

Methods

A sample of male ever smokers (N = 2,637) aged 18+ years was drawn from the 2006 China Health and Nutrition Survey to examine the average length of smoking and socioeconomic differentials in smoking duration. Kaplan-Meier analysis was used to obtain median smoking duration. Log-logistic regression models were employed to estimate the relative duration of smoking, adjusted for demographic characteristics, smoking history, and health status.

Results

Results showed that Chinese male ever smokers aged 18 years and older had a median duration of smoking of 58 years (95% CI: 56–61). Male ever smokers with a lower status job (i.e. farmers, manual and skilled workers, service workers, and office staff) had a significantly longer duration of smoking than those with a professional or administrative job after adjusted for demographic characteristics, smoking history, and health status. Individuals who earned the lowest income and who had no education or were being illiterate smoked for 11% and 14% longer, respectively, relative to those who had the highest income or who had college or above education.

Conclusion

The findings demonstrated the problem of long smoking duration and a pattern of social disparities in smoking duration among Chinese male smokers. Social disparities in smoking behavior may exacerbate the already existing social inequalities in health. Thus, policies and interventions to promote smoking cessation should pay more attention to disadvantaged social groups.     

Selenium status and its correlates in a British national diet and nutrition survey: people aged 65 years and over.

Plasma selenium (Se) concentrations were measured in 1134 British people aged 65 years and over, living in mainland Britain during 1994-1995. Eight hundred and eighty-three lived in the community ("free-living"), while the remainder lived in institutions (residential and nursing homes). The overall mean plasma Se concentrations was 0.90 micromol/l (inner 95% range 0.50-1.36 micromol/l). Free-living people had significantly higher values than counterparts living in institutions, and there was an overall inverse correlation with age. Plasma Se varied with season (lower from October to December than at other times of the year), while values were higher in southern Britain than in the North. Socio-economic associations also existed (lower plasma Se in people receiving state benefits or with poorer educational attainment), while smokers had lower values than non-smokers. Several indices of poor health status or of medicine use were correlated with lower plasma Se, which was also predicted by several biochemical or haematological indices of infection or inflammation. Plasma Se was strongly and directly correlated with plasma albumin, zinc, cholesterol, vitamin C, several carotenoids, alpha-tocopherol, pyridoxal phosphate, and with blood haemoglobin and several anthropometric indices. All relationships were independent of age and gender, and are consistent with the view that plasma Se levels are higher in fit and well-nourished elderly people and lower in those who are frail, poorly-nourished and unwell. Whole-blood glutathione peroxidase generally did not share these relationships, was only very weakly correlated with plasma Se, and appeared to be less useful as a status indicator in this population group.     

Quantifying the Impact of Gestational Diabetes Mellitus,Maternal Weight and Race on Birthweight via Quantile Regression

Background

Quantile regression, a robust semi-parametric approach, was used to examine the impact of gestational diabetes mellitus (GDM) across birthweight quantiles with a focus on maternal prepregnancy body mass index (BMI) and gestational weight gain (GWG).

Methods

Using linked birth certificate, inpatient hospital and prenatal claims data we examined live singleton births to non-Hispanic white (NHW, 135,119) and non-Hispanic black (NHB, 76,675) women in South Carolina who delivered 28–44 weeks gestation in 2004–2008.

Results

At a maternal BMI of 30 kg/m² at the 90^th quantile of birthweight, exposure to GDM was associated with birthweights 84 grams (95% CI 57, 112) higher in NHW and 132 grams (95% CI: 104, 161) higher in NHB. Results at the 50^th quantile were 34 grams (95% CI: 17, 51) and 78 grams (95% CI: 56, 100), respectively. At a maternal GWG of 13.5 kg at the 90^th quantile of birthweight, exposure to GDM was associated with birthweights 83 grams (95% CI: 57, 109) higher in NHW and 135 grams (95% CI: 103, 167) higher in NHB. Results at the 50^th quantile were 55 grams (95% CI: 40, 71) and 69 grams (95% CI: 46, 92), respectively.

Summary

Our findings indicate that GDM, maternal prepregnancy BMI and GWG increase birthweight more in NHW and NHB infants who are already at the greatest risk of macrosomia or being large for gestational age (LGA), that is those at the 90^th rather than the median of the birthweight distribution.     

Elements in the hair of workers at a workshop, foundry, and match factory

The levels of seven elements determined in the hair were compared between male controls and industrial workers from Madras (South India). Particularly, the concentrations of Cd, Cr, Cu, Mn, and Ni in the foundry workers and Cu, Mn, and Ni in the workers of a workshop and match factory were observed to be higher than that of controls working in the office. In addition, the occupation, age, and period of service of workers had an influence, but diet, smoking habits, income of family, and hair color had no influence on the element levels in the hair.     

