Medicine and Health Sciences Commons^™

Factors Associated With The Risk Of Adenoma Recurrence In Distal And Proximal Colon, Adeyinka Laiyemo, Chyke Doubeni, Paul Pinsky, V. Paul Doria-Rose, Pamela Marcus, Robert Schoen, Elaine Lanza, Amanda Cross

Chyke A. Doubeni

Background/Aims: Colonoscopy may be less effective in preventing cancer in the proximal colon. We evaluated whether risk factors for adenoma recurrence exhibit differential effect on adenoma recurrence by colon subsite.

Methods: We examined the association of age, sex, body mass index, smoking status and use of nonsteroidal anti-inflammatory drugs (NSAIDs) on proximal and distal adenoma recurrence among 1,864 participants in the Polyp Prevention Trial. We used multinomial logistic regression models to calculate the relative risk ratios (RRR) and 95% CI.

Results: 733 (39.3%) participants had adenoma recurrence (228 distal only, 369 proximal only and 136 synchronous proximal and distal adenoma). …

Short- And Long-Term Risk Of Colorectal Adenoma Recurrence Among Whites And Blacks, Adeyinka Laiyemo, Chyke Doubeni, Hassan Brim, Hassan Ashktorab, Robert Schoen, Samir Gupta, Aline Charabaty, Elaine Lanza, Duane Smoot, Elizabeth Platz, Amanda Cross

Chyke A. Doubeni

BACKGROUND: It is unclear whether the higher burden from colorectal cancer among blacks is due to an increased biological susceptibility. OBJECTIVE: To determine whether non-Hispanic blacks (blacks) have a higher risk of adenoma recurrence than non-Hispanic whites (whites) after removal of colorectal adenoma. DESIGN: Secondary analysis of the Polyp Prevention Trial (PPT) data. SETTING: United States. PATIENTS: Patients were 1668 self-identified whites and 153 blacks who completed the 4-year trial. Of these, 688 whites and 55 blacks enrolled in a posttrial, passive Polyp Prevention Trial Continued Follow-up Study (PPT-CFS) and underwent another colonoscopy. MAIN OUTCOME MEASUREMENTS: Recurrence and location of …

Screening Colonoscopy And Risk For Incident Late-Stage Colorectal Cancer Diagnosis In Average-Risk Adults: A Nested Case-Control Study, Chyke Doubeni, Sheila Weinmann, Kenneth Adams, Aruna Kamineni, Diana Buist, Arlene Ash, Carolyn Rutter, V. Paul Doria-Rose, Douglas Corley, Robert Greenlee, Jessica Chubak, Andrew Williams, Aimee Kroll-Desrosiers, Eric Johnson, Joseph Webster, Kathryn Richert-Boe, Theodore Levin, Robert Fletcher, Noel Weiss

Chyke A. Doubeni

BACKGROUND: The effectiveness of screening colonoscopy in average-risk adults is uncertain, particularly for right colon cancer. OBJECTIVE: To examine the association between screening colonoscopy and risk for incident late-stage colorectal cancer (CRC). DESIGN: Nested case-control study. SETTING: Four U.S. health plans. PATIENTS: 1039 average-risk adults enrolled for at least 5 years in one of the health plans. Case patients were aged 55 to 85 years on their diagnosis date (reference date) of stage IIB or higher (late-stage) CRC during 2006 to 2008. One or 2 control patients were selected for each case patient, matched on birth year, sex, health plan, …

Perceptions Of Evidence-Based Programs Among Community-Based Organizations Tackling Health Disparities: A Qualitative Study, Shoba Ramanadhan, Josephine Crisostomo, Jaclyn Alexander-Molloy, Ediss Gandelman, Milagro Grullon, Vilma Lora, Chrasandra Reeves, Clara Savage, Kasisomayajula Viswanatha, Chyke Doubeni

Chyke A. Doubeni

Dissemination of prevention-focused evidence-based programs (EBPs) from research to community settings may improve population health and reduce health disparities, but such flow has been limited. Academic-community partnerships using community-based participatory research (CBPR) principles may support increased dissemination of EBPs to community-based organizations (CBOs). This qualitative study examined the EBP-related perceptions and needs of CBOs targeting underserved populations. As part of PLANET MassCONECT, a CBPR study, we conducted six key informant interviews with community leaders and four focus groups with CBO staff members in Boston, Worcester and Lawrence, Massachusetts, in 2008. Working definitions of EBPs among CBO staff members varied greatly …

