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... Address reprint requests to Alfred A. Rimm, PhD, Division of Biostatistics and Clinical Epi-demiology, MedicalCollegeofWisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226. ... Lapidus L, Bengtsson C: Regional obesity as a health... more
... Address reprint requests to Alfred A. Rimm, PhD, Division of Biostatistics and Clinical Epi-demiology, MedicalCollegeofWisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226. ... Lapidus L, Bengtsson C: Regional obesity as a health hazard in women-a prospec-tive study ...
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This study uses 44 consecutive months of data from the Health Care Financing Administration to assess seasonal trends in hip fracture incidence among the United States white population aged 65 years and older. The authors studied a total... more
This study uses 44 consecutive months of data from the Health Care Financing Administration to assess seasonal trends in hip fracture incidence among the United States white population aged 65 years and older. The authors studied a total of 621,387 cases of hip fracture which occurred from January 1984 to September 1987. During the study period, hip fracture incidence rates display a distinctive pattern of seasonal periodicity; high rates are found in the winter and low rates in the summer among both males and females. This pattern of seasonal periodicity is consistent at ages 65-74 years, 75-84 years, and greater than or equal to 85 years. When the time series of rates are stratified into five geographic levels, each level covering 5 degrees of latitude, the distinctive pattern of seasonal periodicity is the same for all levels.
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Data from 4225 persons from the National Health and Nutrition Examination Survey (HANES) was used to determine whether obesity was associated with osteoarthritis (OA) or joint pain. Subjects were divided into four groups on the basis of... more
Data from 4225 persons from the National Health and Nutrition Examination Survey (HANES) was used to determine whether obesity was associated with osteoarthritis (OA) or joint pain. Subjects were divided into four groups on the basis of sex and race. We found that obesity was associated with OA of the knee for each sex/race group (p less than 0.01). The association was strongest for women, and it was present even for subjects without evidence of knee pain on physical examination. Frame size was not significantly associated with OA of the knee. Relative weight was weakly associated with OA of the hips in white women and nonwhite men but not significantly associated with OA of the sacroiliac joint. Diabetes did not seem to be an important risk factor for OA. These results suggest that the additional mechanical stress resulting from obesity is the principal reason for the association between obesity and OA.
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Graft failure was analyzed in 625 patients receiving allogeneic bone marrow transplants from HLA-identical sibling donors as treatment for severe aplastic anemia. Sixty-eight (11%) had no or only transient engraftment. Second bone marrow... more
Graft failure was analyzed in 625 patients receiving allogeneic bone marrow transplants from HLA-identical sibling donors as treatment for severe aplastic anemia. Sixty-eight (11%) had no or only transient engraftment. Second bone marrow transplants were successful in achieving extended survival in 16 of 27 patients with transient initial engraftment but in none of ten patients with no sign of engraftment after the first transplant. The major factors associated with a reduced risk of graft failure were use of radiation for pretransplant immunosuppression and use of cyclosporine rather than methotrexate or T-cell depletion of the donor bone marrow for prophylaxis against graft-v-host disease (GVHD). Among 266 patients prepared for transplantation with cyclophosphamide alone, the risk of graft failure was increased in patients who received previous transfusions and reduced in those who received corticosteroids for previous therapy. Neither cell dose nor administration of donor buffy c...
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Chronic graft-versus-host disease (GVHD) is an important complication of bone marrow transplantation. We analyzed risk factors for chronic GVHD in 2,534 recipients of HLA-identical sibling transplants surviving at least 90 days after... more
Chronic graft-versus-host disease (GVHD) is an important complication of bone marrow transplantation. We analyzed risk factors for chronic GVHD in 2,534 recipients of HLA-identical sibling transplants surviving at least 90 days after transplantation. The actuarial probability of developing chronic GVHD within three years posttransplant was 46% +/- 3% (95% confidence interval). The most important risk factor for chronic GVHD was acute GVHD. The 3-year probabilities of chronic GVHD were 28% +/- 3%, 49% +/- 5%, 59% +/- 6%, 80% +/- 9%, and 85% +/- 15% for persons with grades 0, I, II, III, and IV acute GVHD, respectively (P less than .0001). Among patients with no or grade I acute GVHD, recipient age greater than 20 years, use of non-T-cell depleted bone marrow, and alloimmune female donors for male recipients predicted a higher risk of chronic GVHD. When all three adverse risk factors were present, the probability of chronic GVHD was 62% among persons with no prior acute GVHD and 85% a...
