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Objective: Racial/ethnic minorities in the U.S. have a higher prevalence of type 2 diabetes mellitus (T2DM) than white adults. While many independent risk factors for T2DM have been identified, these determinants are often viewed in isolation without considering the joint contributions of competing risk factors. The objective of this study was to assess the relative contributions of six domains of influence to racial/ethnic disparities in T2DM.Research Design and Methods: Cross-sectional analyses were conducted using the Boston Area Community Health III Survey (2010-2012), the third wave of a population-based sample of men and women from three racial/ethnic groups (black, Hispanic, white) living in Boston, Massachusetts (N = 2,764). Prevalent diabetes was defined by self-report of T2DM, fasting glucose >125 mg/dL, or HbA1c ≥6.5%. Structural equation models were constructed to evaluate the direct effects of each conceptual domain of influence on T2DM prevalence, as well as their indirect effects on the race/ethnicity-T2DM relationship. All direct and indirect pathways were included.Results: The final model indicated that 38.9% and 21.8% of the total effect of black race and Hispanic ethnicity, respectively, on T2DM prevalence was mediated by the socioeconomic, environmental, psychosocial, and lifestyle/behavioral risk scores. The largest mediating influence was the socioeconomic risk score, which explained 21.8% and 26.2% of the total effect of black race and Hispanic ethnicity, respectively.Conclusions: Our study found that socioeconomic factors had the greatest impact on explaining the excess prevalence of T2DM among racial/ethnic minorities. [ABSTRACT FROM AUTHOR]

Evidence to substantiate recommendations for restriction of caffeinated or acidic beverages as self-management for lower urinary tract symptoms (LUTS) is limited. We examined longitudinal and acute associations between beverage intake and LUTS in the Boston Area Community Health (BACH) cohort (n = 4,144) between 2002 and 2010. Multivariable models tested associations between baseline intakes and progression of LUTS at 5-year follow-up, between follow-up intakes and International Prostate Symptom Scores at follow-up, and between 5-year intake changes and LUTS progression. Greater coffee or total caffeine intake at baseline increased the odds of LUTS progression in men (coffee: >2 cups/day vs. none, odds ratio = 2.09, 95% confidence interval: 1.29, 3.40, P-trend = 0.01; caffeine: P-trend < 0.001), particularly storage symptoms. Women who increased coffee intake by at least 2 servings/day during follow-up (compared with categories of decreased or unchanged intakes) had 64% higher odds of progression of urgency (P = 0.003). Women with recently increased soda intake, particularly caffeinated diet soda, had higher symptom scores, urgency, and LUTS progression. Citrus juice intake was associated with 50% lower odds of LUTS progression in men (P = 0.02). Findings support recommendations to limit caffeinated beverage intake for LUTS, and in men, they suggest benefits of citrus juice consumption. Further clinical research is warranted, particularly of the precise role of sodas containing artificial sweeteners in bladder sensations and urological function. [ABSTRACT FROM AUTHOR]

Purpose: Lower urinary tract symptoms (LUTS) such as urinary frequency and urgency are bothersome and associated with reduced quality of life. Atypical antipsychotics (AAPs) have been implicated in increasing the risk of urinary incontinence. In a large community-based sample of men and women, we examined the associations of AAP and selective serotonin reuptake inhibitor (SSRIs) use with LUTS. Methods: Data were collected (2002-2005) from a generalizable sample of Boston, MA, USA, residents aged 30-79 ( N = 5503). LUTS were assessed using the American Urologic Association Symptom Index (AUA-SI). The prevalence of clinically-significant LUTS was estimated using a cutoff AUA-SI score of 8+ to indicate moderate-to-severe symptoms. Confounder-adjusted odds ratios (ORs) and 95% confidence intervals (CI) were calculated from multivariate logistic regression to estimate the associations for psychoactive drugs used in the previous month (SSRIs, AAPs, both) and LUTS. Results: Among women, AAP users had a higher prevalence of LUTS (46.2%) compared with SSRI users (23.5%) and those with depressive symptoms not using SSRIs or AAPs (26.3%). Corresponding prevalence estimates among men were 32.7%, 29.8%, and 33.3%. In multivariate models, AAP use was significantly associated with LUTS among women when used either with (OR = 2.72, 95% CI:1.45-5.10) or without (OR = 3.05, 95% CI:1.30-7.16) SSRIs, but SSRI use without AAP use was not associated with LUTS compared with nonusers without depressive symptoms. No associations were observed among men. Conclusions: In our study, AAPs but not SSRIs were associated with increased prevalence of LUTS among women only. Further prospective research is needed to determine time sequence and cause and effect. [ABSTRACT FROM AUTHOR]

