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15. Neighborhood of residence and incidence of coronary heart disease.

Author

Diez Roux, A V, Diez Roux, A V, Merkin, S S, Arnett, D, Chambless, L, Massing, M, Nieto, F J, Sorlie, P, Szklo, M, Tyroler, H A, Watson, R L, Diez Roux, A V, Diez Roux, A V, Merkin, S S, Arnett, D, Chambless, L, Massing, M, Nieto, F J, Sorlie, P, Szklo, M, Tyroler, H A, and Watson, R L

Abstract

BACKGROUND: Where a person lives is not usually thought of as an independent predictor of his or her health, although physical and social features of places of residence may affect health and health-related behavior. METHODS: Using data from the Atherosclerosis Risk in Communities Study, we examined the relation between characteristics of neighborhoods and the incidence of coronary heart disease. Participants were 45 to 64 years of age at base line and were sampled from four study sites in the United States: Forsyth County, North Carolina; Jackson, Mississippi; the northwestern suburbs of Minneapolis; and Washington County, Maryland. As proxies for neighborhoods, we used block groups containing an average of 1000 people, as defined by the U.S. Census. We constructed a summary score for the socioeconomic environment of each neighborhood that included information about wealth and income, education, and occupation. RESULTS: During a median of 9.1 years of follow-up, 615 coronary events occurred in 13,009 participants. Residents of disadvantaged neighborhoods (those with lower summary scores) had a higher risk of disease than residents of advantaged neighborhoods, even after we controlled for personal income, education, and occupation. Hazard ratios for coronary events in the most disadvantaged group of neighborhoods as compared with the most advantaged group--adjusted for age, study site, and personal socioeconomic indicators--were 1.7 among whites (95 percent confidence interval, 1.3 to 2.3) and 1.4 among blacks (95 percent confidence interval, 0.9 to 2.0). Neighborhood and personal socioeconomic indicators contributed independently to the risk of disease. Hazard ratios for coronary heart disease among low-income persons living in the most disadvantaged neighborhoods, as compared with high-income persons in the most advantaged neighborhoods were 3.1 among whites (95 percent confidence interval, 2.1 to 4.8) and 2.5 among blacks (95 percent confidence interval, 1.4 to 4

Published
2001

17. CHD Risk Factors In African-Americans

Author

Jones, Daniel W, primary, Chambless, Lloyd E, additional, Folsom, Aaron R, additional, Hutchinson, Richard G, additional, Sharrett, Richey A, additional, Tyroler, H A, additional, and Taylor, Herman A, additional

Published
2001
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33. Socioenvironmental Characteristics Associated with the Onset of Decline of Ischemic Heart Disease Mortality in the United States.

Author

Wing, Steve, Casper, Michele, Riggan, Wilson, Hayes, Carl, and Tyroler, H. A.

Subjects
CORONARY disease, MEDICAL care, MORTALITY, WHITE men, DISEASE risk factors, PUBLIC health, HEART diseases, EPIDEMIOLOGY
Abstract

Abstract: The relation of community socioenvironmental characteristics to timing of the onset of decline of ischemic heart disease (IHD) mortality was investigted among the 507 State Economic Areas of the continental United States. Onset of decline was measured using data for White men aged 35-74 and classified as early (1968 or before) vs late (after 1968). Ten socioenvironmental characteristics derived from US Census Bureau data were strongly related to onset of decline. Areas with the poorest socioenvironmental conditions were two to 10 times more likely to experience late onset than those areas with the highest levels. We found that income-related characteristics could account for most of the difference in onset of decline of IHD between metropolitan and non-metropolitan places. We conclude that community socioenvironmental characteristics provide the context for changes in risk factors and medical care. (Am J Public Health 1988; 78:923-926.) [ABSTRACT FROM AUTHOR]

Published
1988
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34. Geographic Variation in the Onset of Decline of Ischemic Heart Disease Mortality in the United States.

Author

Wing, Steve, Hayes, Carl, Heiss, Gerardo, John, Esther, Knowles, Maryilyn, Riggan, Wilson, and Tyroler, H. A.

