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Background: Recent data suggest that neighborhood socioeconomic environment predicts heart failure (HF) hospital readmissions. We investigated whether neighborhood deprivation predicts risk of incident HF beyond individual socioeconomic status in a low-income population.Methods and Results: Participants were 27 078 whites and blacks recruited during 2002 to 2009 in the SCCS (Southern Community Cohort Study), who had no history of HF and were using Centers for Medicare or Medicaid Services. Incident HF diagnoses through December 31, 2010, were ascertained using International Classification of Diseases, Ninth Revision, codes 428.x via linkage with Centers for Medicare or Medicaid Services research files. Participant residential information was geocoded and census tract determined by a spatial join to the US Census Bureau TIGER/Line Shapefiles. The neighborhood deprivation index was constructed using principal components analysis based on census tract-level socioeconomic variables. Cox models with Huber-White cluster sandwich estimator of variance were used to investigate the association between neighborhood deprivation index and HF risk. The study sample was predominantly middle aged (mean, 55.5 years), black (69%), female (63%), low income (70% earned <$15 000/y), and >50% of participants lived in the most deprived neighborhoods (third neighborhood deprivation index tertile). Over median follow-up of 5.2 years, 4300 participants were diagnosed with HF. After adjustment for demographic, lifestyle, and clinical factors, a 1 interquartile increase in neighborhood deprivation index was associated with a 12% increase in risk of HF (hazard ratio, 1.12; 95% confidence interval, 1.07-1.18), and 4.8% of the variance in HF risk (intraclass correlation coefficient, 4.8; 95% confidence interval, 3.6-6.4) was explained by neighborhood deprivation.Conclusions: In this low-income population, scant neighborhood resources compound the risk of HF above and beyond individual socioeconomic status and traditional cardiovascular risk factors. Improvements in community resources may be a significant axis for curbing the burden of HF. [ABSTRACT FROM AUTHOR]

Background--There is a paucity of data on heart failure (HF) incidence among low-income and minority populations. Our objective was to investigate HF incidence and post-HF survival by race and sex among low-income adults in the southeastern United States. Methods and Results--Participants were 27 078 white and black men and women enrolled during 2002 to 2009 in the SCCS (Southern Community Cohort Study) who had no history of HF and were receiving Centers for Medicare and Medicaid Services. Incident HF diagnoses through December 31, 2010 were ascertained using International Classification of Diseases 9th Revision codes 428.x via linkage with Centers for Medicare and Medicaid Services research files. Most participants were black (68.8%), women (62.6%), and earned <$15 000/y (69.7%); mean age was 55.5 (10.4) years. Risk factors for HF were common: hypertension (62.5%), diabetes mellitus (26.5%), myocardial infarction (8.6%), and obesity (44.8%). Over a median follow-up of 5.2 years, 4341 participants were diagnosed with HF. The age-standardized incidence rates were 34.8, 37.3, 34.9, and 35.6/1000 person-years in white women, white men, black men, and black women, respectively, remarkably higher than previously reported. Among HF cases, 952 deaths occurred over a median follow-up of 2.3 years. Men had lower survival; hazard ratios and 95% confidence intervals were 1.63 (1.27-2.08), 1.38 (1.11-1.72), and 0.90 (0.73-1.12) for white men, black men, and black women compared with white women. Conclusions--In this low-income population, HF incidence was higher for all race-sex groups than previously reported in other cohorts. The SCCS is a unique resource to investigate determinants of HF risk in a segment of the population underrepresented in other existing cohorts. [ABSTRACT FROM AUTHOR]