Summary: The relative importance of various contributors to racial/ethnic variation in BMC/BMD is not established. Using population-based data, we determined that body composition differences (specifically skeletal muscle and fat mass) are among the strongest contributors to these variations. Introduction: Racial/ethnic variation in fracture risk is well documented, but the mechanisms by which such heterogeneity arises are poorly understood. We analyzed data from black, Hispanic, and white men enrolled in the Boston Area Community Health/Bone (BACH/Bone) Survey to determine the contributions of risk factors to racial/ethnic differences in bone mineral content (BMC) and density (BMD). Methods: In a population-based study, BMC, BMD, and body composition were ascertained by DXA. Socioeconomic status, health history, and dietary intake were obtained via interview. Hormones and markers of bone turnover were obtained from non-fasting blood samples. Multivariate analyses measured percentage reductions in estimated racial/ethnic differences in BMC/BMD, accompanying the successive removal of covariates from linear regression models. Results: Black men demonstrated greater BMC than their Hispanic and white counterparts. At the femoral neck, adjustment for covariables was sufficient to reduce these differences by 46% and 35%, respectively. While absolute differences in BMC were smaller at the distal radius than femoral neck, the proportionate reductions in racial/ethnic differences after covariable adjustment were comparable or greater. Multivariate models provided evidence that lean and fat mass, serum 25(OH)D, osteocalcin, estradiol, and aspects of socioeconomic status influence the magnitude of racial/ethnic differences in BMC, with lean and fat mass providing the strongest effects. Results for BMD were similar, but typically of lesser magnitude and statistical significance. Conclusions: These cross-sectional analyses demonstrate that much of the racial/ethnic heterogeneity in measures of bone mass and density can be accounted for through variation in body composition, diet, and socio-demographic factors. [ABSTRACT FROM AUTHOR]

There is evidence for a role of inflammation in the etiology of lower urinary tract symptoms (LUTS), raising the possibility that use of nonsteroidal antiinflammatory drugs (NSAIDs) may inhibit the development or progression of LUTS. The authors examined the association between use of prescription and over-the-counter NSAIDs and LUTS among 1,974 men and 2,661 women in the Boston Area Community Health Survey (2002–2005). Multivariable-adjusted logistic regression was used to estimate odds ratios and 95% confidence intervals for LUTS, voiding symptoms, storage symptoms, and nocturia. There was no clear association between use of prescription or over-the-counter NSAIDs (compared with no NSAID use) and overall LUTS, voiding symptoms, or nocturia in men or women. However, over-the-counter NSAID use was positively associated with storage symptoms in women (odds ratio = 1.37, 95% confidence interval: 1.03, 1.83), and there was a positive association between over-the-counter NSAID use and overall LUTS among women with a history of arthritis (odds ratio = 2.09, 95% confidence interval: 1.20, 3.64). These results do not provide strong support for an association between NSAIDs and LUTS. However, the associations between over-the-counter NSAID use and certain urologic symptoms, particularly among women with arthritis, and the potential mechanisms involved should be evaluated in future studies. [ABSTRACT FROM PUBLISHER]

To determine, qualitatively and quantitatively, how individuals use fluid manipulation to self-manage the urinary symptoms of daytime frequency, urgency and urine leakage and the underlying rationale for this behaviour. Lower urinary tract symptoms are prevalent and burdensome, and little is known about how individuals with lower urinary tract symptoms manipulate their fluid intake. A mixed methods design included statistical analysis of data from a population-based survey of urologic symptoms and qualitative analysis of in-depth interviews. Quantitative data came from 5503 participants of the baseline Boston Area Community Health Survey, a population-based, random sample epidemiologic survey of urologic symptoms. Qualitative data came from in-depth interviews with a random subsample from Boston Area Community Health of 152 black, white and Hispanic men and women with LUTS. Qualitative data showed that some respondents restricted fluid intake while others increased it, in both cases with the expectation of improved symptoms. Quantitative data showed that fluid intake was greater in men and women reporting frequency ( p < 0·001). Women with frequency drank significantly more water ( p < 0·001), while women with urgency drank significantly less water ( p = 0·047). This study found divergent expectations of the role of fluids in alleviating symptoms, leading some individuals to restrict and others to increase fluid intake. Individuals with lower urinary tract symptoms may need guidance in fluid management. Nurses should be aware that patients may self-manage lower urinary tract symptoms by restricting fluid intake, putting them at risk for dehydration, constipation and urinary tract infection, but also that they may be increasing their fluid intake, which could worsen symptoms. This study pinpoints a specific area of need among patients with lower urinary tract symptoms and provides a practical opportunity for nurses to assist their patients with behavioural and fluid management by emphasising the clinical guidelines. [ABSTRACT FROM AUTHOR]

This article examines the sociodemographic and health characteristics of the underinsured—people who have some health insurance but are having trouble paying for health care or medications. It uses data from the Boston Area Community Health (BACH) Survey, a large (N = 5,503) community-based random sample of Boston residents aged 30 to 79 years (1,767 black, 1,877 Hispanic, and 1,859 white; 2,301 men and 3,202 women). The authors found that minorities were less likely than whites to have health insurance (for men and women, respectively, 30% and 19% of Hispanics, 16% and 9% of blacks, and 9% and 7% of whites lacked health insurance). Blacks were the most likely to be underinsured (for men and women, respectively, 18% and 20% of blacks vs. 9% and 14% of Hispanics and 8% and 12% of whites were underinsured). Those of lower and middle socioeconomic status were also more likely to be uninsured or underinsured. The health status of the uninsured was similar to that of the adequately insured, whereas those who were underinsured reported more co-morbidities and depression. The underinsured are generally older and sicker, and make greater use of the health care system, and may present a larger public health and health policy challenge than the uninsured. [ABSTRACT FROM AUTHOR]