Research Interests: Genetics, Leukemia, Multivariate Analysis, Humans, Autoimmune Disease, and 14 moreChronic Disease, Female, Blood, Male, Bone marrow, Risk factors, Clinical Sciences, Immune system, Bone Marrow Transplantation, Major histocompatibility complex, Risk Factors, Graft-Versus-Host Disease, Confidence Interval, and Sibling Relations
To determine whether graft-versus-leukemia (GVL) reactions are important in preventing leukemia recurrence after bone marrow transplantation, we studied 2,254 persons receiving HLA-identical sibling bone marrow transplants for acute... more
To determine whether graft-versus-leukemia (GVL) reactions are important in preventing leukemia recurrence after bone marrow transplantation, we studied 2,254 persons receiving HLA-identical sibling bone marrow transplants for acute myelogenous leukemia (AML) in first remission, acute lymphoblastic leukemia (ALL) in first remission, and chronic myelogenous leukemia (CML) in first chronic phase. Four groups were investigated in detail: recipients of non--T-cell depleted allografts without graft-versus-host disease (GVHD), recipients of non--T-cell depleted allografts with GVHD, recipients of T-cell depleted allografts, and recipients of genetically identical twin transplants. Decreased relapse was observed in recipients of non--T-cell depleted allografts with acute (relative risk 0.68, P = .03), chronic (relative risk 0.43, P = .01), and both acute and chronic GVDH (relative risk 0.33, P = .0001) as compared with recipients of non--T-cell depleted allografts without GVHD. These data ...
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We have explored the possibility that inapparent DNA in serum from patients with systemic lupus erythematosus can occupy anti-DNA combining sites and alter the apparent qualitative properties of such an antibody. DNAse digestion of such... more
We have explored the possibility that inapparent DNA in serum from patients with systemic lupus erythematosus can occupy anti-DNA combining sites and alter the apparent qualitative properties of such an antibody. DNAse digestion of such sera altered both the association rate of anti-DNA with 125I-DNA and the slope of binding isotherms in Scathchard analysis, although no immunoprecipitable DNA was detected in these sera. The association rate of serum after DNAse digestion was a better correlate of nephritis and disease activity. These findings suggest that DNA not detectable by counterimmunoelectrophoresis may affect assessment of qualitative properties of anti-DNA without affecting overall antibody titer, and that the association rate after DNAse digestion of serum remains one of the best correlates of disease activity. Our data further suggest that future qualitative studies of anti-DNA behavior utilize plasma rather than serum to avoid the artifact reported here.
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To determine the carbon monoxide exposure experienced by the residents of Chicago, Los Angeles, Milwaukee, and New York, venous blood samples were obtained from adults at arbitrarily chosen blood bank collection sites in the four cities... more
To determine the carbon monoxide exposure experienced by the residents of Chicago, Los Angeles, Milwaukee, and New York, venous blood samples were obtained from adults at arbitrarily chosen blood bank collection sites in the four cities and analyzed for circulating carbon monoxide, carboxyhemoglobin. For comparative purposes, blood was obtained from volunteers breathing carbon monoxide-free air and was found to contain 0.45 percent carboxyhemoglobin. By contrast a high percentage of all the nonsmoking blood donors breathing city air had carboxyhemoglobin saturations greater than 1.5 percent, which indicated that exposure to carbon monoxide in excess of that permitted by the quality standards of the Clean Air Act of 1971 was widespread and occurring regularly.