Background: Lifestyle and socioeconomic status have been implicated in the prevalence of hypertension; thus, we evaluated factors associated with hypertension in a cohort of blacks and whites with similar socioeconomic status characteristics.Methods and Results: We evaluated the prevalence and factors associated with self-reported hypertension (SR-HTN) and ascertained hypertension (A-HTN) among 69,211 participants in the Southern Community Cohort Study. Multivariable logistic regression models were used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) for factors associated with hypertension. The prevalence of SR-HTN was 57% overall. Body mass index was associated with SR-HTN in all race-sex groups, with the OR rising to 4.03 (95% CI, 3.74-4.33) for morbidly obese participants (body mass index, >40 kg/m(2)). Blacks were more likely to have SR-HTN than whites (OR, 1.84; 95% CI, 1.75-1.93), and the association with black race was more pronounced among women (OR, 2.08; 95% CI, 1.95-2.21) than men (OR, 1.47; 95% CI, 1.36-1.60). Similar findings were noted in the analysis of A-HTN. Among those with SR-HTN and A-HTN who reported use of an antihypertensive agent, 94% were on at least one of the major classes of antihypertensive agents, but only 44% were on ≥2 classes and only 29% were on a diuretic. The odds of both uncontrolled hypertension (SR-HTN and A-HTN) and unreported hypertension (no SR-HTN and A-HTN) were twice as high among blacks as whites (OR, 2.13; 95% CI, 1.68-2.69; and OR, 1.99; 95% CI, 1.59-2.48, respectively).Conclusions: Despite socioeconomic status similarities, we observed suboptimal use of antihypertensives in this cohort and racial differences in the prevalence of uncontrolled and unreported hypertension, which merit further investigation. [ABSTRACT FROM AUTHOR]

A previous county mortality study of populations living near two nuclear materials processing and fabrication facilities in Westmoreland and Armstrong counties in Pennsylvania (1950-1995) was extended through 2004. Noncancer mortality (1996-2004) and cancer incidence (1990-2004) were also evaluated. Among the Westmoreland and Armstrong populations, 10,547 cancer deaths occurred during the period 1996 through 2004 and the relative risk (RR) based on comparisons with six demographically similar counties in western Pennsylvania was 0.97, that is, almost exactly as expected, and no different from our previously published analyses covering the years 1950-1995. The results based on cancer incidence data were very similar to those based on cancer mortality data. Over the years 1990 though 2004, 39,350 incident cancers were reported among residents of Armstrong and Westmoreland counties and the RR based on the six demographically similar counties was 0.99, that is, almost exactly as expected. The number of deaths from nonmalignant conditions was 36,565 and very close to the number expected (RR 1.01). Overall, no increases in cancer or nonmalignant diseases could be attributed to living in counties with nuclear materials processing and fabrication facilities. [ABSTRACT FROM AUTHOR]

Previous studies of cancer incidence among persons living in municipalities within one mile of two nuclear materials processing and fabrication plants in Pennsylvania were extended for the years 1998-2004. It had been shown that mailing addresses for residents of rural areas often did not reflect the actual municipality of residence and, if not corrected, would bias study results. The previous studies had corrected for this bias. Accordingly for the extended study, we obtained mailing addresses from the Pennsylvania Department of Health (PDH) for 866 persons with cancer who presumably lived in one of eight minor civil divisions (MCDs) near or encompassing the former nuclear facilities, designated as Area 1 in previous studies conducted by the PDH. Street addresses were geocoded and local postmasters were asked to place rural delivery addresses, post office boxes and street addresses that could not be geocoded into the correct MCD of actual residence. Over 15% of the mailing addresses were found not to be within the boundaries of the Area 1 municipalities. After the mailing addresses of individuals with cancer were placed in their proper MCD of residence, the number of persons diagnosed with cancer (n = 708) and confirmed to have lived in Area 1 was as expected (728.4) based on cancer incidence rates in the general population of Pennsylvania (SIR 0.97; 95% CI 0.90-1.05). To further evaluate the patterns of cancer rates near these nuclear facilities and the influence of improved reporting and geocoding of addresses over time, analyses were conducted of publicly available cancer incidence data from 1990 through 2004. Based on mailing addresses, a steady decrease in the number of cancers reported in the Area 1 proximal MCDs was seen, in contrast to a steady rise in the number of cancers reported in seven adjacent but more distant MCDs from the nuclear facilities, designated as Area 2. These patterns were attributed to improvements over time in the geocoding of residential mailing addresses coupled with the gradual elimination and replacement of rural delivery addresses with street addresses. The incorrect placement of mailing addresses in residential Area 1 municipalities prior to about 2002 overestimated the number of cancers occurring among residents living in close proximity to the nuclear facilities and, correspondingly, underestimated the number among Area 2 residents. Summing Area 1 and Area 2 data showed that there was no change in cancer rates over time. These results are consistent with previous studies indicating that living in municipalities near the former Apollo-Parks nuclear facilities was not associated with an increase in cancer occurrence. [ABSTRACT FROM AUTHOR]