Focus on individual risk factors for osteoporosis could allocate disproportionate attention to trivial relationships. We tested many recognized risk factors of osteoporosis for their association with bone mineral density (BMD) in multivariate models among men. Lean mass accounted for the most variance, with substantially less accounted for by demographic, strength, and health factors. Osteoporosis in men has gained recognition as a public health problem, generating an interest in the search for risk factors. Isolation of individual risk factors could allocate disproportionate attention to relationships that may be of limited consequence. The Boston Area Community Health/Bone (BACH/Bone) Survey is a population-based study of randomly selected community-dwelling men (age, 30–79 years). BMD and lean mass were measured by dual X-ray absorptiometry. Socioeconomic status, health history, and lifestyle factors were obtained via interview. Hormone levels and markers of bone turnover were obtained from non-fasting blood samples. Multivariate analyses measured relative contributions of covariates to femoral neck (hip), one-third distal radius (wrist), and lumbar spine BMD. Factors positively associated with BMD in multivariate models at the three sites were black race and appendicular lean mass. Asthma was consistently negatively associated. Various other risk factors also contributed significantly to each of the individual sites. R2 values for the hip, wrist, and spine were 41%, 30%, and 24%, respectively. Lean mass accounted for the most explained variance at all three sites. These data emphasize the limitation of focusing on individual risk factors and highlight the importance of potentially modifiable lean mass in predicting BMD. [ABSTRACT FROM AUTHOR]

Purpose: In this study we investigated the relationship between lower urinary tract symptoms as defined by the American Urological Association symptom index and the metabolic syndrome, and determined the relationship between individual symptoms comprising the American Urological Association symptom index and the metabolic syndrome. Materials and Methods: The Boston Area Community Health Survey used a 2-stage cluster design to recruit a random sample of 2,301 men 30 to 79 years old. Analyses were conducted on 1,899 men who provided blood samples. Urological symptoms comprising the American Urological Association symptom index were included in the analysis. The metabolic syndrome was defined using a modification of the Adult Treatment Panel III guidelines. The association between lower urinary tract symptoms and the metabolic syndrome was assessed using odds ratios and 95% confidence intervals estimated using logistic regression models. Results: Increased odds of the metabolic syndrome were observed in men with mild to severe symptoms (American Urological Association symptom index 2 to 35) compared to those with an American Urological Association symptom index score of 0 or 1 (multivariate OR 1.68, 95% CI 1.21–2.35). A statistically significant association was observed between the metabolic syndrome and a voiding symptom score of 5 or greater (multivariate adjusted OR 1.73, 95% CI 1.06–2.80) but not for a storage symptom score of 4 or greater (multivariate adjusted OR 0.94, 95% CI 0.66–1.33). Increased odds of the metabolic syndrome were observed even with mild symptoms, primarily for incomplete emptying, intermittency and nocturia. These associations were observed primarily in younger men (younger than 60 years) and were null in older men (60 years old or older). Conclusions: The observed association between urological symptoms and the metabolic syndrome provides further evidence of common underlying factors between lower urinary tract symptoms and chronic conditions outside the urinary tract. [Copyright &y& Elsevier]

Purpose: Racial/ethnic disparities in nocturia prevalence have been reported previously. We estimated nocturia prevalence rates by race/ethnicity and determined the contribution of socioeconomic status to potential differences by race/ethnicity. Materials and Methods: The Boston Area Community Health Survey used a multistage stratified design to recruit a random sample of 5,501 adults, including 2,301 men and 3,200 women, who were 30 to 79 years old. Nocturia was defined as voiding more than once per night in the last week or voiding more than once per night fairly often, usually or almost always in the last month. Self-reported race/ethnicity was defined as black, Hispanic and white. Socioeconomic status was defined as a combination of education and household income. Results: The overall prevalence of nocturia was 28.4% with a higher prevalence in black and Hispanic participants compared to white participants (38.6% and 30.7%, respectively, vs 23.2%), a trend that was consistent by gender. After adjusting for socioeconomic status the increased odds of nocturia in Hispanic men disappeared (adjusted OR 1.04, 95% CI 0.71, 1.52), while the OR in black men was attenuated but remained statistically significant (OR 1.57, 95% CI 1.12, 2.21). In women the association between race/ethnicity and nocturia was attenuated but remained statistically significant after adjusting for socioeconomic status. Conclusions: Socioeconomic status accounts for part of the racial/ethnic disparities in prevalence of nocturia. The effect of socioeconomic status was more pronounced in men and in Hispanic participants, while differences in nocturia prevalence remained significant in black men and women. [Copyright &y& Elsevier]

Purpose: We investigated the association between lower urinary tract symptoms and chronic illness, such as heart disease, diabetes, hypertension and depression, in men and women. In addition, we determined whether a dose-response relationship exists in the association between the severity and duration of urological symptoms and major chronic illnesses. Materials and Methods: The Boston Area Community Health Survey used a multistage stratified design to recruit a random sample of 5,503 adults who were 30 to 79 years old. Urological symptoms in the American Urological Association symptom index were included in analysis. Results: Statistically significant associations that were consistent by gender were observed between depression and all urological symptoms. Nocturia of any degree of severity or duration was associated with heart disease in men and with diabetes in women. In men a dose-response relationship was observed for the association of symptom severity and/or the duration of urinary intermittency and frequency with heart disease, and for the association of urinary urgency with diabetes. In women a history of heart disease was associated with a weak stream and straining, while a history of hypertension was associated with urgency and a weak stream. Conclusions: Results indicate a dose-response relationship in the association of the severity and duration of urological symptoms with major chronic illnesses. An association between urinary symptoms and depression was observed in men and women. In contrast, the association between lower urinary tract symptoms and heart disease, diabetes or hypertension varied by gender, suggesting different mechanisms of association in men and women. [Copyright &y& Elsevier]

The article presents a study on the treatment of Symptomatic Androgen Deficiency (AD) on community-dwelling men conducted in Boston, Massachusettes. A population-based random sample of men with diverse ethnical and racial background is gathered and collected venous blood sample from them. A total of 5.5 percent of the men studied are diagnosed with untreated symptomatic AD, and 0.58 percent are classified with treated AD. The reasons why men with AD are not treated properly in spite of adequate access to care are still unknown.