Obesity, Weight Change, And Risk Of Adenoma Recurrence: A Prospective Trial, Adeyinka Laiyemo, Chyke Doubeni, Dilhana Badurdeen, Gillian Murphy, Pamela Marcus, Robert Schoen, E. Lanza, Duane Smoot, A. Cross

Chyke A. Doubeni

BACKGROUND AND STUDY AIMS: Obesity is a risk factor for colorectal neoplasia. Lifestyle modifications, including weight loss, have been advocated to reduce the risk. However, no prospective study has evaluated whether weight loss actually affects adenoma recurrence. The aim of this study was to examine whether weight change (loss or gain) over 4 years is associated with adenoma recurrence. PATIENTS AND METHODS: A total of 1826 patients with colorectal adenoma in the Polyp Prevention Trial had their height and weight measured at baseline. Adenoma recurrence was determined by end of trial colonoscopy 4 years after study entry when patients' weights …

Factors Associated With Inadequate Colorectal Cancer Screening With Flexible Sigmoidoscopy, Adeyinka Laiyemo, Chyke Doubeni, Paul Pinsky, V. Paul Doria-Rose, Andrew Sanderson, Robert Bresalier, Joel Weissfeld, Robert Schoen, Pamela Marcus, Phillip Prorok, Christine Berg

Chyke A. Doubeni

BACKGROUND AND STUDY AIM: Inadequate colorectal cancer screening wastes limited endoscopic resources. We examined patients factors associated with inadequate flexible sigmoidoscopy (FSG) screening at baseline screening and repeat screening 3-5 years later in 10 geographically-dispersed screening centers participating in the ongoing Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial.

METHODS: A total of 64,554 participants (aged 55-74) completed baseline questionnaires and underwent FSG at baseline. Of these, 39,385 participants returned for repeat screening. We used logistic regression models to assess factors that are associated with inadequate FSG (defined as a study in which the depth of insertion of FSG was …

Contribution Of Behavioral Risk Factors And Obesity To Socioeconomic Differences In Colorectal Cancer Incidence, Chyke Doubeni, Jacqueline Major, Adeyinka Laiyemo, Mario Schootman, Ann Zauber, Albert Hollenbeck, Rashmi Sinha, Jeroan Allison

Chyke A. Doubeni

BACKGROUND:Health behaviors are known risk factors for colorectal cancer and are more common in low socioeconomic status (SES) populations. We evaluated the extent to which behavioral risk factors and body mass index (BMI) explain SES disparities in colorectal cancer incidence, overall and by tumor location.

METHODS: We analyzed prospective National Institutes of Health-AARP Diet and Health Study data on 506 488 participants who were recruited in 1995-1996 from six US states and two metropolitan areas and followed through 2006. Detailed baseline data on risk factors for colorectal cancer, including health behaviors, were obtained using questionnaires. SES was measured by self-reported …

Socioeconomic Status, Healthcare Density, And Risk Of Prostate Cancer Among African American And Caucasian Men In A Large Prospective Study, Jacqueline Major, M. Oliver, Chyke Doubeni, Albert Hollenbeck, Barry Graubard, Rashmi Sinha

Chyke A. Doubeni

OBJECTIVES: The purpose of this study was to separately examine the impact of neighborhood socioeconomic deprivation and availability of healthcare resources on prostate cancer risk among African American and Caucasian men. METHODS: In the large, prospective NIH-AARP Diet and Health Study, we analyzed baseline (1995-1996) data from adult men, aged 50-71 years. Incident prostate cancer cases (n = 22,523; 1,089 among African Americans) were identified through December 2006. Lifestyle and health risk information was ascertained by questionnaires administered at baseline. Area-level socioeconomic indicators were ascertained by linkage to the US Census and the Area Resource File. Multilevel Cox models were …

Variation Of Adenoma Prevalence By Age, Sex, Race, And Colon Location In A Large Population: Implications For Screening And Quality Programs, Douglas Corley, Christopher Jensen, Amy Marks, Wei Zhao, Jolanda De Boer, Theodore Levin, Chyke Doubeni, Bruce Fireman, Charles Quesenberry