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ABSTRACT Supralethal doses of chemoradiotherapy followed by allogeneic bone marrow transplantation are being used to treat patients with acute leukaemia refractory to conventional chemotherapy regimens1-5. Despite this approach, leukaemia... more
ABSTRACT Supralethal doses of chemoradiotherapy followed by allogeneic bone marrow transplantation are being used to treat patients with acute leukaemia refractory to conventional chemotherapy regimens1-5. Despite this approach, leukaemia has recurred in about one-third of the patients1-5. One strategy to solve this problem would be to transplant marrow with antileukaemic reactivity to obtain a graft-versus-leukaemia (GvL) effect against residual leukaemia cells6. Many workers have demonstrated antileukaemic effects following transplantation of immunocompetent cells from allogeneic donors in animal models, but graft-versus-host (GvH) disease proved to be a complication6-8. Recently, Weiden et al.9 presented evidence of a GvL effect in human recipients of marrow grafts from HLA compatible allogeneic donors. Unfortunately, this antileukaemic effect was associated with moderate, severe or lethal GvH disease, and the lower probability of recurrent leukaemia was offset by a higher probability of GvH-related mortality9. We report here the results that suggest a clinically feasible method of obtaining desired GvL effects while avoiding undesired GvH reactions. Alloimmunisation of CBA (H-2k) mice was found to induce a population of cells which, when transplanted into leukaemic AKR (H-2k) mice, led to the destruction of disseminated leukaemia (AKR-L) cells. Furthermore, the transplanted cells caused no augmentation in the mild GvH disease observed when cells from unimmunised CBA donors were administered to lethally irradiated non-leukaemic AKR hosts.
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The relationship between the levels of high density lipoprotein cholesterol (HDLC) and the extent of coronary artery occlusion (ascertained by arteriography) was studied in four hundred male patients. The group with HDLC levels over 50... more
The relationship between the levels of high density lipoprotein cholesterol (HDLC) and the extent of coronary artery occlusion (ascertained by arteriography) was studied in four hundred male patients. The group with HDLC levels over 50 mg/dl showed a significantly lower coronary artery occlusion score and lower plasma triglyceride levels than the patients with HDLC levels less than 35 mg/dl. The former group also imbibed more alcohol and had less smoking experience.
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Cerebral arterial aneurysms are common in the general population and their rupture is a catastrophic event. Considerable uncertainty remains concerning the conditions that predispose individuals to aneurysm formation or rupture. The role... more
Cerebral arterial aneurysms are common in the general population and their rupture is a catastrophic event. Considerable uncertainty remains concerning the conditions that predispose individuals to aneurysm formation or rupture. The role of systemic hypertension in aneurysm formation and rupture has been especially controversial. Demographic variables have rarely been addressed because of the small sample sizes in previous studies. The authors describe the demographics and prevalence of hypertension in 20,767 Medicare patients with an unruptured aneurysm and compared these to a random sample of the hospitalized Medicare population. The prevalence of hypertension in patients with unruptured aneurysms was 43.2% compared with 34.4% in the random sample. Patients who survived their initial hospitalization were separated into two groups: those with an unruptured cerebral aneurysm as the primary diagnosis and those with an unruptured cerebral aneurysm as a secondary diagnosis. Follow-up data for 18,119 patients were examined to determine the risk of subarachnoid hemorrhage (SAH) associated with age, gender, race, hypertension, insulin-dependent diabetes mellitus, and surgical treatment. For patients with an unruptured cerebral aneurysm as the primary diagnosis, hypertension was found to be a significant risk factor for future SAH (risk ratio: 1.46, 95% confidence interval (CI): 1.01-2.11), whereas surgical treatment (risk ratio: 0.29, 95% CI: 0.09-0.97) had a significant protective effect. Advancing age had a small but significant protective effect in both groups. Elderly patients identified with unruptured aneurysms are more likely to have coexisting hypertension than the general hospitalized population. In elderly patients hospitalized with an unruptured cerebral aneurysm as their primary diagnosis, hypertension is a risk factor for subsequent SAH, whereas surgical treatment is a protective factor against SAH.
Research Interests: Demography, Neurosurgery, Multivariate Analysis, Humans, Hypertension, and 16 moreFemale, Male, Follow-up studies, Subarachnoid hemorrhage, Risk factors, Clinical Sciences, Aged, Prevalence, Middle Aged, Risk Factor, Age Factors, Risk Factors, Neurosciences, Proportional Hazards Models, Logistic Models, and Case Control Studies
The extent to which birth defects after infertility treatment may be explained by underlying parental factors is uncertain.
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In this study of 208 patients attending a Primary Care Medical Clinic of a metropolitan teaching hospital, objective measurements were used to assess the effect of discontinuous care as a result of resident turnover on patient... more
In this study of 208 patients attending a Primary Care Medical Clinic of a metropolitan teaching hospital, objective measurements were used to assess the effect of discontinuous care as a result of resident turnover on patient appointment-keeping behavior. A change of resident resulted in no significant difference in return visit failure rate, subsequent appointment-keeping rate, or number of patients expressing new problems or requiring chronic therapy plan changes.