OBJECTIVES: To determine whether testosterone (T) levels are associated with frailty or its components. DESIGN: Population-based cohort study conducted in three waves (T1: 1987–1989, T2: 1995–1997, T3: 2002–2004). SETTING: Communities in the Boston, Massachusetts, area. PARTICIPANTS: Six hundred forty-six men aged 50 to 86 at T3 with complete data on frailty components and hormone measurements. MEASUREMENTS: The frailty phenotype was defined as the presence of three or more of the following: weight loss, exhaustion, low physical activity, slowness, and weakness. Men were classified as frail (≥3 components), intermediate (1–2 components), and nonfrail (0 components). Whether total and free T or sex hormone–binding globulin (SHBG) levels were associated cross-sectionally with frailty and with degree of frailty was determined. Potential confounders such as age, chronic disease, lifestyle factors, diet, and physical activity were considered. RESULTS: No association was observed between total or free T and the frailty phenotype after adjusting for confounders. Conversely, a significant association was observed between SHBG and frailty phenotype with an adjusted odds ratio of 1.25 (95% confidence interval=1.06–1.46) per 10-nM increase in SHBG levels. Associations between hormones and degree of frailty were similar to those for overall frailty. Of frailty components, grip strength and physical activity, but not exhaustion, slow walking, or weight loss, were associated with total T levels, whereas SHBG was related to weight loss, exhaustion, and physical activity. CONCLUSION: Total and free T levels were not associated with frailty phenotype, but SHBG was. Furthermore, T and SHBG levels were associated with some, but not all, components of frailty. Therefore, T trials in older men should focus on men experiencing decreases in strength. [ABSTRACT FROM AUTHOR]

In a large epidemiological study, authors investigated the effect of LUTS on quality of life among various cultures. They showed a close association between the two, and that the effect of having moderate symptoms has a similar effect on quality of life as diabetes, hypertension or cancer, and that having severe symptoms had a similar effect as a heart attack or stroke. OBJECTIVES To investigate the effect of lower urinary tract symptoms (LUTS) on quality of life (QoL) and to determine its extent across a variety of cultures, and the confounding effects of self-reported comorbidities and demographics. SUBJECTS AND METHODS Data were obtained from two population-based studies in five cities: UREPIK (Boxmeer, the Netherlands; Auxerre, France; Birmingham, UK; and Seoul, Korea) and the Boston Area Community Health (BACH) study (Boston, USA). UREPIK used stratified random samples of men aged 40–79 years. BACH used a multistage stratified cluster sample to randomly select adults aged 40–79 years. QoL was assessed using a standard Medical Outcomes Study–Short Form 12 (SF-12, mental and physical health component scores); LUTS was assessed using the International Prostate Symptom Score (IPSS). The association between QoL and IPSS, associated illnesses, and lifestyle factors was investigated using weighted regression. RESULTS The UREPIK studied 4800 men aged 40–79 years; BACH recruited 1686 men aged 40–79 years. The prevalence of LUTS, defined as an IPSS of ≥8, varied by city ( P < 0.001), with Auxerre reporting a prevalence (se) of 18.1 (1.2)%, Birmingham 25.6 (1.5)%, Boston 25.1 (1.6)%, Boxmeer 21.2 (1.3)%, and Seoul 19.0 (1.2)%. Overall, this was similar to the reported rate of high blood pressure. Severe LUTS, defined as an IPSS of ≥20, affected ≈ 3.3% of the age group; this was roughly similar to stroke (2.2%), cancer (4.5%), or heart attack (4.5%) and less than half as much as diabetes (8.6%). A 10-point increase in IPSS was associated with a 3.3 (0.3)-point reduction in SF-12 physical health component score, with the same effect in all cities ( P = 0.682 for the interaction test). This was more than the physical health component score reduction caused by cancer, diabetes, or high blood pressure (2 points each), but less than stroke or heart attack (6 points). The comorbidities had no significant impact on SF-12 mental health component score (other than a heart attack, that had a 1.8-point reduction). A 10-point increase in IPSS was associated with a 3.4 (0.6)-point reduction of the mental health component score in the four western cities and a 1.4 (0.3)-point reduction in Seoul. CONCLUSIONS Increasingly severe LUTS is associated with a lower QoL. The effect of moderate LUTS on QoL physical health component score is similar to that of having diabetes, high blood pressure or cancer, while the effect of severe LUTS is similar to a heart attack or stroke. These changes were consistent across cultures. This analysis shows the magnitude and consistency of the effects of LUTS on QoL. While these patients might be seen by several types of practitioners, it is likely that urologists will be in the best position to recognize the true impact of LUTS on a patient’s QoL, to be aware of the effects of therapies for LUTS on QoL, and to ensure that colleagues in other disciplines recognize the importance of these symptoms and their treatment. [ABSTRACT FROM AUTHOR]

The article studies the prevalence of lower urinary tract symptoms (LUTS) and effect on quality of life in a racially and ethnically diverse random sample in Boston, Massachusetts. It shows that LUTS are common among both men and women and increased substantially with age. The article also shows that LUTS have a negative impact on quality of life across age, sex, and race/ethnic groups.

