Showing papers by "Frank E. Speizer published in 1986"

Validation of questionnaire information on risk factors and disease outcomes in a prospective cohort study of women

Abstract: To assess the validity of self-reported illnesses, medical records were reviewed for participants reporting major illnesses on the biennial follow-up questionnaires used in a prospective cohort study which began in 1976. In over 90% of cases of cancer of the breast, skin, large bowel, and thyroid, histopathology reports confirmed the subjects' self-report. Lower levels of confirmation were obtained for cancers of the lung, ovary, and uterus. Application of strict diagnostic criteria also gave lower levels of confirmation for myocardial infarction (68%) and stroke (66%). Among random samples of women reporting fractures and hypertension all records obtained confirmed self-reports. For self-reported elevated cholesterol levels 85.7% of self-reports were confirmed. Self-report is a valuable epidemiologic tool but may require additional documentation when the disease is diagnostically complex.

Effects of ambient sulfur oxides and suspended particles on respiratory health of preadolescent children.

Abstract: Reported here are the results from an ongoing study of outdoor air pollution and respiratory health of children living in six cities in the eastern and midwestern United States. The study enrolled 10,106 white preadolescent children between 1974 and 1977 in 3 successive annual visits to each city. Each child received a spirometric examination, and a parent completed a standard questionnaire. Of this cohort, 8,380 children were seen for a second examination 1 yr later. An air pollution monitoring program was begun in each community at about the time of the first examination. For this report, measurements of total suspended particulates (TSP), the sulfate fraction of TSP (TSO/sub 4/), and sulfur dioxide (SO2) concentrations at study-affiliated outdoor stations were combined with measurements at other public and private monitoring sites to create a record of TSP, TSO/sub 4/, and SO/sub 2/ concentrations in each of 9 air pollution regions during the 1-yr period preceding each examination and, for TSP, during each child's lifetime up to the time of testing. Across the 6 cities, frequency of cough was significantly associated with the average of 24-h mean concentrations of all 3 air pollutants during the year preceding the health examination (p less thanmore » 0.01). Rates of bronchitis and a composite measure of lower respiratory illness were significantly associated with average particulate concentrations (p less than 0.05). In analyses restricted to lifetime residents, these outcomes were significantly associated with measures of lifetime mean TSP concentration. Within the cities, however, temporal and spatial variation in air pollutant concentrations and illness and symptom rates were not positively associated.« less

A prospective study of parental history of myocardial infarction and coronary heart disease in women

Abstract: Among 121,964 women aged 30-55 years in 1976, 117,156 who were initially free from coronary heart disease provided information on a number of coronary risk factors including parental history of myocardial infarction and were followed prospectively. In 1976, 31,101 (26.5%) reported that at least one parent had suffered a myocardial infarction. Questionnaires in 1978 and 1980 identified women who had developed nonfatal myocardial infarction (n = 132) and angina pectoris (n = 101). Fatal coronary heart disease cases (n = 42) were ascertained by searches of state vital records. The age-adjusted relative risk of nonfatal myocardial infarction for women with a parental history of myocardial infarction less than or equal to 60 years of age compared with women with no family history was 2.8 (95% confidence limits (CL) 1.8, 4.3). For those with a parental history of myocardial infarction greater than 60 years of age, the age-adjusted relative risk of nonfatal myocardial infarction was 1.0 (CL 0.5, 1.8). The age-adjusted relative risks of fatal coronary heart disease were 5.0 (CL 2.7, 9.2) for parental history before age 61 and 2.6 (CL 1.1, 5.8) for parental history after age 60. The corresponding relative risks of angina pectoris were 3.4 (CL 2.2, 5.2) and 1.9 (CL 1.2, 3.2), respectively. These associations were only slightly altered by adjustment for history of hypertension, diabetes, high cholesterol, use of oral contraceptives, menopause, postmenopausal hormone use, obesity, or smoking, in individual stratified analysis or in multivariate analyses. These data support the hypothesis that parental history of myocardial infarction has an independent effect on risk that is not explained solely by individual risk factors.