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This study examines the differences in the rates of coronary artery bypass grafting (CABG) between white and black Medicare patients. This is a cross-sectional study with data from the 1986 Health Care Financing Administration hospital... more
This study examines the differences in the rates of coronary artery bypass grafting (CABG) between white and black Medicare patients. This is a cross-sectional study with data from the 1986 Health Care Financing Administration hospital claims records on all Medicare patients, the 1988 update of the Bureau of Health Professions area resource file, and the 1985 Census Bureau's county population estimates file. Data are from all Medicare patients in the United States in 1986. Sex- and age-adjusted CABG rates for whites and blacks over the age of 65 years were computed for each of 50 states and 305 Standard Metropolitan Statistical Areas (SMSAs). Nationally the CABG rate was 27.1 per 10,000 for whites (40.4 for white men and 16.2 for white women), but only 7.6 for blacks (9.3 for black men and 6.4 for black women). Racial differences were greater in the Southeast, particularly in nonmetropolitan areas, than in other regions. Neither white nor black SMSA rates were associated with the rate of admission for acute myocardial infarction (an indication of the amount of coronary artery disease). White rates, but not black rates, were associated with the number of thoracic surgeons per 100,000 people. For patients insured by Medicare, race is strongly associated with CABG rates, and this association is greater for men than for women and greater in the Southeast than in other parts of the country. Physician supply may relate to the CABG rates for whites.
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The effect of aortocoronary vein-bypass operation on changes in occupational status was investigated in a cohort of 893 men. The median period of time between the operation and follow-up evaluation of postoperative occupational status was... more
The effect of aortocoronary vein-bypass operation on changes in occupational status was investigated in a cohort of 893 men. The median period of time between the operation and follow-up evaluation of postoperative occupational status was 14 months. The patients were divided into two age groups, with 55 years as the dividing point. The results showed that 11% of the younger men and 26% of the older group who were employed before the operation retired following the operation. In addition, 30% of the patients changed their occupational status following the operation. When occupational changes also resulted in changes in physical demands, 49% of the patients took new jobs that were less demanding physically, while 40% took jobs that were more demanding. Close to 9% of the patients were retired prior to the operation; about one fifth of them came out of retirement following the operation.
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Blood pressure measurements were obtained among 92,074 persons in Milwaukee between 1974 and 1976 by the Milwaukee Blood Pressure Program. Systolic hypertension was more prevalent in young white men than blacks below 25 years of age, was... more
Blood pressure measurements were obtained among 92,074 persons in Milwaukee between 1974 and 1976 by the Milwaukee Blood Pressure Program. Systolic hypertension was more prevalent in young white men than blacks below 25 years of age, was more common in middle-aged blacks than whites, and was equally prevalent among all persons past 65 years. Diastolic hypertension was more prevalent in blacks than whites of all ages. Whereas the prevalence of systolic hypertension in the population increased with age and was present in a majority or near majority of persons past 65 years, the prevalence of diastolic hypertension rose until the sixth decade, after which it declined. Hypertension was primarily of a diastolic variety in young blacks, whereas systolic hypertension was a prominent feature in young whites.
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Unlike most European and Asian countries, radical vaginal hysterectomy (RVH) is not performed often in the United States, especially among older women. To examine the changes in RVH over the years, trends in hospital stay, hospital... more
Unlike most European and Asian countries, radical vaginal hysterectomy (RVH) is not performed often in the United States, especially among older women. To examine the changes in RVH over the years, trends in hospital stay, hospital charges, and patient survival, we studied women aged 65 years and older undergoing RVH and compared them with patients receiving radical abdominal hysterectomy (RAH). During the study period there were a total of 288 RVH surgeries compared with 4,835 RAH surgeries. There were no significant changes in the number or proportion of RVH patients over 8 years (p = .50, trend test). On the average, RVH patients were significantly older and had shorter hospital stays. Among patients without cancer, there were no significant differences in the age, race, or survival of patients having either RVH or RAH. Similar results were obtained for patients with cancer.