Chyke A. Doubeni

BACKGROUND and AIMS: Reliable community-based colorectal adenoma prevalence estimates are needed to inform colonoscopy quality standards and to estimate patient colorectal cancer risks; however, minimal data exist from populations with large numbers of diverse patients and examiners. METHODS: We evaluated the prevalence of adenomas detected by sex, age, race/ethnicity, and colon location among 20,792 Kaiser Permanente Northern California members >/=50 years of age who received a screening colonoscopy exam (102 gastroenterologists, years 2006-2008). RESULTS: Prevalence of detected adenomas increased more rapidly with age in the proximal colon (adjusted odds ratio [OR], 2.39; 95% confidence interval [CI], 2.05-2.80; 70-74 vs 50-54 …

Self-Reported Colorectal Cancer Screening Of Medicare Beneficiaries In Family Medicine Vs. Internal Medicine Practices In The United States: A Cross-Sectional Study, Angela Higgins, Anna Doubeni, Karon Phillips, Adeyinka Laiyemo, Becky Briesacher, Jennifer Tjia, Chyke Doubeni

Chyke A. Doubeni

BACKGROUND: The benefit of screening for decreasing the risk of death from colorectal cancer (CRC) has been shown, yet many patients in primary care are still not undergoing screening according to guidelines. There are known variations in delivery of preventive health care services among primary care physicians. This study compared self-reported CRC screening rates and patient awareness of the need for CRC screening of patients receiving care from family medicine (FPs) vs. internal medicine (internists) physicians. METHODS: Nationally representative sample of non-institutionalized beneficiaries who received medical care from FPs or internists in 2006 (using Medicare Current Beneficiary Survey). The main …

Neighborhood Socioeconomic Status And Use Of Colonoscopy In An Insured Population--A Retrospective Cohort Study, Chyke Doubeni, Guruprasad Jambaulikar, Hassan Fouayzi, Scott Robinson, Margaret Gunter, Terry Field, Douglas Roblin, Robert Fletcher

Chyke A. Doubeni

BACKGROUND: Low-socioeconomic status (SES) is associated with a higher colorectal cancer (CRC) incidence and mortality. Screening with colonoscopy, the most commonly used test in the US, has been shown to reduce the risk of death from CRC. This study examined if, among insured persons receiving care in integrated healthcare delivery systems, differences exist in colonoscopy use according to neighborhood SES. METHODS: We assembled a retrospective cohort of 100,566 men and women, 50-74 years old, who had been enrolled in one of three US health plans for >/=1 year on January 1, 2000. Subjects were followed until the date of first …

Socioeconomic Deprivation Impact On Meat Intake And Mortality: Nih-Aarp Diet And Health Study, Jacqueline Major, Amanda Cross, Chyke Doubeni, Yikyung Park, Min Lian, Albert Hollenbeck, Arthur Schatzkin, Barry Graubard, Rashmi Sinha

Chyke A. Doubeni

OBJECTIVE: Previous studies have not examined potential interactions between meat intake and characteristics of the local environment on the risk of mortality. This study examined the impact of area socioeconomic deprivation on the association between meat intake and all-cause and cause-specific mortality after accounting for individual-level risk factors.

METHODS: In the prospective NIH-AARP Diet and Health Study, we analyzed data from adults, ages 50-71 years at baseline (1995-1996). Individual-level dietary intake and health risk information were linked to the demographic and socioeconomic context of participants' local environment based on census tract data. Deaths (n = 33,831) were identified through December …

Patterns And Predictors Of Mammography Utilization Among Breast Cancer Survivors, Chyke Doubeni, Terry Field, Marianne Yood, Sharon Rolnick, Charles Quessenberry, Hassan Fouayzi, Jerry Gurwitz, Feifei Wei

Chyke A. Doubeni

BACKGROUND: Improvements in cancer detection and treatment have resulted in increasing numbers of breast cancer survivors. Information regarding the use of mammography by breast cancer survivors is limited. METHODS: The use of surveillance mammography was examined over a 5-year period in a retrospective cohort of women age>or=55 years who were diagnosed with incident primary breast cancer (1996-1997) while enrolled in 1 of 4 geographically diverse integrated health systems. RESULTS: Of the 797 women included in the study, 80% (n=636) underwent mammograms during the first year after treatment for breast cancer. The percentage of women having mammograms during each yearly …

Perceived Accessibility As A Predictor Of Youth Smoking, Chyke Doubeni, Wenjun Li, Hassan Fouayzi, Joseph Difranza

Chyke A. Doubeni

PURPOSE: Youths who smoke are more likely to perceive that cigarettes are easily accessible, but the relationship between perceived accessibility of cigarettes and the risk of smoking is not clear. The objective of this study was to determine whether perceived accessibility predicted future smoking among youths. METHODS: This study used data from the second Development and Assessment of Nicotine Dependence in Youth (DANDY-2) study, a 4-year (2002-2006) cohort study that began with 1,246 sixth-grade students in 6 Massachusetts communities. DANDY-2 comprised 11 waves of in-person interviews. A total of 1,195 students who were aged 11 to 14 years at the …