The article presents a research paper on the cancer mortality among the populations residing near the Hanford nuclear facility site in Richland, Washington. It was reported that the radio active isotopes were released into the environment from the site between 1944 and 1957. It informs that the epidemiologic study in the cancer mortality was conducted with a comparison to other counties. The study evaluated the cancer mortality recorded in the four counties near to the site from 1950 through 2000, which have the highest estimated exposure. It was compared with the cancer mortality experience in five demographically similar counties in Washington with minimal radio active isotope exposure. The study found that the overall cancer rates in the study counties were slightly below those in the comparison counties and the rates were not significantly increased in the exposed counties. More over the result showed no evidence for the cancer death rates over time differed between the study counties and the comparison counties. The study reveals that the living near the Hanford site has not increased cancer mortality.

There has been concern that living near nuclear installations might increase the risk of cancer, including childhood leukemia, in surrounding communities. Such concern has been voiced by residents in Armstrong and Westmoreland Counties in Western Pennsylvania in conjunction with the operation of two former nuclear materials processing facilities located in the Apollo borough and the Parks township, just three miles apart. These facilities began operating in 1957 and 1960 and processed uranium and plutonium for commercial and naval applications. To evaluate the possibility of increased cancer rates in communities around the ApolloParks nuclear facilities, a cancer incidence and a cancer mortality survey were conducted. The county mortality findings are reported here. Nearly 40,000 cancer deaths occurred in the population residing in Armstrong and Westmoreland Counties from 1950 through 1995. Each of these two study counties was matched for comparison to three control counties in the same region on the basis of age, race, urbanization, and socioeconomic factors available from the 1990 U.S. Census. There were over 77,000 cancer deaths in the 6 control counties during the 45 y studied. Following similar methods used by the National Cancer Institute, Standardized Mortality Ratios (SMRs) were computed as the ratio of observed numbers of cancers in the study and control counties compared to the expected number derived from general population rates of the United States. Relative risks (RR) were computed as the ratios of the SMRs for the study and the control counties. There were no significant increases in the study counties for any cancer when comparisons were made with either the U.S. population or the control counties. In particular, deaths due to cancers of the lung, bone, liver, and kidney were not more frequent in the study counties than in the control counties. These are the cancers of a priori interest given that uranium and/or plutonium might be expected to concentrate in these tissues. Deaths from all cancers combined also were not increased in the study counties, and the RRs of cancer mortality before the facilities operated (1950-1964), during plant operations (1965-1980) and after plant closure (1980-1995) were similar: 0.96, 0.95 and 0.98, respectively. For childhood leukemia mortality, the relative risk comparing the study counties with their controls before plant start-up was 1.02, while during operations (RR 0.81) and after closure (RR 0.57) the relative risks were lower. The study is limited by the correlational approach and the relatively large size of the geographic areas of the counties studied. [ABSTRACT FROM AUTHOR]

Because nuclear facilities can release radionuclides into the surrounding environment accidentally or during normal operations, there has been public concern over the possibility of adverse health effects. Two former nuclear materials processing facilities in Armstrong County Pennsylvania have been the focus of such public concern for over 20 y. The Apollo and Parks facilities processed uranium and plutonium fuels for use in nuclear applications. To evaluate the possibility of increased cancer rates in the communities near the Apollo-Parks nuclear processing materials plants, cancer incidence rates were assessed for the years 1993-1997, or nearly 40 y after the plants had begun operation in 1957 and 1960, respectively. The rates of cancer were evaluated among the approximately 17,000 persons living in 1 of 8 municipalities encompassing or near these nuclear sites. Numbers of cancers and mailing addresses (n = 935) were obtained from the Pennsylvania Department of Health. Because mailing addresses in small rural areas do not always reflect actual residences within a municipality, each of 935 addresses was validated (and corrections made when indicated) by contacting area postmasters and using Census Bureau geocoding information, street maps, and aerial photographs. Standardized Incidence Ratios (SIRs) were computed as the ratio of observed numbers of cancers in the study area compared to the expected number derived from general population rates of Pennsylvania. Forty percent of the mailing addresses were found not to be within the boundaries of the study municipalities. After excluding these persons who did not reside in one of the eight municipalities near the Apollo-Parks facilities, 581 cancers remained in contrast to 574.0 expected (SIR 1.01; 95% confidence interval 0.93-1.10). Based upon knowledge of the tissues where uranium or plutonium likely would be deposited after intake, cancers of the lung (SIR 0.88), kidney (SIR 1.05), non-Hodgkin's lymphoma (SIR 1.10), liver (SIR 0.61), and bone (2 observed vs. 1.19 expected) were carefully evaluated but no significant excesses were noted at these sites. Cancers of the female breast and thyroid and leukemia also were not significantly increased, as expected since these tissues are not sites where uranium or plutonium would concentrate. Overall, no increase in cancer risk could be attributed to living near the two former nuclear materials processing facilities. However, misleading elevations in cancer risks would have been suggested if mailing addresses had not been corrected to exclude addresses that were not within the boundaries of the municipalities for which population data were available. The study had sufficient power to exclude increased cancer risks of 10% or greater. [ABSTRACT FROM AUTHOR]