Relationship among serum selenium levels,lipid peroxidation,and acute bronchiolitis in infancy

Thirty-four infants with acute bronchiolitis and 25 age-matched healthy controls were enrolled to investigate the possible relationship between serum malondialdehyde (MDA) and selenium (Se) levels and the occurrence and severity of acute bronchiolitis in children. Serum samples were taken for serum Se and MDA measurements, and the clinical score was assessed at admission. Blood was taken again from the children with bronchiolitis at 2 mo after discharge from the hospital. Mean serum MDA levels were significantly higher in patients with acute bronchiolitis than at the postbronchiolitis stage and the controls (4.2±2.5nmol./L, 1.4±0.8 nmol/L, and 0.7±0.2 nmol/L, respectively [p<0.001]). Infants with bronchiolitis had lower mean serum Se levels at the acute stage than after 2 mo (31.7±28.9μg/L versus 68.4±26.4 μg/L, p<0.05, respectively); both of which were significantly lower than the control group measurements (145.0±21.9 μg/L) (p<0.001). There was a negative correlation between serum MDA and Se levels in the patient group (=−0.85, p<0.001). The age of the patient, child's immunization status, parental smoking habit, and family crowding index were not correlated with serum Se, MDA levels, or clinical score at admission. In conclusion, increased MDA levels and impaired Se status demonstrate the presence of possible relationship of these parameters with pathogenesis of acute bronchiolitis, and antioxidant supplementation with Se might be thought to supply a beneficial effect against bronchiolitis.     

Race/ethnicity and telomere length in the Multi-Ethnic Study of Atherosclerosis

Telomere length has emerged as a marker of exposure to oxidative stress and aging. Race/ethnic differences in telomere length have been infrequently investigated. Leukocyte telomere length (LTL) was assessed 981 white, black and Hispanic men and women aged 45–84 years participating in the Multi-Ethnic Study of Atherosclerosis. Direct measurement and questionnaire were used to assess covariates. Linear regression was used to estimate associations of LTL with race/ethnicity and age after adjustment for sex, income, education, smoking, physical activity, diet and body mass index. On average blacks and Hispanics had shorter telomeres than whites [adjusted mean differences (standard error) in T/S ratio compared to whites: −0.041 (0.018) for blacks and −0.044 (0.018) for Hispanics]. Blacks and Hispanics showed greater differences in telomere length associated with age than whites (adjusted mean differences in T / S ratio per 1 year increase in age −0.0018, −0.0047 and −0.0055 in whites, blacks and Hispanics respectively). Differences in age associations were more pronounced and only statistically significant in women. Race/ethnic differences in LTL may reflect the cumulative burden of differential exposure to oxidative stress (and its predictors) over the lifecourse.     

Sex and Ethnic Differences in 47 Candidate Proteomic Markers of Cardiovascular Disease: The Mayo Clinic Proteomic Markers of Arteriosclerosis Study

Background

Cardiovascular disease (CVD) susceptibility differs between men and women and varies with ethnicity. This variability is not entirely explained by conventional CVD risk factors. We examined differences in circulating levels of 47 novel protein markers of CVD in 2561 men and women of African-American (AA) and non-Hispanic White (NHW) ethnicity, enrolled at geographically distinct sites.

Methodology/Principal Findings

Participants (1,324 AAs, mean age 63.5 y, 71% women; 1,237 NHWs, mean age 58.9 y, 57% women) belonged to sibships ascertained on the basis of hypertension. Solid-phase immunoassays and immunoturbidometric, clot-based, chromogenic, and electrophoretic assays were used to measure the 47 protein markers in plasma or serum. Marker levels were log transformed and outliers were adjusted to within 4 SD. To identify markers independently associated with sex or ethnicity, we employed multivariable regression analyses that adjusted for conventional risk factors, prior history of CVD, medication use and lifestyle factors (physical activity, alcohol consumption and education). Generalized estimating equations were used to correct for intrafamilial correlations. After adjustment for the above covariates, female sex was associated with higher levels of 29 markers and lower levels of 6 markers. Female sex was independently associated with higher levels of several inflammatory markers as well as lipoproteins, adipokines, natriuretic peptides, vasoconstrictor peptides and markers of calcification and thrombosis. AA ethnicity was associated with higher levels of 19 markers and lower levels of 6 markers, including higher levels of several inflammatory makers, higher leptin and lower adiponectin levels, lower levels of vasodilator-natriuretic peptides, higher levels of vasoconstrictor-antidiuretic peptides and markers of calcification and thrombosis.

Conclusions/Significance

Plasma levels of several novel protein markers of CVD differ significantly in the context of sex and ethnicity. These results have implications for individualized CVD risk assessment.     