Perceived Accessibility Of Cigarettes Among Youth: A Prospective Cohort Study, Chyke Doubeni, Wenjun Li, Hassan Fouayzi, Joseph Difranza

Chyke A. Doubeni

BACKGROUND: The accessibility of tobacco for youth is difficult to measure, partly because of the varied sources of cigarettes. Perceptions about the accessibility of cigarettes assesses availability from all potential sources and has been found to predict future smoking. This study examines the determinants of perceived accessibility from the perspective of a longitudinal study. METHODS: Data were derived from the second Development and Assessment of Nicotine Dependence in Youth study, a 4-year longitudinal study of 1246 sixth-grade students who underwent up to 11 in-person interviews from 2002 to 2006. Perceived accessibility was assessed prospectively by asking students whether they agreed …

Under Utilization Of Surveillance Mammography Among Older Breast Cancer Survivors., Terry Field, Chyke Doubeni, Matthew Fox, Diana Buist, Feifei Wei, Ann Geiger, Virginia Quinn, Timothy Lash, Marianne Prout, Marianne Yood, Floyd Frost, Rebecca Silliman

Chyke A. Doubeni

BACKGROUND: Annual surveillance mammography is recommended for follow-up of women with a history of breast cancer. We examined surveillance mammography among breast cancer survivors who were enrolled in integrated healthcare systems. METHODS: Women in this study were 65 or older when diagnosed with early stage invasive breast cancer (N = 1,762). We assessed mammography use during 4 years of follow-up, using generalized estimating equations to account for repeated measurements. RESULTS: Eighty-two percent had mammograms during the first year after treatment; the percentage declined to 68.5% in the fourth year of follow-up. Controlling for age and comorbidity, women who were at …

Primary Care, Economic Barriers To Health Care, And Use Of Colorectal Cancer Screening Tests Among Medicare Enrollees Over Time, Chyke Doubeni, Adeyinka Laiyemo, Angela Higgins, Carrie Klabunde, George Reed, Terry Field, Robert Fletcher

Chyke A. Doubeni

PURPOSE: Colorectal cancer (CRC) screening remains underutilized. The objective of this study was to examine the impact of primary care and economic barriers to health care on CRC testing relative to the 2001 Medicare expansion of screening coverage.

METHODS: Medicare Current Beneficiary Survey data were use to study community-dwelling enrollees aged 65 to 80 years, free of renal disease and CRC, and who participated in the survey in 2000 (n = 8,330), 2003 (n = 7,889), or 2005 (n = 7,614). Three outcomes were examined: colonoscopy/sigmoidoscopy within 5 years (recent endoscopy), endoscopy more than 5 years previously, and fecal occult …

Trends And Outcomes Associated With Angiotensin-Converting Enzyme Inhibitors, Chyke Doubeni, Carol Bigelow, Darleen Lessard, Frederick Spencer, Jorge Yarzebski, Joel Gore, Jerry Gurwitz, Robert Goldberg

Chyke A. Doubeni

BACKGROUND: Limited recent data are available describing the patterns of use of angiotensin converting enzyme inhibitor (ACEI) therapy in patients with acute myocardial infarction (AMI), particularly from the more generalizable population-based setting. The purpose of this study was to examine trends in the receipt of ACEIs and associated short-term outcomes in patients hospitalized with AMI in a large Northeastern community.

METHODS: We conducted a community-wide study of 7991 patients hospitalized with AMI in all metropolitan Worcester, Massachusetts, medical centers during 8 annual periods between 1990 and 2003.