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This study examined the relationship between atrial fibrillation and (1) stroke and (2) all-cause mortality. All eligible Medicare patients older than 65 years of age hospitalized in 1985 were followed up for 4 years. Kaplan-Meier and Cox... more
This study examined the relationship between atrial fibrillation and (1) stroke and (2) all-cause mortality. All eligible Medicare patients older than 65 years of age hospitalized in 1985 were followed up for 4 years. Kaplan-Meier and Cox proportional hazards models were used for assessment of risk of stroke and mortality. A total of 4,282,607 eligible Medicare patients were hospitalized in 1985. The mean age was 76.1 (+/- 7.7) years; 58.7% were female; 7.2% were Black; and 8.4% had a diagnosis of atrial fibrillation. During the follow-up period, 66,063 patients (32.6/1000 person-years) developed nonembolic stroke and 7285 (3.6/1000 person-years) developed embolic stroke. After adjustment for age, race, sex, and comorbid conditions, atrial fibrillation remained a significant risk factor for both nonembolic stroke (relative risk [RR] = 1.56) and embolic stroke (RR = 5.80) and for mortality (RR = 1.31). Approximately 4.5% of nonembolic and 28.7% of embolic strokes among hospitalized Medicare patients aged 65 years and older were attributable to atrial fibrillation. This study demonstrates that atrial fibrillation is associated with an appreciable increase in the risk of stroke (both embolic and nonembolic) and in the risk of mortality from all causes.
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This paper describes the all-cause mortality experience, following a fracture of the hip, of 712,027 persons covered by the Medicare program from 1984 through 1987. White women experienced the lowest mortality rate (17.2 per 1000... more
This paper describes the all-cause mortality experience, following a fracture of the hip, of 712,027 persons covered by the Medicare program from 1984 through 1987. White women experienced the lowest mortality rate (17.2 per 1000 person-months), followed by Black women (22.9 per 1000 person-months), Black men (33.5 per 1000 person-months), and White men (33.7 per 1000 person-months). The observed race-sex differences in survival were found at all ages and regardless of the number of comorbid conditions listed with the discharge diagnosis. While these data demonstrate marked race-sex differences in survival following hip fracture, the cause of these differences is not immediately apparent and demands further investigation.
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Current methods to evaluate quality of care are usually limited to reviews of individual cases or comparisons of hospital mortality rates. We present an alternative method that compares complication rates adjusted for patient... more
Current methods to evaluate quality of care are usually limited to reviews of individual cases or comparisons of hospital mortality rates. We present an alternative method that compares complication rates adjusted for patient characteristics. Detailed clinical data that were specifically designed for quality comparisons of providers of revascularization procedures were abstracted from the medical records of 1998 Medicare patients, in 16 hospitals, who had coronary artery bypass surgery and 2091 patients, in 16 hospitals, who had angioplasty. Providers were ranked on the basis of an unadjusted risk, a risk adjusted for detailed clinical information, and a risk adjusted only for patient comorbidities. Complication rates differed significantly and substantially among the hospitals. Clinical adjustment changed the hospital rankings for the bypass surgery hospitals, but not for the angioplasty hospitals. Adjustment for comorbidities did not affect hospital rankings for either procedure. When sample sizes are limited, adverse outcome rates may be a more sensitive measure of quality of care than mortality rates. Rates that are unadjusted or adjusted only for comorbidities may be inadequate for evaluating some providers of bypass surgery.
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Our purpose was to examine length of hospital stay, complications, morbidity, and mortality associated with surgery for urinary incontinence in women > 65 years old. Data obtained from Medicare billing forms (HCFA form 1450, UB-82,... more
Our purpose was to examine length of hospital stay, complications, morbidity, and mortality associated with surgery for urinary incontinence in women > 65 years old. Data obtained from Medicare billing forms (HCFA form 1450, UB-82, UB-92) in the Medicare Provider Analysis and Review Record database for surgical procedures done for incontinence (international Classification of Diseases, Ninth Revision, codes 59.3 to 59.79) from 1984 to 1991 were reviewed. Comorbidities and reasons for readmission were extracted from secondary diagnosis codes. There wee 66,478 patients in the cohort. The mean and median ages were 71 years. The 30-day surgical mortality was 0.33%. Length of stay and mortality increased linearly with age. Acute events associated with death were myocardial infarction (14.2% of deaths), cerebrovascular accident (stroke) (14.6%), pulmonary embolism or deep vein thrombosis (9.7%), and pneumonia (2.7%). Patients who died had higher rates of diabetes and heart failure but not of hypertension. The 30-day readmission rate was 4.8% with higher rates in patients > 80 years old. Urinary tract infection (12.2%), hypertension (16%), and unspecified complications (9%) were the most frequent diagnoses on readmissions. Myocardial infarction, pulmonary embolism, cerebrovascular accident, deep vein thrombosis, and pneumonia each occurred in only 1%. Incontinence surgery is safe in the "young elderly." Those > 80 years old and with certain chronic illness should be counseled about increased risks.