Subjects
CORONARY disease, HEART diseases, CARDIOLOGY, DEMOGRAPHY, OLDER people, MORTALITY, DEMOGRAPHIC surveys, MEDICAL care
Abstract

Abstract: This report examines geographic variation in the onset of the decline of ischemic heart disease (IHD) mortality in white males aged 35-74 during the period 1968-78. Using a quadratic regression model. State Economic Areas (SEAs) were classified as experiencing onset of the decline in 1968 or earlier, 1969-72, or 1973 or later. In the United States as a whole, approximately one-third of SEAs experienced a late onset of the decline (after 1968). Metropolitan SEAs were in advance of non-metropolitan, and the North east and Pacific states showed earlier onset than the South and midsections of the country. The acceleration of the national decline after 1972 appears to be due to declines in areas tn which rates had been increasing or in plateau until that time. Evidence about geographic variation in the onset of decline may provide clues about social and environmental factors responsible for the decline. [ABSTRACT FROM AUTHOR]

Published
1986
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42. Multi-country comparison of plasma lipid relationship to years of schooling in men and women.

Author

Perova, N V, Davis, C E, Tao, S, Pajak, A, Stein, Y, Broda, G B, Li, Y, and Tyroler, H A

Abstract

The association between coronary heart disease (CHD) and social status has differed among societies in strength and direction. As years of schooling is a major determinant of socioeconomic status and dyslipidaemia a major CHD determinant, the purpose of this investigation is to estimate the association of years of schooling with plasma lipids and lipoproteins among samples from five countries representing different cultures, socio-political systems and stages of economic development.

Published
2001
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43. Status of Patients Seven Years After Completion of the Hypertension Detection and Follow-up Program in Evans County, Georgia

Author

Comberg, H. U., Knowles, M., Tyroler, H. A., Heyden, S., Hames, C. G., and Sabo, D.

Subjects
Adult, Male, Georgia, Black People, Middle Aged, Cohort Studies, Random Allocation, Original Communications, Hypertension, Humans, Female, cardiovascular diseases, Antihypertensive Agents, Aged, Follow-Up Studies
Abstract

The Evans County, Georgia, cohort of the Hypertension Detection and Follow-up Program (HDFP) was reexamined seven years after termination of the trial in 1979. Of the 510 survivors, 91 percent of the black and 91 percent of the white hypertensive subjects were evaluated by blood pressure (BP) levels, electrocardiograms (ECG), height-weight measurements, and questionnaire. The HDFP had treated a randomly selected half of the patients in an intensive stepped care (SC) program and the other half was referred to usual care (RC). At the beginning of the five-year trial, diastolic blood pressure (DBP) levels were higher in blacks in both SC and RC. At the completion of the trial in 1979, black women had mean DBP levels comparable to whites in both SC and RC, but black men displayed higher levels. During the five years of the trial there were no cases of left ventricular hypertrophy (LVH) in SC in either race. In RC the incidence of LVH was slightly higher in blacks than in whites. During the seven-year post-trial period, the incidence of LVH in blacks rose to 13 percent, more than double that of whites. Medication compliance was reduced in black men during this time, most likely because of removal of the supporting elements of HDFP (frequent medical contacts, free medication).In both races, hypertensive subjects underwent weight changes during the seven years of the post-trial period. Weight loss of 15 lb was associated with normotension. Weight gain of 9 to 10 lb over seven years was associated with hypertensive BP levels.The supportive or detrimental effect of weight loss or weight gain on BP levels was thus reconfirmed in this biracial cohort.

Published
1988

44. Blood Pressure and Skin Color.

Author

Tyroler, H. A. and James, Sherman A.

Subjects
*PHYSICAL anthropology -- Research, *HUMAN skin color, *BLOOD pressure, *SKIN color of African Americans, *PUBLIC health, *RACE discrimination, *ETIOLOGY of diseases, *DISEASES in African Americans
Abstract

The article focuses on a study which explores the role of skin color and ethnicity in elevated blood pressure of urban black and white residents of Detroit, Michigan. It is suggested that even if effective treatment is available to reduce deterioration abnormalities of moderate and severe elevation of blood pressure, its primary prevention should be the long range public health goal. Studies have documented the prevalence of morbidity and mortality associated with high blood pressure among African Americans compared to the white population. Detroit researchers used color-consciousness among white and black Americans, and found the truth that blacks with darker skin suffered rejection and discrimination compared to those with lighter skin color.

Published
1978
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