RESULTS: Among all patients, 44% received ACEI therapy during their acute hospitalization. There …

Socioeconomic Status And The Risk Of Colorectal Cancer: An Analysis Of More Than A Half Million Adults In The National Institutes Of Health-Aarp Diet And Health Study, Chyke Doubeni, Adeyinka Laiyemo, Jacqueline Major, Mario Schootman, Min Lian, Yikyung Park, Barry Graubard, Albert Hollenbeck, Rashmi Sinha

Chyke A. Doubeni

BACKGROUND: No previous prospective US study has examined whether the incidence of colorectal cancer (CRC) is disproportionately high in low socioeconomic status (SES) populations of both men and women. This study examined the relationship between both individual and area-level SES and CRC incidence, overall and by tumor location. METHODS: Data were obtained from the ongoing prospective National Institutes of Health-AARP Diet and Health Study of persons (50-71 years old) who resided in 6 US states and 2 metropolitan areas at baseline in 1995-1996. Incident CRCs were ascertained from tumor registries through December 2006. SES was measured by self-reported education and …

Socioeconomic And Racial Patterns Of Colorectal Cancer Screening Among Medicare Enrollees In 2000 To 2005, Chyke Doubeni, Adeyinka Laiyemo, George Reed, Terry Field, Robert Fletcher

Chyke A. Doubeni

BACKGROUND: Lower rates of screening among minorities and low-income populations contribute to colorectal cancer health disparities. Therefore, we examined patterns of colorectal cancer screening and associations with race-ethnicity, education, and income over time. METHODS: Repeated cross-sectional data from the Medicare Current Beneficiary Survey of noninstitutionalized colorectal cancer-free Medicare enrollees ages 65 to 80 years interviewed in 2000 (n = 8,355), 2003 (n = 7,922), and 2005 (n = 7,646). We examined rates of colonoscopy/sigmoidoscopy use within 5 years (recent endoscopy), colonoscopy/sigmoidoscopy use >5 years previously, or fecal occult blood test (FOBT) within 2 years. RESULTS: Among those included in the …

Disparities And Survival Among Breast Cancer Patients, Terry Field, Diana Buist, Chyke Doubeni, Shelley Enger, Hassan Fouayzi, Gene Hart, Eli Korner, Lois Lamerato, Donald Bachman, Jennifer Ellis, Lisa Herrinton, Mark Hornbrook, Richard Krajenta, Liyan Liu, Janice Yao

Chyke A. Doubeni

BACKGROUND: Although rates of survival for women with breast cancer have improved, the survival disparity between African American and white women in the United States has increased.

PURPOSE: To determine whether this survival disparity persists in an insured population with access to medical care.

METHODS: In this retrospective cohort study, we extracted data from the tumor registries of six nonprofit, integrated health care delivery systems affiliated with the Cancer Research Network and assessed the survival of African American (n = 2276) and white (n = 18 879) female enrollees who were diagnosed with invasive breast cancer from January 1, 1993, …

Race And Colorectal Cancer Disparities: Health-Care Utilization Vs Different Cancer Susceptibilities, Adeyinka Laiyemo, Chyke Doubeni, Paul Pinsky, V. Doria-Rose, Robert Bresalier, Lois Lamerato, E. Crawford, Paul Kvale, Mona Fouad, Thomas Hickey, Thomas Riley, Joel Weissfeld, Robert Schoen, Pamela Marcus, Philip Prorok, Christine Berg

Chyke A. Doubeni

BACKGROUND: It is unclear whether the disproportionately higher incidence and mortality from colorectal cancer among blacks compared with whites reflect differences in health-care utilization or colorectal cancer susceptibility. METHODS: A total of 60, 572 non-Hispanic white and black participants in the ongoing Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial underwent trial-sponsored screening flexible sigmoidoscopy (FSG) without biopsy at baseline in 10 geographically dispersed centers from November 1993 to July 2001. Subjects with polyps or mass lesions detected by FSG were referred to their physicians for diagnostic workup, the cost of which was not covered by PLCO. The records …

Treatment Practices And Outcomes Of Patients With Established Peripheral Arterial Disease Hospitalized With Acute Myocardial Infarction In A Community Setting, Frederick Spencer, Darleen Lessard, Chyke Doubeni, Jorge Yarzebski, Joel Gore, Robert Goldberg

Chyke A. Doubeni

BACKGROUND: There are little contemporary data available describing the hospital and long-term outcomes of patients with peripheral arterial disease (PAD) who are hospitalized with acute myocardial infarction (AMI). The objectives of our population-based study were to examine the hospital and long-term outcomes, as well as the use of different treatment practices, among patients with established PAD who were hospitalized with AMI. METHODS: The study sample consisted of 4480 patients hospitalized with AMI at all Worcester, Mass, medical centers in 4 alternate years between 1997 and 2003. RESULTS: Among the metropolitan Worcester residents hospitalized with AMI, 13.5% had a history of …

Early Course Of Nicotine Dependence In Adolescent Smokers, Chyke Doubeni, George Reed, Joseph Difranza