Objective Sex steroids may contribute to the increased prevalence of heart disease (HD) in men compared to age-matched women. Androgens bind their cognate receptor, and androgen action is inversely proportional to the number of CAG repeats in exon 1 of the androgen receptor gene. Longer, less androgenic CAG repeats have been associated with higher high-density lipoprotein (HDL) levels, which might protect against HD. Therefore, we hypothesized that CAG repeat length contributes to HD risk in men. Design Longitudinal, population-based cohort study. Population One thousand thirty-four participants from the Massachusetts Male Ageing Study, a cohort of 1709 men from the Boston area, aged 40-70, observed at three time points over 15 years. Methods Poisson regression. Measurements Heart disease was determined by self-report, medical records or from the National Death Index. Lipids and hormones were measured from blood samples drawn at each time point. CAG repeat length was assessed from DNA collected at the second time point. Results We found no increased risk of HD associated with CAG repeat length in our analyses. Moreover, CAG repeat length was not related to body mass index, HDL, low-density lipoprotein or waist to hip ratio in this cohort; nor did CAG repeat length predict changes in these variables over 15 years of follow-up. Conclusions In contrast to previous smaller, cross-sectional analyses, in this large cohort of community-dwelling men followed over 15 years, CAG repeat length was not related to the incidence or prevalence of HD or alterations in HDL. If androgens impact HD risk, this effect is unlikely to be mediated via CAG repeat length. [ABSTRACT FROM AUTHOR]

Objective Cross-sectional data suggest that obesity, particularly central obesity, may be associated with decreased production of sex steroid hormones in men. However, longitudinal hormone data on men in relation to obesity status are limited. Previous studies have not consistently demonstrated whether sex steroids are associated specifically to body mass index or to measures of central obesity. Our objective was to examine the relation of obesity (body mass index > 30 kg/m2), and of central obesity (waist circumference > 100 cm or waist to hip ratio > 0·95) to longitudinal change in sex steroid hormones in men. Design Prospective follow-up of a population-based sample of men in Boston. Patients Nine hundred forty-two (942) men in the Massachusetts Male Ageing Study with complete anthropometry and hormone data at baseline (1987–1989, ages 40–70) and follow-up (1995–1997). Measurements Free and total testosterone (FT and TT), dehydroepiandrosterone sulphate (DHEAS), and sex hormone-binding globulin (SHBG) were assessed using standardized methods. Health behaviours and medical history were obtained by structured interview. Repeated measures regression was used to describe trends in steroid hormones and SHBG in relation to obesity status, adjusting for age, smoking, alcohol, comorbidities, and physical activity. Results Obesity was associated with decreased levels of total and free testosterone, and of SHBG at follow-up relative to baseline. For any given baseline concentration of TT, FT or SHBG, follow-up levels were lowest among men who remained obese or who became obese during follow-up. This was true for all three indices of obesity. Central adiposity was associated with lower DHEAS levels at follow-up, while elevated body mass index was not. Conclusions Obesity may predict greater decline in testosterone and SHBG levels with age. Central adiposity may be a more important predictor of decline in DHEAS than is body mass index. [ABSTRACT FROM AUTHOR]

There is little consensus on what androgen levels are‘normal’ for healthy, ageing men. Using data from the Massachusetts Male Ageing Study (MMAS), we estimated age-specific, normal androgen levels for men aged 40–79 years while accounting for health status and behavioural factors known to influence hormone levels.Prospective, observational study.Community-based random sample of men aged 40–79 years:n = 1677 men studied at T1 (1987–1989),n = 1031 at T2 (1995–1997) andn = 631 at T3 (2002–2004), for a total of 3339 observations. The average number of years between the T1 and T2 interviews was 8·8 (range 7·1–10·4 years) and 6·4 (range 5·6–7·9 years) between T2 and T3.Serum total testosterone (T) and sex hormone-binding globulin (SHBG) were measured on nonfasting blood samples collected within 4 h of subject's awakening. Free and bio-available T were calculated from T and SHBG using the Södergard equation. Trained interviewers administered an in-home questionnaire of health, medication and lifestyle. Participants were considered apparently healthy if all of the following were met: (i) absence of self-reported chronic disease (diabetes, heart disease, high blood pressure, cancer, ulcer); (ii) not on prescription medication believed to affect hormone levels; (iii) body mass index (BMI) not exceeding 29 kg/m2; (iv) alcohol consumption less than or equal to six drinks/day; and (v) nonsmoking.Chronic disease and high BMI significantly decreased whereas smoking tended to increase total, free and bio-available T concentrations. Apparently healthy men had significantly higher median hormone concentrations at most time points than did not apparently healthy men. Due to the opposite effects of smoking and the other components of the definition, apparently healthy men were compared to nonsmoking, apparently unhealthy men. The former group had significantly higher androgen levels (Wilcoxon rank-sumP-values ranged from 0·01 to 0·0001) for all hormones at all interviews. Ninety-five percent of apparently healthy men in their 40s, 50s, 60s and 70s would be expected to have total T in the range (2·5–97·5th percentile): 8·7–31·7, 7·5–30·4, 6·8–29·8 and 5·4–28·4 nm(251–914, 216–876, 196–859, 156–818 ng/dl), respectively.Age, health and lifestyle factors impact androgen levels and should be accounted for in calculations of normal reference ranges. We propose the following age-specific thresholds, below which a man is considered to have an abnormally low total T: 8·7, 7·5, 6·8 and 5·4 nm(251, 216, 196 and 156 ng/dl) for men in their 40s, 50s, 60s and 70s, respectively. These cutoffs correspond to the 2·5th percentile in our data; thus, approximately 2·5% of men aged 40–79 years would have abnormally low T levels based on hormone levels alone. [ABSTRACT FROM AUTHOR]