Research Interests: Chronic illness, Comorbidity, Heart Failure, Urinary incontinence, Humans, and 14 moreDeep Vein Thrombosis, United States, Female, Pulmonary Embolism, American, Urinary tract infection, Length of Stay, Medicare, Aged, International Classification of Diseases, Study design, Elderly Women, Cerebrovascular Accident, and Cohort Studies
Research Interests: Risk, Stroke, Humans, United States, Female, and 6 moreMale, Atrial Fibrillation, Patient Admission, Medicare, Aged, and Atrial Flutter
The relationship between alcohol intake and the extent of coronary artery occlusion was studied and indicated that the patients who abstained or consumed less than 1 oz of alcohol weekly had significantly higher occlusion scores than... more
The relationship between alcohol intake and the extent of coronary artery occlusion was studied and indicated that the patients who abstained or consumed less than 1 oz of alcohol weekly had significantly higher occlusion scores than those imbibing moderate amounts.
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A study of 59,556 weight-conscious women in the United States who participated and supported this study is reported. A leader-directed confidential questionnaire was administered to small groups of TOPS Club women in 1969 and 1970, and... more
A study of 59,556 weight-conscious women in the United States who participated and supported this study is reported. A leader-directed confidential questionnaire was administered to small groups of TOPS Club women in 1969 and 1970, and obtained height, education, weight, age, family income, and husband's education.An inverse relationship between socioeconomic status (income) and obesity was found. The most important finding in the study was that the degree of obesity of the women was inversely related to their husband's education level, but not correlated with their own education level. The strength of the inverse relationship between income (or husband's education) and obesity was much less than that of a study conducted 20 yr ago. This suggests “melting pot” factors in our society which have reduced social class differences with regard to eating behavior and body image goals.
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Research Interests: Clinical Epidemiology, Birth Weight, Pregnancy, Humans, Mathematical Sciences, and 17 moreUnited States, Female, Risk factors, Medicaid, Newborn Infant, Ohio, Prevalence, Congenital Anomalies, Adult, Analysis of Variance, Adverse Event, Cesarean Section, Risk Factors, Medical Records, Cross sectional Study, Birth Certificates, and Cross Sectional Studies
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Little is known about variation in surveillance practices following the diagnosis of invasive melanoma. The objective of this study was to characterize geographic, patient, and tumor variation in the use of follow-up surveillance testing... more
Little is known about variation in surveillance practices following the diagnosis of invasive melanoma. The objective of this study was to characterize geographic, patient, and tumor variation in the use of follow-up surveillance testing in patients with local or regional stage melanoma. A cohort of Medicare beneficiaries > or =65 y diagnosed with invasive melanoma during 1992 to 1996 living in a Surveillance, Epidemiology, and End Results registry area was studied. Outpatient and inpatient Medicare claims 3 mo following diagnosis were examined for up to 2 y for surveillance procedures of interest. Use of chest X-ray, chest computed tomography scan, abdominal and/or pelvic computed tomography scan, abdominal ultrasound, head computed tomography scan, head magnetic resonance imaging, laboratory testing, and skin examinations were compared between patient groups and geographic regions. A total of 3389 patients were identified for the analysis. Surveillance testing was relatively common, ranging from 13% for abdominal ultrasound to 80% for laboratory testing. Follow-up skin examinations were performed in 70% to 90% of patients. The use of most surveillance procedures was associated (p<0.01) with younger age, male gender, regional stage tumors, and geographical area, with up to 2-fold differences observed. In contrast, there was much less variability in the receipt of skin examinations. Further studies are needed to determine the etiology and impact of such disparities, and the influence of surveillance procedures on morbidity and mortality.