Provides information on a study which evaluated risk of lung cancer and other diseases among male employees at gas generator utility companies in the United States. Methods; Results and discussion.

In this article, biomedical literature assessing risks of nasal cancer and nonmalignant nasal pathology among woodworkers in North America is reviewed in detail and contrasted with experience from Europe and elsewhere. Exceptionally high rates of nasal adenocarcinoma have occurred among European hardwood furniture workers, but the epidemiologic evidence documents a disparity in findings between North America and Europe. Cohort studies of American wood-dust-exposed groups do not reveal excesses of nasal cancer, and wood-dust associations from US and Canadian case-control studies of nasal cancer tend not to be strong and differ across studies. Quantitative wood-dust exposure data are generally unavailable, but general dose information in European studies suggests that the excess risk of nasal cancer is associated with high levels of exposure. There is also an inconsistent association between wood-dust exposure per se and mucostasis or nasal histologic changes, and the mucostasis/metaplasia/dysplasia route to nasal cancer is still an unverified hypothesis. Considering the totality of evidence on the risk of cancer in exposed workers, it appears that wood-dust-related nasal adenocarcinoma essentially can be eliminated in Europe and its occurrence prevented in the United States if wood-dust exposures do not exceed an 8-hour time-weighted average 5 mg/m3 standard. [ABSTRACT FROM AUTHOR]

Background and Objectives: Although the importance of healthy lifestyles for preventing Alzheimer disease and related dementias (ADRD) has been recognized, epidemiologic evidence remains limited for non-White or low-income individuals who bear disproportionate burdens of ADRD. This population-based cohort study aims to investigate associations of lifestyle factors, individually and together, with the risk of ADRD among socioeconomically disadvantaged Americans., Methods: In the Southern Community Cohort Study, comprising two-thirds self-reported Black and primarily low-income Americans, we identified incident ADRD using claims data among participants enrolled in Medicare for at least 12 consecutive months after age 65 years. Five lifestyle factors-tobacco smoking, alcohol consumption, leisure-time physical activity (LTPA), sleep hours, and diet quality-were each scored 0 (unhealthy), 1 (intermediate), or 2 (healthy) based on the health guidelines. A composite lifestyle score was created by summing all scores. Cox regression was used to estimate hazard ratios (HRs, 95% CIs) for incident ADRD, treating death as a competing risk., Results: We identified 1,694 patients with newly diagnosed ADRD among 17,209 participants during a median follow-up of 4.0 years in claims data; the mean age at ADRD diagnosis was 74.0 years. Healthy lifestyles were individually associated with an 11%-25% reduced risk of ADRD: multivariable-adjusted HR (95% CI) was 0.87 (0.76-0.99) for never vs current smoking, 0.81 (0.72-0.92) for low-to-moderate vs no alcohol consumption, 0.89 (0.77-1.03) for ≥150 minutes of moderate or ≥75 minutes of vigorous LTPA each week vs none, 0.75 (0.64-0.87) for 7-9 hours vs >9 hours of sleep, and 0.85 (0.75-0.96) for the highest vs lowest tertiles of the Healthy Eating Index. The composite lifestyle score showed a dose-response association with up to 36% reduced risk of ADRD: multivariable-adjusted HRs (95% CIs) across quartiles were 1 (ref), 0.88 (0.77-0.99), 0.79 (0.70-0.90), and 0.64 (0.55-0.74); p trend <0.001. The beneficial associations were observed regardless of participants' sociodemographics (e.g., race, education, and income) and health conditions (e.g., history of cardiometabolic diseases and depression)., Discussion: Our findings support significant benefits of healthy lifestyles for ADRD prevention among socioeconomically disadvantaged Americans, suggesting that promoting healthy lifestyles and reducing barriers to lifestyle changes are crucial to tackling the growing burden and disparities posed by ADRD., (© 2022 American Academy of Neurology.)