To describe within-individual change in sexual function over a 9-year period and to determine whether the amount of change differs by age group. Cohort study; participants interviewed at baseline (1987–89) and follow-up (1995–97). Population-based; communities surrounding Boston, Massachusetts. One thousand eighty-five men aged 40 to 70 at baseline (born between 1917 and 1947) with complete baseline and follow-up sexual function data. Within-person change (follow-up minus baseline) in the following sexual function variables: sexual intercourse, erection frequency, sexual desire, ejaculation with masturbation, satisfaction with sex, and difficulty with orgasm. Unadjusted analyses showed significant longitudinal changes over the 9-year period in all domains of sexual function except frequency of ejaculation with masturbation, which showed no change between baseline and follow-up. Adjusted for baseline sexual function, within-person change in all outcomes was strongly related to age, with decline in sexual function becoming more pronounced with increasing age. For example, over the 9-year study period, sexual intercourse or activity frequency decreased by less than once per month, two times per month, and three times per month in men in their 40s, 50s, and 60s, respectively. Number of erections per month declined by 3, 9, and 13 in men in their 40s, 50s, and 60s, respectively. This research fills a major gap in the literature by providing age-specific estimates of change in sexual functioning over a 9-year period in a cohort of unselected men. [ABSTRACT FROM AUTHOR]

The prevalence of foot and ankle disorders was determined in a community-based, multiethnic (non-Hispanic White, African American, and Puerto Rican) random sample of 784 community-dwelling adults aged 65 or more years in 2001–2002 in Springfield, Massachusetts. Overall, the five most common conditions were toenail disorders (74.9%), lesser toe deformities (60.0%), corns and calluses (58.2%), bunions (37.1%), and signs of fungal infection, cracks/fissures, or maceration between toes (36.3%); 30.9% had some tenderness to palpation of the foot or ankle, and 14.9% had ankle joint pain on most days in the past 4 weeks. Toenail conditions, fungal symptoms, and ulcers or lacerations were more common in men, while bunions and corns and calluses were more common in women (p < 0.001). Significant racial/ethnic differences, independent of education or gender, were found for the prevalence of most toe deformities and flat feet, as well as for corns and calluses, fungal signs, edema, ankle joint pain, tenderness to palpation, and sensory loss. Foot and ankle disorders are common in these older adults. Examination of their prevalence in different segments of the community may inform future studies to determine etiology and means of prevention. [ABSTRACT FROM AUTHOR]

The adrenal steroid dehydroepiandrosterone (DHEA) and its sulfate (DHEAS) have been characterized as "protective" against ischemic heart disease (IHD), especially in men, on the basis of sparse epidemiologic evidence. The authors used data from the Massachusetts Male Aging Study, a random sample prospective study of 1,709 men aged 40-70 years at baseline, to test whether serum levels of DHEA or DHEAS could predict incident IHD over a 9-year interval. At baseline (1987-1989) and follow-up (1995-1997), an interviewer-phlebotomist visited each subject in his home to obtain comprehensive health information, body measurements, and blood samples for hormone and lipid analysis. Incident IHD between baseline and follow-up was ascertained from hospital records and death registries, supplemented by self-report and evidence of medication. In the analysis sample of 1,167 men, those with serum DHEAS in the lowest quartile at baseline (<1.6 µg/ml) were significantly more likely to incur IHD by follow-up (adjusted odds ratio = 1.60, 95 percent confidence interval: 1.07, 2.39; p = 0.02), independently of a comprehensive set of known risk factors including age, obesity, diabetes, hypertension, smoking, serum lipids, alcohol intake, and physical activity. Low serum DHEA was similarly predictive. These results confirm prior evidence that low DHEA and DHEAS can predict IHD in men. [ABSTRACT FROM AUTHOR]