Parity and Breast Cancer Risk: Possible Effect on Age at Diagnosis

Abstract: We examined the effect of parity on breast cancer risk on the basis of information from 107,146 married female nurses followed prospectively between 1976-1980. For everparous women, a significant protective effect against breast cancer was observed with increasing parity (chi 12 for trend = 14.2, p less than 0.001). Adjustment for age at first birth and other potential confounders by multiple logistic regression did not materially affect this trend. After controlling for these risk factors, the overall relative risk of breast cancer for women with four or more pregnancies lasting 6 months or longer was 0.68 (95% confidence limits 0.51-0.90) compared with women with only one pregnancy. When nulliparous and everparous women were compared, an interaction of age and everparous status in 1976 was observed. The logistic regression coefficient for the interaction was 0.3419 (95% confidence limits 0.0374-0.6464). Specifically, for women of parity 2 relative to nulliparous, the relative risk of breast cancer and the 95% confidence intervals were 1.85 (1.09, 3.14), 1.32 (0.92, 1.89), and 0.93 (0.62, 1.41) for 30-39, 40-49 and 50-55-year-old women, respectively. This points to the need of presenting age-specific, rather than age-adjusted, relative risks in future studies of breast cancer and parity.

Indoor air pollution and pulmonary function growth in preadolescent children

Abstract: Results are reported from a study of the association between exposure to sidestream cigarette smoke or gas-stove emissions and pulmonary-function level and growth rate of 7,834 children seen at 2-5 annual visits between the ages of 6-10 years. Children whose mothers smoked one pack of cigarettes per day had levels of forced expiratory volume in one second (FEV1) at age eight that were 0.81% lower than children of nonsmoking mothers (p<0.0001), and FEV1 growth rates approximately 0.17% per year lower (p=0.05). For a child of age eight with an FEV1 of 1.62 liters, this corresponds to a deficit in rate of change of FEV1 of approximately 3 ml/annum and a deficit of 13 ml at age eight. Children whose mothers smoked one pack per day had levels of forced vital capacity (FVC) at age eight that were 0.33% higher than children of nonsmokers (p=0.12); however, their growth rates of FVC were 0.17% per year lower (p=0.04). Because few mothers changed their smoking habits during the course of the study, it was not possible to determine whether the difference in rate of growth was due to current exposure or to an effect of prenatal and early childhood exposure on the coursemore » of development.« less

The relationship of blood lead to blood pressure in a longitudinal study of working men

Abstract: The relationship of lead exposure to blood pressure has been examined in a longitudinal study of a cohort of 89 Boston, Massachusetts, policemen. At the baseline examination, subjects had a blood lead determination and three consecutive blood pressure measurements. Triplicate blood pressure measurements were also taken at years 3, 4, and 5. Multivariate analysis revealed that, after correction for previous systolic blood pressure, body mass index, age, and smoking, a high level of blood lead was a significant predictor of subsequent elevation of systolic pressure. Bootstrap simulations of these models provided supporting evidence for the observed associations. These data suggest that lead exposure can significantly affect systolic pressure.

Oral Contraceptives and Breast Cancer: A Prospective Cohort Study

Abstract: In 1976, information on oral contraceptive (OC) use as well as numerous risk factors for breast cancer was provided by 121,964 married female registered nurses aged 30 to 55 years. Ninety-two percent of women in the cohort completed follow-up questionnaires, and vital records were systematically searched to ascertain deaths among nonrespondents. After four years of follow-up, 592 incident cases of breast cancer were identified. Compared with never users, the age-adjusted relative risk (RR) of breast cancer, regardless of menopausal status, among all women who had ever used OCs was 1.0. Among premenopausal women compared with those who had never used OCs, the RR of breast cancer was 1.5 for current use of OCs in 1976 and 1.0 for past use. Among postmenopausal women, the RR for past use of OCs was 1.0. These estimates were essentially unaltered after controlling for other known risk factors for breast cancer in multiple logistic regression analysis. Furthermore, there was no modification of these effects by family history of breast cancer, age at first use, timing of the first birth, or other breast cancer risk factors. Data on past use of OCs provide substantial reassuring evidence that there is no large excess risk of breast cancer within a few years of cessation of pill use. The observed moderate elevation of breast cancer risk with current use was of borderline statistical significance. However, the observation was based on 29 cases and may reflect the effect of sampling variability, as most other studies have not observed a relationship between current use of OCs and breast cancer in women of this age.

Determinants of response to eucapneic hyperventilation with cold air in a population-based study.

Abstract: A population-based, epidemiologic investigation conducted in children, adolescents, and young adults analyzed the response to eucapneic hyperventilation with cold air as a continuous variable to better define factors that influence the expression of bronchial responsiveness. Among respiratory illness/symptom variables, only the report of asthma or persistent wheeze in the previous year and the report of a respiratory illness that led to activity restriction were significantly associated with response to cold air. Furthermore, a low, prechallenge FEF25–75/FVC ratio was a significant predictor of response, especially among those subjects who reported a respiratory illness that led to activity restriction. This relationship was not observed for a low prechallenge FEF25–75

A Prospective Study of Postmenopausal Estrogen Therapy and Coronary Heart Disease