Association of race and health insurance in treatment disparities of colon cancer: A retrospective analysis utilizing a national population database in the United States

BackgroundBoth health insurance status and race independently impact colon cancer (CC) care delivery and outcomes. The relative importance of these factors in explaining racial and insurance disparities is less clear, however. This study aimed to determine the association and interaction of race and insurance with CC treatment disparities.Study settingRetrospective cohort review of a prospective hospital-based database.Methods and findingsIn this cross-sectional study, patients diagnosed with stage I to III CC in the United States were identified from the National Cancer Database (NCDB; 2006 to 2016). Multivariable regression with generalized estimating equations (GEEs) were performed to evaluate the association of insurance and race/ethnicity with odds of receipt of surgery (stage I to III) and adjuvant chemotherapy (stage III), with an additional 2-way interaction term to evaluate for effect modification. Confounders included sex, age, median income, rurality, comorbidity, and nodes and margin status for the model for chemotherapy. Of 353,998 patients included, 73.8% (n = 261,349) were non-Hispanic White (NHW) and 11.7% (n = 41,511) were non-Hispanic Black (NHB). NHB patients were less likely to undergo resection [odds ratio (OR) 0.66, 95% confidence interval [CI] 0.61 to 0.72, p < 0.001] or to receive adjuvant chemotherapy [OR 0.83, 95% CI 0.78 to 0.87, p < 0.001] compared to NHW patients. NHB patients with private or Medicare insurance were less likely to undergo resection [OR 0.76, 95% CI 0.63 to 0.91, p = 0.004 (private insurance); OR 0.59, 95% CI 0.53 to 0.66, p < 0.001 (Medicare)] and to receive adjuvant chemotherapy [0.77, 95% CI 0.68 to 0.87, p < 0.001 (private insurance); OR 0.86, 95% CI 0.80 to 0.91, p < 0.001 (Medicare)] compared to similarly insured NHW patients. Although Hispanic patients with private and Medicare insurance were also less likely to undergo surgical resection, this was not the case with adjuvant chemotherapy. This study is mainly limited by the retrospective nature and by the variables provided in the dataset; granular details such as continuity or disruption of insurance coverage or specific chemotherapy agents or dosing cannot be assessed within NCDB.ConclusionsThis study suggests that racial disparities in receipt of treatment for CC persist even among patients with similar health insurance coverage and that different disparities exist for different racial/ethnic groups. Changes in health policy must therefore recognize that provision of insurance alone may not eliminate cancer treatment racial disparities.

Scarlett Hao and colleagues utilize a national population database to investigate the association of race and health insurance in treatment disparities of colon cancer in US.     

Head and neck squamous cell carcinomas among males of the three largest Asian diasporas in the US, 2004–2013

BackgroundHead and neck squamous cell carcinomas (HNSCC) have not been fully examined in the Asian diasporas in the US, despite certain Asian countries having the highest incidence of specific HNSCCs.MethodsNational Cancer Database was used to compare 1046 Chinese, 887 South Asian (Indian/Pakistani), and 499 Filipino males to 156,927 Non-Hispanic White (NHW) males diagnosed with HNSCC between 2004−2013. Multinomial logistic regression was used to assess the association of race/ethnicity with two outcomes – site group and late-stage diagnosis. Temporal trends were explored for site groups and subsites.ResultsSouth Asians had a greater proportion of oral cavity cancer [OCC] compared to NHWs (59 % vs. 25 %; OR_adj =7.3 (95 % CI: 5.9–9.0)). In contrast, Chinese (64 % vs. 9%; OR_adj =34.0 (95 % CI: 26.5–43.6)) and Filipinos (47 % vs. 9%; OR_adj =10.0 (95 % CI: 7.8–12.9)) had a greater proportion of non-oropharyngeal cancer compared to NHWs. All three Asian subgroups had a higher likelihood of being diagnosed by age 40 (14 % Chinese, 10 % South Asian and 8% Filipino compared to 3% in NHW; p < 0.001). Chinese males had lower odds of late-stage diagnosis, compared to NHWs. South Asian cases doubled from 2004 to 2013 largely due to an increase in OCC cases (34 cases in 2004 to 86 in 2013).ConclusionAsian diasporas are at a higher likelihood of specific HNSCCs. Risk factors, screening and survival need to be studied further, and policy changes are needed to promote screening and to discourage high-risk habits in these Asian subgroups.     

Concentrations and interactions of selected essential and non-essential elements in bowhead and beluga whales of arctic Alaska.

In this study, we evaluated concentrations of twelve essential and non-essential elements (As, Cd, Co, Cu, Pb, Mg, Mn, Hg, Mo, Se, Ag, and Zn) in tissues of bowhead (Balaena mysticetus) and beluga (Delphinapterus leucas) whales from arctic Alaska (USA) and northwestern Canada. Tissue samples were collected between 1983 and 1997, mostly in 1995-97. The essential elements are reported to develop reference ranges for health status determination, and to help assess known or suspected interactions affecting toxicoses of cadmium (Cd) and mercury (Hg). In some tissues, Cd, Hg, and selenium (Se) were present at concentrations that have been associated with toxicoses in some domestic animals. Nevertheless, tissue levels of all elements were within ranges that have been reported previously in marine mammals. While mean Ag concentrations in beluga whale liver were relatively high (15.91 micrograms/g ww), Ag was not associated with hepatic Se levels or age, contrary to previous findings. Significant associations included: Cd with age, Zn, or Cu; Cu with age, Zn or Ag; and Hg with age, Se, Zn, or Cu. This study found hepatic Hg:Se molar ratios to be consistently lower than unity and different between species. Possible explanations for observed elemental correlations (i.e., interactions) and ancillary mechanisms of Cd and Hg detoxification are discussed.