Although interviewer error is widely recognized as an important source of variation in epidemiologic investigations, scant published information exists documenting the impact of interviewer variation on study findings. Using data from the Massachusetts Women's Health Study, a population-based cohort study of 2,569 middle-aged women (1982–1987), the authors evaluated interviewer variation in responses to different types of questions, and assessed the impact of interviewer variation on inferences derived from study data. Respondent sociodemographic and lifestyle characteristics were similar for the four study interviewers at the first follow-up. No interviewer variation was detected for questions concerning recall of specific events, but responses to questions regarding recall of subjective or personal information or those which required further probing did differ significantly by interviewer. Adjustment for interviewer effects had no impact on the conclusions obtained from one analysis of predictors of depression, despite significant interviewer variation in the outcome and predictor variables, but it did change conclusions from an analysis of the impact of support networks on psychological symptoms, wherein the interviewer variable was strongly related to the outcome after data were controlled for predictor variables. Given these findings, examination of data for interviewer effects is advisable despite incorporation of quality control measures in a study's design. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: Health care reform was introduced in Massachusetts (MA) in 2006 and serves as a model for what was subsequently introduced nationally as the Patient Protection and Affordable Care Act. The Boston Area Community Health survey collected data before (2002–2005) and after (2006–2010) introduction of the MA health insurance mandate, providing a unique opportunity to assess its effects in a large, epidemiologic cohort. Methods: We report on the apparent effects of the mandate on the same participants over time, focusing specifically on the vulnerable working poor (WP). We evaluated differences in subpopulations of interest at pre- and post-reform periods to explore whether MA health care reform resulted in an overall gain in insurance coverage. Results: MA health care reform was associated with net gains in health insurance coverage overall and among the subgroups studied. Our findings suggest that despite being targeted by health care reform legislation, the WP in MA continue to report lower rates of insurance coverage compared with both the nonworking poor and the not poor. Conclusions: MA health care reform legislation, including the expansion of Medicaid, resulted in substantial overall gains in coverage. Disparities in insurance coverage persist among some subgroups following health care reform implementation in MA. These results have important implications for health services researchers and policy makers, particularly in light of the ongoing implementation of the Patient Protection and Affordable Care Act. [Copyright &y& Elsevier]

Racial/ethnic disparities in the prevalence of type 2 diabetes mellitus (T2DM) are well documented and until recently, research has focused almost exclusively on individual-based determinants as potential contributors to these disparities (health behaviors, biological/genetic factors, and individual-level socio-demographics). Research on the role of neighborhood characteristics in relation to racial/ethnic disparities in T2DM is very limited. Therefore, the aim of this research is to identify and estimate the contribution of specific aspects of neighborhoods that may be associated with racial/ethnic disparities in T2DM. Data from the Boston Area Community Health III Survey (N = 2764) was used in this study, which is a community-based random-sample survey of adults in Boston, Massachusetts from three racial/ethnic groups (Black, Hispanic, and White). We applied two-level random intercepts logistic regression to assess the associations between race/ethnicity, neighborhood characteristics (census tract socioeconomic status, racial composition, property and violent crime, open space, geographic proximity to grocery stores, convenience stores, and fast food, and neighborhood disorder) and prevalent T2DM (fasting glucose > 125 mg/dL, HbA1c ≥ 6.5%, or self-report of a T2DM diagnosis). Black and Hispanic participants had 2.89 times and 1.48 times the odds of T2DM as White participants, respectively. Multilevel models indicated a significant between-neighborhood variance estimate of 0.943, providing evidence of neighborhood variation. Individual demographics (race/ethnicity, age and gender) explained 22.3% of the neighborhood variability in T2DM. The addition of neighborhood-level variables to the model had very little effect on the magnitude of the racial/ethnic disparities and on the between-neighborhood variability. For example, census tract poverty explained less than 1% and 6% of the excess odds of T2DM among Blacks and Hispanics and only 1.8% of the neighborhood variance in T2DM. While the findings of this study overall suggest that neighborhood factors are not a major contributor to racial/ethnic disparities in T2DM, further research is needed including data from other geographic locations. [ABSTRACT FROM AUTHOR]

Purpose: Statins may ameliorate lower urinary tract symptoms (LUTS) through anti-inflammatory or other pathways. We investigated the association between statin use and storage, voiding, and overall LUTS symptoms. Methods: The Boston Area Community Health Survey is an epidemiologic study of Boston, MA residents (2301 men; 3202 women) 30–79 years of age. LUTS, voiding, and storage symptoms were ascertained through an interviewer-administered questionnaire and defined as scores of greater than or equal to 8, greater than or equal to 5, and greater than or equal to 4, respectively, on relevant components of the American Urologic Association Symptom Index. Participants were included if they had a history of provider-diagnosed high cholesterol or recently used statin medications (n = 1346). Associations were estimated using odds ratios (ORs) and 95% confidence intervals (CI) from multivariate logistic regression. Results: In multivariate models, statin use had no association with LUTS (OR = 1.03, 95% CI: 0.70, 1.51) among women. No associations were observed for any LUTS among younger (<60) men, but among older (60+) men, we observed significant inverse associations for voiding (OR = 0.23, 95% CI: 0.08, 0.66), storage (OR = 0.24, 95% CI: 0.11, 0.56), and overall LUTS (OR = 0.15, 95% CI: 0.05, 0.44). Conclusions: Our results suggest that use of statins is associated with a lower prevalence of urologic symptoms among older men but not among women or younger men. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: The objective of this study was to determine the relative contribution of modifiable risk factors (physical activity, smoking, and alcohol consumption) to inter-subject variation in erectile dysfunction (ED). Methods: The Boston Area Community Health (BACH) Survey used a multistage stratified random sample to recruit 2301 men age 30–79 years from the city of Boston between 2002 and 2005. ED was assessed using the 5-item International Index of Erectile Function (IIEF-5). Multiple linear regression models and R 2 were used to determine the proportion of the variance explained by modifiable risk factors. Results: In unadjusted analyses, lifestyle factors accounted for 12.2% of the inter-subject variability in IIEF-5 scores, comparable to the proportion explained by comorbid conditions (14.7%) and socioeconomic status (9%). Lifestyle factors were also significantly associated with age, comorbid conditions and socioeconomic status (SES). A multivariate model including all covariates associated with ED explained 29% of the variance, with lifestyle factors accounting for 0.9% over and above all other covariates in the model. Analyses repeated in a subgroup of 1215 men without comorbid conditions show lifestyle factors accounting for 2.5% of the variance after accounting for all other variables in the model. Conclusions: Results of the present study demonstrate the contribution of modifiable lifestyle factors to the prevalence of ED. These results suggest a role for behavior modification in the prevention of ED. [Copyright &y& Elsevier]