To compare temporal trends in the incidence and mortality of renal cell cancer among blacks and whites for clues to etiologic differences. We examined trends in age-adjusted and age-specific Surveillance Epidemiology and End Results incidence and US mortality rates for renal cancer for 1973 through 2007, as well as nephrectomy rates from surgery codes for kidney cancer for 2000 through 2007. For nearly four decades, incidence rates for renal cell cancer have been rising more rapidly among blacks than whites, leading to a shift in excess from among whites to among blacks, almost entirely accounted for by an excess of localized disease. The incidence patterns are puzzling, as localized renal cell cancer is primarily detected incidentally by imaging, to which blacks have historically had less access. In contrast to the incidence patterns, there has been an unexpected convergence of renal cancer mortality rates, which have been virtually identical among blacks and whites since the early 1990 s. Nephrectomy rates, regardless of stage, were lower among blacks than among whites, despite almost identical cause-specific survival rates in both races. The identical mortality patterns, combined with higher and more rapidly increasing incidence and lower rates of nephrectomies among blacks, suggest that renal cell cancer may tend to be a less aggressive tumor in blacks. This hypothesis is supported by the favorable stage distribution among blacks and their higher survival for distant and unstaged cancer. Further research into the enigmatic descriptive epidemiology and the biology and natural history of renal cell cancer may shed light on the etiology of this malignancy and its more frequent occurrence among black Americans.

Background: The first Björk-Shiley convexoconcave (BSCC) prosthetic heart valves were implanted in 1978. The 25th anniversary provided a stimulus to summarize the research data relevant to BSCC valve fracture, patient management, and current clinical options., Methods and Results: Published and unpublished data on the risks of BSCC valve fracture and replacement were compiled, and strategies for identifying candidates for prophylactic valve reoperation were summarized. By December 2003, outlet strut fractures (OSFs), often with fatal outcomes, had been reported in 633 BSCC valves (0.7% of 86,000 valves implanted). Fractures still continue to occur, but average rates of OSFs in 60 degrees valves are now <0.1% per year. OSF risk varies markedly by valve characteristics, especially valve angle and size, with weaker effects associated with other manufacturing variables. OSF risks are mildly lower among women than men but decline sharply with advancing age. The risks of valve replacement typically greatly exceed those of OSF. By comparing individualized estimated risks of OSF versus valve replacement, guidelines have been developed to identify the small percentage of BSCC patients (mostly younger men) who would be expected to have a gain in life expectancy should reoperative surgery be performed., Conclusions: Twenty-five years after the initial BSCC valve implants, fractures continue to occur. Continued monitoring of BSCC patients is needed to track and quantify risks and enable periodic updating of guidelines for patients and their physicians.

Objective: We sought to evaluate rates of hospitalizations for neurodegenerative disorders in a cohort of Danish metal manufacturing employees., Methods: A retrospective cohort study was conducted from 1977 to 2002 among 27,839 male Danish metal-manufacturing employees, with 9,817 of those employed in departments engaged in mild or stainless-steel welding and 6,163 welders., Results: The standardized hospitalization ratio and 95% confidence intervals (CI) for Parkinson's disease were 0.9 (CI = 0.7-1.2) for men in steel-manufacturing companies, 1.0 (CI = 0.7-1.5) for men in welding departments, and 0.9 (CI = 0.4-1.5) for welders. Observed numbers for other neurological conditions were small and not above population expectations. Analyses for time period worked, age, and duration of welding were unremarkable., Conclusions: This relatively large cohort study with long-term follow-up provides no support for the hypothesis that rates of hospitalization for Parkinson's disease or other neurological conditions are elevated under the exposure circumstances of these Danish workers.