Abstract: To clarify the possible role of postmenopausal estrogen use in coronary heart disease, we surveyed 121,964 female nurses, aged 30 to 55 years, with mailed questionnaires, beginning in 1976. Information on hormone use and other potential risk factors was updated and the incidence of coronary heart disease was ascertained through additional questionnaires in 1978 and 1980, with a 92.7 per cent follow-up. End points were documented by medical records. During 105,786 person-years of observation among 32,317 postmenopausal women who were initially free of coronary disease, 90 women had either nonfatal myocardial infarctions (65 cases) or fatal coronary heart disease (25 cases). As compared with the risk in women who had never used postmenopausal hormones, the age-adjusted relative risk of coronary disease in those who had ever used them was 0.5 (95 per cent confidence limits, 0.3 and 0.8; P = 0.007), and the risk in current users was 0.3 (95 per cent confidence limits, 0.2 and 0.6; P = 0.001). The relative risks were similar for fatal and nonfatal disease and were unaltered after adjustment for cigarette smoking, hypertension, diabetes, high cholesterol levels, a parental history of myocardial infarction, past use of oral contraceptives, and obesity. These data support the hypothesis that the postmenopausal use of estrogen reduces the risk of severe coronary heart disease.

Overview of the risk of respiratory cancer from airborne contaminants.

Abstract: This overview on defining risk of respiratory cancer from airborne pollutants summarizes broad issues related to a number of the environmental agents that are discussed in the articles that follow. Lung cancer kills more than 100,000 people annually and is the major form of cancer in both sexes in middle age. Cigarette smoking is the major cause of respiratory cancer and must be taken into account in any study of the effect of an environmental agent on the risk of respiratory cancer, particularly at relatively low levels of excess risk (RR greater than 1.0 but less than 2.0). The agents considered in this series all have the potential for widespread community exposures, either because there is widespread long-term exposure (passive smoking), the agents are direct byproducts of energy consumption (organic particles), have ubiquitous production and use patterns (formaldehyde and fibers), or occur widely in natural settings (radon). Several issues--measurement of exposure, latency, confounding factors and bias, extrapolation from animals to humans, population at risk, and attributable risk--must be considered for each agent. A further issue related to exposure estimates is the relationship of exposure to actual dose. Understanding exposure some 25 to 40 years in the past is important because of the prolonged latency period in the development of respiratory cancers. To the degree that these agents act synergistically with smoking, the reduction of smoking or of exposure to these agents may have greater public health consequences than would be anticipated from the directly measured attributable risk of each of these agents separately.

A population-based case-control study of mesothelioma deaths among U.S. railroad workers.

Abstract: We have completed a case-control analysis of mesothelioma deaths among current and retired U.S. railroad employees. Cause-specific death certificates were obtained for 87% of 15,059 deaths reported by the railroad retirement board, and 20 mesotheliomas were identified according to death certificate diagnosis. A 10:1 matched analysis with railroad workers dying of nonmalignant, nonaccidental causes yielded a very strong association with prior railroad work in jobs with potential asbestos exposure (odds ratio = 7.2, 95% lower confidence limit = 3.3). Consideration of railroad occupations with regular asbestos exposures (e.g., skilled trades, steam locomotive repair) yielded an odds ratio of 21.4 (95% lower confidence limit = 8.7), but the occupations with potential intermittent exposure (e.g., engineers, firemen, carmen) yielded a nonsignificant odds ratio of 2.3 (95% lower confidence limit = 0.5). Applying mesothelioma mortality rates from this study to the population of U.S. railroad workers at risk yields an estimate of 416 cases of mesothelioma occurring among U.S. railroad workers between 1981 and 2000.

Health effects of air pollution due to coal combustion in the Chestnut Ridge region of Pennsylvania: cross-section survey of children.

Abstract: A cross-sectional study of 4,071 children aged 6-11 yr of age from a rural region of Western Pennsylvania was conducted in spring of 1979 Standardized children's questionnaires were distributed to the parents and returned by the children to school, where spirometry was performed The region was divided into low-, moderate-, and high-pollution areas on the basis of the 1974-1978, 3-hr, 24-hr, and annual averages for sulfur dioxide (SO2) Seventeen monitoring stations in the region and a triangulation procedure were used to estimate centroid levels in each geographic residence area After adjusting the respiratory symptom response outcomes and the pulmonary function levels for known predictors, no significant association was noted for level of SO2 However, the highest exposure categories were only slightly above the present annual and 24-hr National Air Quality Standards for SO2 We conclude that at levels of exposure to which these children were exposed, only by study of potentially sensitive subsets or measures of acute response would it be possible to detect respiratory outcomes associated with ambient air pollution