Objectives: To investigate the relationship between the severity of urine leakage and quality of life (QOL) in men and women of different race/ethnicity. Methods: An epidemiologic survey was conducted with a population-based random sample of 3202 women and 2301 men (1767 black, 1877 Hispanic, 1859 white) aged 30-79 years in Boston, MA. Severity of leakage was based on frequency and amount by the Sandvik Severity Scale. QOL was measured with physical and mental component summaries of Medical Outcomes Study Short Form-12. Covariates included race/ethnicity, age, socioeconomic status, urinary incontinence risk factors, and comorbidities. Analysis included multivariate linear regression modeling by gender. Results: Urine leakage, most of which was mild or moderate, was reported in 30% of women and 18% of men. Women (5.1%) were more likely than men (0.9%) to report severe leakage. In multivariate analysis, as severity of leakage increased, both components of QOL declined, with decreases in scores of 7-8 points for men (P ≤.001 for each) and 4-6 points (P <.05 and P = .001, respectively) for women. Severe leakage was associated with a greater decline in QOL than that observed for most other comorbidities considered. The effect of urine leakage on QOL was similar among racial and ethnic groups. Conclusions: Urine leakage impairs QOL for both men and women, with no evidence of different effects by racial/ethnic group. Leakage has clinically significant effects on physical health-related QOL for men and on mental health QOL for both men and women. [Copyright &y& Elsevier]

Objectives: To determine whether an association exists between C-reactive protein (CRP) levels and lower urinary tract symptoms (LUTS) as assessed by the American Urological Association Symptom Index (AUA-SI) among both men and women, and to determine the association of CRP levels with the individual urologic symptoms comprising the AUA-SI among both men and women. Methods: The Boston Area Community Health survey used a multistage stratified design to recruit a random sample of 5502 adults aged 30-79 years. Blood samples were obtained from 3752 participants. The analyses were conducted on 1898 men and 1854 women with complete data on CRP levels. Overall LUTS was defined as an AUA-SI of ≥8 (moderate to severe LUTS). The urologic symptoms comprising the AUA-SI were included in the analysis as reports of fairly often to almost always vs non/rarely/a few times. Results: A statistically significant association was observed between the CRP levels and overall LUTS among both men and women. The pattern of associations between the individual symptoms and CRP levels varied by sex. Nocturia and straining were associated with greater CRP levels among men, and incomplete emptying and weak stream were associated with greater CRP levels among women. Conclusions: The results of this study have demonstrated an association between CRP levels and LUTS in both men and women. The dose-response relationship between increased CRP levels and an increased odds of LUTS supports the hypothesized role of inflammatory processes in the etiology of LUTS. [Copyright &y& Elsevier]

Introduction. Few population-based studies have assessed variations in the burden of erectile dysfunction (ED) by race/ethnicity. Aim. To estimate prevalence rates of ED by race/ethnicity and determine the contribution of behavioral risk factors, chronic illnesses, and socioeconomic factors to potential race/ethnic differences in ED. Methods. The Boston Area Community Health (BACH) Survey is a study of urologic symptoms in a racially and ethnically diverse population. BACH used a multistage stratified random sample to recruit 2,301 men aged 30–79 years from the city of Boston. Self-reported race/ethnicity was defined as Black, Hispanic, and White. Socioeconomic status (SES) was defined as a combination of education and household income. Main Outcome Measures. ED assessed using the 5-item International Index of Erectile Function (IIEF-5). IIEF-5 scores were used both as a continuous variable and dichotomized as ≤16 vs. ≥17. Results. Overall prevalence of ED (defined as an IIEF-5 score ≤16) was 20.7% with higher prevalence observed among both Black men (24.9%) and Hispanic men (25.3%) compared to White men (18.1%). Increased odds of ED were observed for both Black and Hispanic men after adjusting for age, comorbid conditions (cardiovascular disease, diabetes, depression), and behavioral risk factors (smoking, physical activity, alcohol use). After controlling for the effect of SES, the association between race/ethnicity and ED disappeared. In contrast, men in the low SES category had an over two-fold increase in risk of ED (adjusted odds ratio of 2.26, 95% confidence interval 1.39, 3.66). Conclusions. The increased risk of ED in Black and Hispanic men is associated with differences in SES rather than differences in known risk factors of ED. Kupelian V, Link CL, Rosen RC, and McKinlay JB. Socioeconomic status, not race/ethnicity, contributes to variation in the prevalence of erectile dysfunction: Results from the Boston Area Community Health (BACH) Survey. J Sex Med 2008;5:1325–1333. [ABSTRACT FROM AUTHOR]

Focuses on a study which determined whether incident erectile dysfunction varies by socioeconomic factors, using data from the Massachusetts Male Aging Study. Background to the study; Measurement of socioeconomic factors; Results and discussion.