Chyke A. Doubeni

OBJECTIVE: The goal was to characterize the early course of nicotine dependence. METHODS: Data were collected from 1246 sixth-graders in a 4-year (2002-2006) prospective study using 11 individual interviews. Subjects were monitored for 10 symptoms of dependence by using the Hooked on Nicotine Checklist. The bidirectional prospective relationship between the intensity of dependence (number of symptoms) and smoking frequency was examined by using cross-lagged analyses. RESULTS: Of the 370 subjects who had inhaled from a cigarette, 62% smoked at least once per month, 53% experienced dependence symptoms, and 40% experienced escalation to daily smoking. Smoking frequency predicted the number of …

Likelihood Of Missed And Recurrent Adenomas In The Proximal Versus The Distal Colon, Adeyinka Laiyemo, Chyke Doubeni, Andrew Sanderson, Paul Pinsky, Dilhana Badurdeen, V. Doria-Rose, Pamela Marcus, Robert Schoen, Elaine Lanza, Arthur Schatzkin, Amanda Cross

Chyke A. Doubeni

BACKGROUND: Colonoscopy may be less efficacious in reducing colorectal cancer mortality in the proximal compared with the distal colon. A greater likelihood for missed and recurrent adenomas in the proximal colon may contribute to this phenomenon.

OBJECTIVE: To examine whether a proximal adenoma is associated with the risk and location of missed and recurrent adenomas.

DESIGN: Prospective.

SETTING: Polyp Prevention Trial.

PARTICIPANTS: A total of 1864 patients with an adenoma at baseline underwent a follow-up colonoscopy 4 years later (adenoma recurrence). Of these, 1731 underwent a clearing colonoscopy 1 year after the baseline examination (missed adenoma).

MAIN OUTCOME MEASUREMENTS: Association …

Racial And Ethnic Trends Of Colorectal Cancer Screening Among Medicare Enrollees, Chyke Doubeni, Adeyinka Laiyemo, Carrie Klabunde, Angela Higgins, Terry Field, Robert Fletcher

Chyke A. Doubeni

BACKGROUND: Colorectal cancer (CRC) screening rates have remained lower than the Healthy People 2010 goal, particularly among minority populations. PURPOSE: This study aimed to examine the racial-ethnic trends in CRC screening and the continued impact of healthcare access indicators on screening differences after Medicare expanded coverage. METHODS: The study used data from the Medicare Current Beneficiary Survey for 2000, 2003, and 2005. The sample was restricted to non-Hispanic whites, non-Hispanic blacks, and Hispanics. The primary outcome was the proportion of enrollees who underwent lower-gastrointestinal endoscopy within 5 years and/or home fecal occult blood test within 1 year. RESULTS: Over the …

Health Status, Neighborhood Socioeconomic Context, And Premature Mortality In The United States: The National Institutes Of Health-Aarp Diet And Health Study, Chyke Doubeni, Mario Schootman, Jacqueline Major, Rosalie Torres Stone, Adeyinka Laiyemo, Yikyung Park, Min Lian, Lynne Messer, Barry Graubard, Rashmi Sinha, Albert Hollenbeck, Arthur Schatzkin

Chyke A. Doubeni

Objectives. We examined whether the risk of premature mortality associated with living in socioeconomically deprived neighborhoods varies according to the health status of individuals. Methods. Community-dwelling adults (n=566402; age=50-71 years) in 6 US states and 2 metropolitan areas participated in the ongoing prospective National Institutes of Health-AARP Diet and Health Study, which began in 1995. We used baseline data for 565679 participants on health behaviors, self-rated health status, and medical history, collected by mailed questionnaires. Participants were linked to 2000 census data for an index of census tract socioeconomic deprivation. The main outcome was all-cause mortality ascertained through 2006. Results. …

Identifying Unrecognized Peripheral Arterial Disease Among Asymptomatic Patients In The Primary Care Setting., Chyke Doubeni, Robert Yood, Srinivas Emani, Jerry Gurwitz

Chyke A. Doubeni

National initiatives to enhance recognition of the detrimental impact of peripheral arterial disease on the health of adult Americans have been advocated. The objective of this study was to evaluate a strategy for identifying patients with unrecognized peripheral arterial disease from among persons without known atherosclerotic disease in the primary care setting. A cross-sectional design was used. Participants were patients receiving care from a multispecialty group practice in Massachusetts between July 2002 and July 2003, with a scheduled appointment with a primary care physician. Persons 70 years of age or older who were not already known to have atherosclerotic disease …